Overview

Cascara sagrada is a type of plant called Fragula purshiana. Dietary supplements and teas that contain cascara sagrada are made from the bark of this tree. These products are commonly used for the short-term treatment of constipation. Although they may also be used for other reasons, their benefits for other uses are not well defined. Common side effects include cramping, stomach pain, diarrhea, nausea, and vomiting. Serious side effects are uncommon and typically occur only with overuse or misuse. Before taking cascara sagrada, make sure to tell your health care provider about any health conditions you have or medicines you are taking.

Uses

What is cascara sagrada used for?

Cascara sagrada is commonly used for constipation. It may also be used for other reasons, but its benefits are not well defined.

Note: The FDA has not reviewed cascara sagrada supplements for safety and effectiveness. Learn more about dietary supplements here. Cascara sagrada is generally recognized as safe (GRAS) by the FDA as a food flavoring. Learn more about GRAS status here.

How does cascara sagrada work (mechanism of action)?

Cascara sagrada is a type of plant called Frangula purshiana. It is native to the Pacific coast of North America. It is sometimes used as a food flavoring. Dietary supplements that contain cascara sagrada are made from its bark.

Cascara sagrada bark contains chemicals called cascarosides. These chemicals are a type of stimulant laxative, meaning that they stimulate the lining of your intestines to help push stool (poop) through faster. Stimulant laxatives work quickly and can often help bring on a bowel movement within 12 hours. However, they may also cause diarrhea and cramping. Regular use of cascara sagrada may increase your risk of having side effects (see the Side Effects section for more information). Stimulant laxatives, including cascara sagrada, should not be used for more than a week unless your health care provider tells you to do so.

Herbal products, such as cascara sagrada, naturally contain many chemicals. The amounts of each chemical in a specific cascara sagrada product may vary. Some, none, or all of these chemicals may have effects on the body. These effects may change depending on how much of each chemical is found in the product you are using.

How should I store cascara sagrada?

You should store cascara sagrada according to the product label. Most dietary supplements should be kept in a cool, dry location that is out of the reach of children and pets and not in direct sunlight.

Side Effects

What are the most common side effects of cascara sagrada?

The most common side effects of cascara sagrada are listed below. These side effects may vary depending on the dose you are taking or the specific product you are using. Tell your health care provider if you have any of these side effects that bother you.

• Cramping or stomach pain
• Diarrhea
• Nausea or vomiting

There may be other side effects of cascara sagrada that are not listed here. Contact your health care provider if you think you are having a side effect of a supplement. In the U.S., you can report side effects to the FDA at www.safetyreporting.hhs.gov or by calling 888-SAFEFOOD (888-723-3366). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of cascara sagrada?

While less common, the most serious side effects of cascara sagrada are described below, along with what to do if they happen.

Severe Allergic Reactions. Cascara sagrada may cause allergic reactions, which can be serious. Stop taking cascara sagrada and get help right away if you have any of the following symptoms of a serious allergic reaction.

• Breathing problems or wheezing
• Racing heart
• Fever or general ill feeling
• Swollen lymph nodes
• Swelling of the face, lips, mouth, tongue, or throat
• Trouble swallowing or throat tightness
• Itching or skin rash
• Bumps on the skin called hives, which can be red, pink, white, or brown depending on your skin tone
• Nausea or vomiting
• Dizziness, feeling lightheaded, or fainting
• Stomach cramps
• Joint pain

Low Potassium Levels (Hypokalemia). Cascara sagrada can cause diarrhea. This can lead to a low potassium level, which can be serious. Your risk may be higher if you use certain medicines or if you take cascara sagrada regularly for a while. Call your health care provider if you have any of the following symptoms of a low potassium level.

• Weakness
• Unusual tiredness
• Muscle cramps or twitching
• Constipation

Precautions

Who should not use cascara sagrada?

Allergies to Ingredients. People who are allergic to any of the following should not take cascara sagrada.

• Cascara
• Cascara sagrada
• Frangula purshiana
• Rhamnus purshiana
• Any of the ingredients in the specific product

Your pharmacist can tell you all of the ingredients in the specific cascara sagrada products they stock.

Digestive Tract Problems. Tell your health care provider if you have constipation with stomach pain, nausea, or vomiting. These could be symptoms of a more serious condition. Cascara sagrada should not be used if you have certain stomach problems, including a gut blockage or tear, ulcerative colitis, Crohn’s disease, appendicitis, poop stuck in your digestive tract (fecal impaction), bleeding in your digestive tract or rectal bleeding, or blood in your poop.

