Note: Several types of senna products are available on the market and multiple formulations exist that are not equivalent; products composed of sennosides are considered OTC medications; senna pod concentrate and senna leaf extract are considered dietary supplements and are not interchangeable on a mL to mL (or mg to mg) basis with other senna products that contain sennosides; close attention must be paid to the product description and concentration when ordering or administering.
Constipation: Oral:
Sennosides:
Syrup (8.8 mg sennosides/5 mL):
Children 2 to <6 years: 2.5 to 3.75 mL (4.4 to 6.6 mg sennosides) at bedtime, not to exceed 3.75 mL (6.6 mg sennosides) twice daily
Children 6 to <12 years: 5 to 7.5 mL (8.8 to 13.2 mg sennosides) at bedtime, not to exceed 7.5 mL (13.2 mg sennosides) twice daily
Children ≥12 years and Adolescents: 10 to 15 mL (17.6 mg to 26.4 mg sennosides) at bedtime, not to exceed 15 mL (26.4 mg sennosides) twice daily.
Tablets:
8.6 mg sennosides/tablet:
Children 2 to <6 years: 1/2 tablet (4.3 mg sennosides) at bedtime, not to exceed 1 tablet (8.6 mg sennosides) twice daily
Children 6 to <12 years: 1 tablet (8.6 mg sennosides) at bedtime, not to exceed 2 tablets (17.2 mg sennosides) twice daily
Children ≥12 years and Adolescents: 2 tablets (17.2 mg sennosides) at bedtime, not to exceed 4 tablets (34.4 mg sennosides) twice daily
15 mg sennosides/tablet:
Children 6 to <12 years: 1 tablet (15 mg sennosides) once or twice daily
Children ≥12 years and Adolescents: 2 tablets (30 mg sennosides) once or twice daily
25 mg sennosides/tablet:
Children 6 to <12 years: 1 tablet (25 mg sennosides) once or twice daily
Children ≥12 years and Adolescents: 2 tablets (50 mg sennosides) once or twice daily
Senna pod concentrate liquid (Fletcher's Laxative for Kids; 167 mg/5 mL senna pod concentrate): Note: Senna pod concentrate is considered a dietary supplement and is not interchangeable on a mL to mL (or mg to mg) basis with other senna products that contain sennosides.
Children 2 to <6 years: 5 to 10 mL (167 to 333 mg senna pod concentrate) once or twice daily
Children and Adolescents 6 to 15 years: 10 to 15 mL (333 to 500 mg senna pod concentrate) once or twice daily
Senna Leaf Extract Syrup (176 mg/5 mL senna leaf extract): Note: Senna leaf extract is considered a dietary supplement and is not interchangeable on a mL to mL (or mg to mg) basis with other senna products that contain sennosides. Begin with once daily dosing (at bedtime); increase to twice daily if needed.
Children 2 to <6 years: 2.5 to 3.75 mL (88 to 132 mg senna leaf extract) once or twice daily; maximum daily dose: 7.5 mL/day
Children ≥6 years to <12 years: 5 to 7.5 mL (176 to 264 mg senna leaf extract) once or twice daily; maximum daily dose: 15 mL/day
Children ≥12 years and Adolescents: 10 to 15 mL (352 to 528 mg senna leaf extract) once or twice daily; maximum daily dose: 30 mL/day
Bowel evacuation: Children ≥12 years and Adolescents: Oral: 130 mg sennosides between 2:00 PM to 4:00 PM on the day prior to procedure
(For additional information see "Senna: Drug information")
Note: Several types of senna products are available on the market and multiple formulations exist that are not equivalent; products composed of sennosides are considered OTC medications; senna pod concentrate and senna leaf extract are considered dietary supplements and are not interchangeable on a mL-to-mL (or mg-to-mg) basis with other senna products that contain sennosides; close attention must be paid to the product description and concentration when ordering or administering.
Constipation: Oral:
Sennosides:
Syrup (8.8 mg sennosides/5 mL): 10 to 15 mL (17.6 mg to 26.4 mg sennosides) once daily; maximum: 15 mL (26.4 mg sennosides) twice daily.
