Classifications: gi stimulant, laxative; Therapeutic: laxative, gi stimulant
Pregnancy Category: C
325 mg tablets; liquid
Acts principally in large intestine by stimulating propulsive movements of colon through direct chemical irritation. Casanthrol,
which is present in a variety of OTC mixtures, is a derivative of cascara sagrada.
Effective laxative with results in 612 h. Useful in conditions where straining at stool is to be avoided.
Temporary relief of constipation and to prevent straining at stool in various disease conditions. Sometimes used with milk
Abdominal pain, fecal impaction; GI bleeding, ulcerations; appendicitis, gastroenteritis, intestinal obstruction, CHF; pregnancy
Lactation; renal impairment; diabetic patients; rectal bleeding; concomitant laxative use.
Route & Dosage
Adult: PO Tablet: 3251000 mg/d; fluid extract: 0.51.5 mL/d; aromatic fluid extract: 26 mL/d
Child: PO 212 y, ? of adult dose; <2 y, 1/4 of adult dose
Infant: PO Aromatic fluid extract: 1.25 mL/d as single dose
- Administer with a full glass of water on an empty stomach for best results. Results may be delayed somewhat by food.
- Store in tightly covered, light-resistant containers, unless otherwise directed by manufacturer.
Adverse Effects (≥1%) GI:
Anorexia, nausea, gripping, abnormally loose stools, constipation
rebound, melanosis of colon. Metabolic:
Hypokalemia, impaired glucose tolerance, calcium deficiency. Urogenital:
Discoloration of urine.
Diagnostic Test Interference
Possibility of interference with PSP excretion test because of urine discoloration.
Decreased effect of oral anticoagulants
Minimal from GI tract. Onset:
612 h. Metabolism:
In liver. Elimination:
In feces and urine; excreted in breast milk.
Assessment & Drug Effects
- Monitor electrolyte balance if significant diarrhea occurs, especially with frail older adults.
- Monitor restoration of normal bowel function.
Patient & Family Education
- A single dose taken before retiring usually results in evacuation of soft stool 612 h later.
- Frequent or prolonged use of irritant cathartics disrupts normal reflex activity of colon and rectum and can lead to drug
dependence for evacuation.
- See bisacodyl for additional information.