• Cascara Sagrada


    Supplement Forms/Alternate Names

    • Rhamnus purshiana ; Sacred Bark; Frangula purshiana ; Chitum; Californian Buckthorn; Bitter Bark; Buckthorn; Chittem Bark; Dogwood Bark; Purshiana Bark; Rhamni Purshianae Cortex; Sagrada Bark; Yellow Bark

    Principal Proposed Uses

    Cascara sagrada means ‘sacred bark’ in Spanish. The bark of this tree, which grows mostly on the west coast of the United States and parts of South America, 1 is mainly used to treat constipation . Cascara sagrada can be found as an ingredient in over-the-counter laxatives. 2 In addition to relieving constipation, cascara sagrada has also been used by Native Americans to treat liver problems, gallstones , joint and muscle pain , gonorrhea, indigestion , upset stomach, and dysentery (infection in the intestines that causes pain, fever, and diarrhea ). 2
    Cascara sagrada bark contains anthraquinones. Anthraquinones are substances found in plants that give them their color. Because of this, they have been used as dyes. Certain anthraquinones in cascara sagrada, called cascarosides A and B, are also responsible for the bark’s laxative effect. When a person ingests the bark, the cascarosides interact with bacteria living in the large intestine to form substances that stimulate the intestine to move the bowels. 3


    Cascara sagrada is available as an over-the-counter laxative in the forms of tablets, capsules, and liquids.
    In its raw form, the bark cannot safely be used until it is at least one year old or heated to above 212°F (100°C). Bark that is young or untreated has too strong of a laxative effect and produces severe intestinal spasm and cramping. 3

    Therapeutic Dosages

    The recommend dose of cut or powdered aged bark is 1-2 grams per day (containing 20-30 milligrams of cascaroside A). However, since few people consume the raw bark, dosages vary considerably depending on the product containing cascara sagrada. Therefore, it is best to check the product label for the appropriate dosage.
    Make sure to read the label if you are considering the laxative for a child, as there may be instructions specific to children. Cascara should not be used by children under 12 unless specifically recommended by their physician.
    Overdosing on laxatives can cause nausea , vomiting, abdominal cramping, and dehydration. Taking too much cascara sagrada may also lead to abdominal pain, diarrhea, collapse, bloody stools, and in extreme cases, electrolyte abnormalities and heart rhythm disturbances. 6

    Therapeutic Uses

    Cascara sagrada is most often used to treat constipation.

    What Is the Scientific Evidence for Cascara Sagrada?

    In a review of laxatives used in the treatment of chronic diarrhea, researchers were unable to uncover any studies on the effectiveness of cascara sagrada alone or in combination with other laxatives. 11 The evidence for its benefit is based on its traditional use and the known effects of cascaroside anthraquinones on bowel stimulation.
    A few case reports have linked cascara sagrada to serious liver problems. 5,8,7

    Safety Issues

    Cascara sagrada should be avoided in cases of intestinal blockage, inflammatory bowel disease (eg, Crohn's disease , ulcerative colitis ), appendicitis, or abdominal pain of unknown origin. 10
    Since little safety information is available, women who are pregnant or lactating and children under 12 years old should not use cascara sagrada. 3
    Some people taking cascara sagrada may develop a dependency on the laxative. 3
    Frequent use may also cause a change in color of the stools and urine, however this is not harmful. 3,4 Harmless pigmentation inside the colon may also occur.

    Interactions You Should Know About

    Chronic use, meaning using the laxative for more than seven days, may lead to fluid and electrolyte loss (eg, potassium) and loss of proper intestinal muscle contractions. This effect may be increased if you are taking heart medicines, diuretics, corticosteroids, or licorice root . 9


    1. Venes D. Taber's Cyclopedic Medical Dictionary . 20th ed. FA Davis Company; 2005.

    2. Peters M. BMA A-Z Family Medical Encyclopedia . 2004.

    3. Foster S. Peterson Field Guide to Western Medicinal Plants & Herbs . 2002.

    4. Stimulant laxatives. PubMed Health website. Available at: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000099 . Reviewed February 1, 2009. Accessed September 17, 2010.

    5. Nadir A, Reddy D, Van Thiel DH. Cascara sagrada-induced intrahepatic cholestasis causing portal hypertension: case report and review of herbal hepatotoxicity. Am J Gastroenterol . 2000 Dec;95(12):3634-7.

    6. Malagelada JR, Malagelada C. Nausea and vomiting. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease . 8th ed. Philadelphia, PA: Saunders Elsevier; 2006:chap 8.

    7. Jacobsen C, Semb S, Kromann-Andersen H. Toxic hepatitis following consumption of the herbal medicinal product cascara sagrada. Ugeskr Laeger . 2009 Nov 9;171(46):3367-9.

    8. Pittler MH, Ernst E. Systematic review: hepatoxic events associated with herbal medicinal products. Aliment Pharmacol Ther . 2003;18:451-471.

    9. Go for natural laxative relief, but best if not from senna or cascara. Environmental Nutrition ; 2002 May; 25(5):7.

    10. Cascara. Memorial Sloan-Kettering Cancer Center website. Available at: http://www.mskcc.org/mskcc/html/69165.cfm . Updated August 24, 2010. Accessed September 20, 2010.

    11. Frizelle F, Barclay M. Constipation in adults. Clin Evid (Online). 2007 Aug 1:0413.

    Revision Information

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