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Cascara is a popular herbal medication and over-the-counter therapy of constipation

Liver safety of Cascara

Cascara is generally safe and well tolerated, but can cause adverse events including clinically apparent liver injury when used in high doses for longer than recommended periods.

Cascara (Rhamnus purshiana) bark
Cascara (Rhamnus purshiana) bark

Dried bark

  • Cascara sagrada is an herbal medication used for centuries as a laxative which is now available in the United States without prescription for short term treatment of constipation
  • Cascara is typically an extract from the dried, aged bark of Rhamnus purshiana, a species of buckthorn tree or shrub native to North America. 

History of Cascara

Cascara sagrada is Spanish for “sacred bark” and was used for centuries by Native Americans as a laxative. 


Cascara became accepted in western medical practice in the 19th century and is still used in over-the-counter laxative preparations, often in combination with other herbals such as aloe vera. 

Active ingredients

The active laxative components in cascara are anthraquinone derivatives and their glucosides, referred to as cascarosides. 

Mechanism of action of Cascara

  • They appear to act locally as an irritant to the colon promoting peristalsis and stool evacuation. 
  • Anthraquinones also inhibit reabsorption of electrolytes and water from the colon. 
  • Cascara is minimally absorbed. 
Rhamnus purshiana
Rhamnus purshiana

Dosage and administration for Cascara

The typical dose is 300 mg once daily, but it is recommended for short term use only (less than one week). 

Side effects of Cascara

Side effects include abdominal cramps and electrolyte imbalance.  Long term use or abuse can lead to “cathartic” colon with diarrhea, cramps, weight loss and darkened pigmentation of the colonic mucosa.

Herbal and dietary supplements

Chinese and Other Asian Herbal Medicines

Multi-Ingredient Nutritional Supplements

See also Nutritional supplements

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