What should I know about cascara sagrada before using it?

Cascara sagrada is available as a tea and a dietary supplement. Very small amounts may also be added to food as a flavoring. It cannot be marketed to treat or cure a disease.

Read and follow the directions on the specific product you are taking, or take it as recommended by your health care provider.

Keep cascara sagrada out of the reach of children. Children under 12 years of age may be at increased risk for side effects from cascara sagrada. Speak with a health care provider about the possible risks.

In rare cases, taking cascara sagrada has caused parts of the colon in some people to become darker, a condition called melanosis coli. This color change does not cause any symptoms, but it is not clear whether it can affect your health. Your risk of developing this condition is higher if you use cascara sagrada regularly for a long time. Speak with your health care provider if you have concerns.

Cascara sagrada may cause your urine to turn reddish-brown or bright yellow. This change in color is harmless and should go away after you stop taking cascara sagrada.

If you are using cascara sagrada for constipation, you should not take it regularly for more than one week unless your health care provider tells you to do so. If you have rectal bleeding or blood in your poop, stop taking cascara sagrada and contact your health care provider right away.

Herbal products, such as cascara sagrada, naturally contain many chemicals. The amount of each chemical in a specific cascara sagrada product can change for many reasons, including the area where the tree was grown, the weather during growth, the time of year when it was harvested, and the way that the tree was processed after it was harvested. If you switch to a new bottle or a different brand, you may not have the same effects or side effects because of this variability. Talk to your health care provider if you have questions or concerns.

Cascara sagrada is available in different forms, including tea, dried and ground powder, tablets, and capsules. Each of these forms may contain different amounts of the chemicals that are naturally found in the plant.

The FDA has not tested cascara sagrada products to confirm that they contain the ingredients stated on their labels. Some dietary supplements have been tested by third-party organizations to confirm that they contain the ingredients listed on their labels and do not contain any harmful chemicals. Learn more about how to choose a safe dietary supplement product here.

What should I tell my health care provider before using cascara sagrada?

Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them know if cascara sagrada is right for you.

In particular, make sure that you discuss any of the following.

Current and Past Health Conditions.Tell your health care provider if you have any of the following.

• A new change in your bowel habits that lasts for two weeks or more
• An electrolyte imbalance, including low potassium levels
• Kidney or liver problems

Other Medicines and Supplements.Cascara sagrada may interact with other medicines and supplements. Before taking cascara sagrada, tell your health care provider about any prescription or OTC medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Pregnancy. It is not known if or how cascara sagrada could affect pregnancy or harm a fetus. Tell your health care provider if you are pregnant or plan to become pregnant.

Breastfeeding. Cascara sagrada passes into breast milk and may cause harm to an infant or a small child. Tell your health care provider if you are breastfeeding or plan to breastfeed.

Interactions

Does cascara sagrada interact with foods or drinks?

There are no known interactions between cascara sagrada and foods or drinks.

It is unknown if drinking alcohol will affect cascara sagrada.

Does cascara sagrada interact with medicines (drug interactions)?

Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before taking cascara sagrada.

• A corticosteroid, such as dexamethasone, methylprednisolone, or prednisone, which is a medicine for certain inflammatory conditions
• A diuretic, also called a water pill, which is a medicine used to reduce edema (fluid retention) and blood pressure
• A medicine used to control your heart rate or rhythm (antiarrhythmic)
• Digoxin (Lanoxin), which is a medicine used to treat irregular heartbeat and some types of heart failure
• Lily-of-the-valley, which is a supplement that may be used for certain heart problems
• A laxative to clean out your bowel (bowel prep), such as before a colonoscopy
• Another stimulant laxative, such as bisacodyl or senna
• Large amounts of licorice candies, teas, or supplements

Cascara sagrada may affect how well some other medicines work. Tell your health care provider about all medicines that you take or have recently taken.

The interactions between cascara sagrada and medicines are not fully understood. As with most dietary supplements, the research on drug interactions with cascara sagrada is incomplete. Always check with your health care provider before taking cascara sagrada with any medicines.

Dosing

What should I do if I accidentally use too much cascara sagrada?

If you or someone else has used too much cascara sagrada, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

Read the product label closely and speak with a health care provider about how to take cascara sagrada safely. Do not take double or extra doses, even if you miss a dose.