What Is Cascara Sagrada?

This once-popular natural laxative poses certain risks

Cascara sagrada (Rhamnus purshiana) is a shrub native to western North America. Its bark is processed for medicinal purposes. Cascara sagrada contains organic plant compounds called anthraquinones that have powerful laxative effects.

Since the 1890s, Cascara sagrada has been listed on the U.S. Pharmacopeia, which contains standards for medications and supplements. It received initial approval from the U.S. Food and Drug Administration (FDA) for use as an over-the-counter (OTC) laxative for constipation. However, the FDA reversed that approval in November 2002. This was due to concerns about long-term safety and the lack of research on its effectiveness.

Because of the FDA ruling and the cost of clinical trials, many manufacturers opted to have their products reclassified as a "dietary supplement" rather than an OTC laxative.

Cascara sagrada should not be confused with cascara. Cascara is the dried skin of coffee cherries that some use to make lattes and other coffee drinks.

This article discusses the potential uses of cascara sagrada. It also covers the risk factors and side effects of taking this supplement.

Dietary supplements are not regulated like drugs in the United States, meaning the Food and Drug Administration (FDA) does not approve them for safety and effectiveness before products are marketed. When possible, choose a supplement tested by a trusted third party, such as USP, ConsumerLabs, or NSF. 
However, even if supplements are third-party tested, that doesn’t mean they are necessarily safe for all or effective in general. Therefore, it is important to talk to your healthcare provider about any supplements you plan to take and check in about potential interactions with other supplements or medications

Supplement Facts

  • Active Ingredient(s): Anthraquinones
  • Alternate Name(s): Sacred bark, California Buckthorn, Yellow Bark
  • Legal Status: FDA ruled that cascara sagrada is not safe as a stimulant laxative
  • Suggested Dose: No suggested recommended dose
  • Safety Considerations: Pregnant or lactating individuals and children should not take it. Individuals who are taking digoxin, corticosteroids, stimulant laxatives, warfarin, and diuretics should not use cascara sagrada.

Purported Uses of Cascara Sagrada

Supplement use should be individualized and vetted by a healthcare professional, such as a registered dietitian nutritionist, pharmacist, or a healthcare provider No supplement is intended to treat, cure, or prevent a disease.

Research on the potential health benefits of cascara sagrada is very limited, and research suggests it has some risks. More studies are needed.

Constipation

Cascara sagrada is no longer an FDA-approved OTC laxative but may be found in herbal supplements. Although it is primarily used for constipation, its approval was removed due to the lack of evidence of its effectiveness and concerns about its long-term safety.

The anthraquinones in the bark slow down water absorption and electrolytes in the intestines. Because of this, stool volume increases as it absorbs the excess water, which increases pressure within the intestine. This stimulates muscle contractions in the colon (peristalsis), speeding the clearance of the bowel.

Cascara sagrada is considered a stimulant laxative, causing intestinal muscle contractions. In this way, it's similar to other natural laxatives like aloe vera and senna. However, unlike these counterparts, the effect of cascara sagrada tends to be gentler, resulting in fewer loose or watery stools.

Cascara sagrada works differently than demulcent laxatives like psyllium. This laxative creates a gel-like substance that helps ease stool from the bowels.

If you are experiencing constipation, seek medical guidance from a healthcare provider. In addition to diet changes, there are other OTC and prescription medication options that can help alleviate your symptoms.

It is from the bark of this tree that the drug, Cascara Sagrada, is obtained.

Julia Rogers/Flickr

 

What Are the Side Effects of Cascara Sagrada?

Cascara sagrada may lead to side effects in some individuals. It is intended for short-term use only (less than seven days). In some cases, it may cause abdominal pain and cramping (most commonly when used to treat severe constipation).

The long-term use of cascara sagrada is another matter. The concerns stemmed primarily from the evidence that anthraquinones may be harmful if overconsumed. Cascara sagrada can also cause a condition known as melanosis coli, discoloration of the lining of the colon.

If used long-term, cascara sagrada may cause severe dehydration and the rapid loss of electrolytes. Electrolytes are minerals your body needs like sodium, potassium, and chloride. This can trigger an array of potentially serious side effects, including:

  • Severe nausea
  • Loss of energy
  • Headaches
  • Muscle weakness, spasms, or cramps
  • Irregular heartbeat (arrhythmia)
  • Skipped heartbeats (palpitations)
  • Rapid heartbeat (tachycardia)
  • Numbness or tingling of the hands or feet (neuropathy)
  • Reduced urine output
  • Confusion
  • Return of constipation (rebound constipation)

Precautions

Pregnant or breastfeeding individuals and children should not take cascara sagrada in any form, as not enough research has been done in these populations.

