CASCARA SAGRADA
| CASCARA SAGRADA (kas-kar'a) Classifications: gi stimulant, laxative; Therapeutic: laxative, gi stimulant Prototype: Bisacodyl Pregnancy Category: C |
Availability
325 mg tablets; liquid
Action
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.
Therapeutic Effect
Effective laxative with results in 6–12 h. Useful in conditions where straining at stool is to be avoided.
Uses
Temporary relief of constipation and to prevent straining at stool in various disease conditions. Sometimes used with milk of magnesia.
Contraindications
Abdominal pain, fecal impaction; GI bleeding, ulcerations; appendicitis, gastroenteritis, intestinal obstruction, CHF; pregnancy (category C).
Cautious Use
Lactation; renal impairment; diabetic patients; rectal bleeding; concomitant laxative use.
Route & Dosage
| Laxative Adult: PO Tablet: 325–1000 mg/d; fluid extract: 0.5–1.5 mL/d; aromatic fluid extract: 2–6 mL/d Child: PO 2–12 y, ? of adult dose; <2 y, 1/4 of adult dose Infant: PO Aromatic fluid extract: 1.25 mL/d as single dose |
Administration
Oral- 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.
Interactions
Drug: Decreased effect of oral anticoagulants.Pharmacokinetics
Absorption: Minimal from GI tract. Onset: 6–12 h. Metabolism: In liver. Elimination: In feces and urine; excreted in breast milk.Nursing Implications
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 6–12 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.
Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; 
Canadian drug name; 
Prototype drug