ALEXANDRIAN SENNA (Senna alexandrina Mill.) +

ALEXANDRIAN SENNA (Senna alexandrina Mill.) +

Synonyms — Cassia acutifolia Delile, C. angustifolia Vahl, C. lanceolata Forssk., C. senna L.
Activities (Alexandrian Senna) — Antidysenteric (f; WHO); Antileukemic (1; CAN); Antispasmodic
(f; PED); Bitter (f; PED); Carminative (f; WHO); Expectorant (f; WHO); Fungicide
(1; JAD); Hepatoprotective (1; CAN); Laxative (1; BGB; PH2; PIP; SKY); Mutagenic (1;
BGB); Peristaltic (1; PED; WHO).
Indications (Alexandrian Senna) — Anemia (f; PH2); Cancer (f; JLH); Constipation (2; BGB;
KOM; PH2; PIP; SKY; WHO); Cramp (f; PED); Dermatosis (f; WHO); Dysentery (1; WHO);
Dyspepsia (f; WHO); Enterosis (f; PH2); Fever (f; PH2; WHO); Fungus (1; JAD); Gas (f; WHO);
Gonorrhea (f; WHO); Hemorrhoid (f; BGB; PIP; WHO); Hepatosis (1; CAN; PH2); Infection (1;
JAD); Jaundice (f; PH2); Leukemia (1; CAN); Mycosis (1; JAD); Ringworm (1; JAD); Splenosis
(f; PH2); Typhoid (f; PH2); Wound (f; WHO).
Dosages (Alexandrian Senna) — 0.5–2 g (0.5–1 tsp)/cup water (APA); 1–2 g fruit (WHO);
3–6 alexandrian or 4–12 tinnevelly pods steeped in 150 ml warm water 6–12 hours (CAN);
0.5–2 g dry leaflets (CAN); 1–2 g dry leaf (PED; WHO); 1 g dry leaf:5 ml alcohol/5 ml water
(PED); 0.5–2 ml liquid leaf extract (1:1 in 25% ethanol) (CAN); 20–30 mg hydroxyanthracene
derivatives/day calculated as sennoside B (KOM); 2 (25 mg) StX extracts 1–2 ×/day (APA);
10–60 mg sennosides (SKY).
Contraindications, Interactions, and Side Effects (Alexandrian Senna) — Class 2b, 2c, 2d
(AHP). Commission E and other sources report interaction of anthranoid laxatives (AEH).
Anthranoid-containing laxatives can be habit-forming. Some contain compounds suspected of
being cytotoxic, genotoxic, mutagenic, and even tumorigenic. Epidemiological studies in
Germany reveal that abusers of anthranoid laxatives have three times higher rate of colon
carcinoma. One woman developed clubbing of her digits and hypertropic osteoarthropathy

after taking at least three tablets daily for 3 years for weight loss. She also experienced several
months of secondary amenorrhea. Of senna leaf, Blumenthal et al. lists abdominal pain of
unknown origin, acute intestinal inflammation (e.g., Crohn’s disease and colitis ulcerosa), and
appendicitis as contraindications. Because of the anthraquinones, nonstandardized preparations
should be avoided during pregnancy and lactation (CAN). “Anthraquinones may be secreted
into breast milk” (CAN). Should not be used in lactation, pregnancy, or with children under
12 years old (KOM). Occasional cramp-like discomfort of the GI tract may require dosage
reduction (KOM). Side effects with chronic abuse: disturbance of electrolyte balance, especially
hypokalemia (may be exacerbated by simultaneous administration of corticoadrenal
steroids, licorice root, or thiazide diuretics), leading to cardiopathy, muscular weakness especially
with concurrent uses of cardiac glycosides, corticosteroids, or diuretics (KOM). Pigmentation
of the intestinal mucosae (pseudomelanosis coli) is harmless and usually reverses
on discontinuation of the drug. Laxative like this should not be used more than 1–2 weeks
without medical advice (KOM). CAN report anthraquinones are purgative and irritate GI tract.
Also contraindicated in hemorrhoids and nephropathy (CAN), intestinal obstruction, abdominal
pain of unknown causes, any enterosis (appendicitis, colitis, Crohn’s disease, irritable bowel
syndrome) hemorrhoids, nephropathy, menstruation (AHP). Do not use more than 8–10 days
(AHP). Do not use this in case of abdominal pain or diarrhea. Consult a health care provider
prior to use in pregnancy or nursing. Discontinue use if diarrhea or watery stools occur. Not
for long term use (AHP). “Some herbal laxative preparations, such as cascara and senna for
example, can cause an increase in the potency of digoxin” (D’epiro, 1997). Pedersen (1998)
cautions against taking the fresh leaf (we have done that in Peru with modest laxative results).
“Senna causes gripping unless taken in combination with carminative herbs such as ginger,
cloves, or various mint species.” Although GRAS, senna can be more habit-forming than
cascara (PED). Lininger et al. (1998) pronounce it “safe for children over the age of six” (half
the adult dose) (SKY). I’d be more cautious.
Extracts (Alexandrian Senna) — Possibly representing a negative case for my synergy
proposition, “The toxicity of total extracts is greater than that of the individual sennosides. It
has been proposed that the laxative and toxic components of senna could be separated” (CAN).
Elsewhere, I have read that the sennosides are synergetic as far as their laxative action is
concerned. But then anomalously, CAN report that sennosides A and B are reported to be most
potent with respect to laxative action, but the least toxic compared to other anthraquinone
fractions. LD50s of sennosides A & B are 4100 mg/kg ivn mus and of rhein-8-glycoside 400
mg/kg ivn mus. All fractions had LD50 = >5000 mg/kg orl rat.

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