People with the following gastrointestinal disorders should also not take cascara sagrada due to stomach cramping, which could make the below conditions worse:

  • Intestinal obstruction
  • Crohn's disease
  • Ulcerative colitis
  • Appendicitis
  • Stomach ulcers
  • Unexplained stomach pain

Dosage: How Much Cascara Sagrada Should I Take?

Always speak with a healthcare provider before taking a supplement to ensure that the supplement and dosage is appropriate for your individuals needs

There is not enough scientific evidence to determine a standard or appropriate dose of cascara sagrada at this time. More research is needed on dosages for specific health needs and populations.

What Happens If I Take Too Much Cascara Sagrada?

As a general guideline, never take more than the manufacturer's recommended dosage. If you experience side effects of any kind, stop taking cascara sagrada and speak with your healthcare provider.

Interactions

It is essential to carefully read a supplement's ingredient list and nutrition facts panel to know which ingredients and how much of each ingredient is included. Please review this supplement label with your healthcare provider to discuss potential interactions with foods, other supplements, and medications.

Cascara sagrada may have interactions with different medications, herbs, and supplements because of its effects on electrolyte imbalances. Please talk with your healthcare provider about using cascara sagrada if you take the following medications or supplements.

Medications:

Herbs and supplements:

  • Chromium-containing herbs and supplements (e.g., bilberry, brewer's yeast, horsetail)
  • Herbs that contain cardiac glycosides, chemicals that can damage the heart (e.g., black hellebore, foxglove, lily-of-the-valley, oleander, pleurisy root)
  • Licorice
  • Stimulant laxative herbs (e.g., aloe, alder buckthorn, gossypol, rhubarb, and senna)

How to Store Cascara Sagrada

Store cascara sagrada according to manufacturer's directions on the package. Discard as indicated on the packaging.

Frequently Asked Questions

  • Is cascara sagrada and cascara the same thing?

    No, cascara sagrada and cascara are two different things. Cascara is the dried skin of coffee cherries that can be used to make lattes and other coffee drinks. Cascara sagrada is a shrub whose bark is processed for medicinal purposes.

  • Does cascara sagrada interact with other herbs?

    Yes, cascara sagrada can interact with other herbs.

    Herbs that contain natural cardiac glycosides can interact with cascara sagrada in the same way cardiac glycoside medications such as digoxin do, causing a loss of potassium that could lead to heart damage. These include:

    • Black hellebore
    • Foxglove
    • Lily-of-the-valley
    • Oleander
    • Pleurisy root
    • Horsetail
    • Licorice
    • Aloe
    • Alder buckthorn
    • Gossypol
    • Rhubarb
    • Senna
  • Can I take cascara sagrada every day?

    No, experts suggest that cascara sagrada is "possibly safe" when taken for less than seven days (one week). Side effects include cramps and stomach pains. If taken for more than this time period, it could cause more serious side effects. Please talk with your healthcare provider about starting any herbal supplement.

Sources of Cascara Sagrada & What to Look For

Cascara sagrada can often be purchased online or at health food stores. The herb comes in many formulations, including capsules, powders, tinctures, and teas. This can make it difficult to know how much or little of a product you need to achieve the desired effect.

It is important to note that supplements on the market are not strictly regulated in the United States. Sometimes, a product may contain ingredients other than those listed on the label. Remember it is illegal for any company to market a dietary supplement product as a treatment or cure for a specific disease.

Summary

Cascara sagrada is a dietary supplement made from the bark of a shrub in North America. It's used for its laxative effects to treat constipation. It does this by slowing down the water and electrolytes absorbed in the intestines. This allows stool volume to increase with extra water and stimulates muscle contractions in the colon.

However, cascara sagrada has possible side effects, especially if taken long-term. It can cause dehydration and loss of electrolytes (minerals), leading to serious side effects and complications.

Talk with your healthcare provider before taking cascara sagrada, particularly if you have another health condition or are taking other medications or herbal supplements. They may be able to guide you to other safer and potentially more effective treatments for your constipation.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Food and Drug Administration. Status of certain additional over-the-counter drug category II and III active ingredients. Final rule. Fed Regist. 2002;67(90):31125-7.

  3. MedlinePlus. Cascara sagrada.

  4. National Institutes of Health. Cascara. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-2017.

  5. Vitalone A, Menniti-Ippolito F, Raschetti R, Renda F, Tartaglia L, Mazzanti G. Surveillance of suspected adverse reactions to herbal products used as laxatives. Eur J Clin Pharmacol. 2012;68(3):231-8. doi:10.1007/s00228-011-1128-y

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Additional Reading

By Alena Clark, PhD
Alena Clark, PhD, is a registered dietitian and experienced nutrition and health educator

Originally written by
Cathy Wong
Cathy Wong

Cathy Wong is a nutritionist and wellness expert. Her work is regularly featured in media such as First For Women, Woman's World, and Natural Health.

Learn about our editorial process