Tablets:
8.6 mg sennosides/tablet: Two tablets (17.2 mg sennosides) once daily; maximum: 4 tablets (34.4 mg sennosides) twice daily
15 mg sennosides/tablet: Two tablets (30 mg sennosides) once or twice daily
17.2 mg sennosides/tablet: One tablet (17.2 mg sennosides) once daily; maximum: 2 tablets (34.4 mg sennosides) twice daily
25 mg sennosides/tablet: Two tablets (50 mg sennosides) once or twice daily
Senna leaf extract syrup (176 mg/5 mL senna leaf extract): Note: Senna leaf extract is considered a dietary supplement and is not interchangeable on a mL-to-mL (or mg-to-mg) basis with other senna products that contain sennosides.
10 to 15 mL (352 to 528 mg senna leaf extract) once daily (preferably at bedtime); may increase to 10 to 15 mL (352 to 528 mg senna leaf extract) twice daily if needed; maximum daily dose: 30 mL/day
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Leaves, Oral:
Generic: (454 g [DSC])
Liquid, Oral:
Generic: 8.8 mg/5 mL (237 mL)
Syrup, Oral:
Senna-GRX: 8.8 mg/5 mL (15 mL [DSC], 236 mL [DSC]) [contains parabens, propylene glycol]
Generic: 8.8 mg/5 mL (5 mL, 236 mL [DSC], 237 mL); 176 mg/5 mL (15 mL, 237 mL)
Tablet, Oral:
Ex-Lax: 15 mg [DSC] [sodium free]
Ex-Lax Maximum Strength: 25 mg [contains corn starch, fd&c blue #1 aluminum lake, methylparaben, propylparaben, sodium benzoate]
Ex-Lax Maximum Strength: 25 mg [DSC] [sodium free]
Geri-kot: 8.6 mg
GoodSense Laxative Pills: 25 mg [contains brilliant blue fcf (fd&c blue #1), corn starch]
GoodSense Senna Laxative: 8.6 mg
Perdiem Overnight Relief: 15 mg [DSC]
Perdiem Overnight Relief: 15 mg [contains corn starch, methylparaben, propylparaben, sodium benzoate]
Senexon: 8.6 mg [DSC]
Senna Laxative: 8.6 mg
Senna Smooth: 15 mg [contains sodium benzoate]
Senna-Lax: 8.6 mg
Senna-Tabs: 8.6 mg
Senna-Time: 8.6 mg
SennaCon: 8.6 mg [DSC]
Senno: 8.6 mg
Senokot: 8.6 mg
Senokot Extra Strength: 17.2 mg
Generic: 8.6 mg
Tablet Chewable, Oral:
Ex-Lax: 15 mg [DSC] [contains soybean lecithin, whey]
Ex-Lax: 15 mg [contains soybean lecithin, whey; chocolate flavor]
Senokot Laxative Gummies: 8.7 mg [contains coconut oil (copra/cocos nucifera oil)]
Senokot Laxative Gummies: 8.7 mg [dairy free, egg free, fish derivative free, gluten free, peanut free, shellfish free, soy free; contains coconut oil (copra/cocos nucifera oil)]
May be product dependent
Oral: Administer at bedtime (preferable) with water; syrup can be taken with juice or milk or mixed with ice cream to mask taste.
Once-daily doses should be preferentially taken at bedtime. Administer 2 hours before or after other medications.
Store at 20°C to 25°C (77°F); excursions are permitted between 15°C and 30°C (59°F to 86°F).
Short-term treatment of constipation (OTC products; FDA approved in ages ≥2 years and adults; consult specific product formulations for appropriate age groups)
Perdiem may be confused with Pyridium
Senexon may be confused with Cenestin
Senokot may be confused with Depakote
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
Frequency not defined: Gastrointestinal: Abdominal cramps, diarrhea, nausea, vomiting
Dosage form specific issues:
• Benzyl alcohol and derivatives: Some dosage forms may contain sodium benzoate/benzoic acid; benzoic acid (benzoate) is a metabolite of benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol derivative with caution in neonates. See manufacturer’s labeling.
Other warnings/precautions:
• Appropriate use: Failure to have a bowel movement or occurrence of rectal bleeding after use should be reported to health care provider.
• Self-medication (OTC use): Not recommended for use in patients experiencing stomach pain, nausea, vomiting, or a sudden change in bowel movements which lasts >2 weeks. Not recommended for OTC use in children <2 years of age. Do not use for more than 1 week.
None known.
Dichlorphenamide: Laxatives may enhance the hypokalemic effect of Dichlorphenamide. Risk C: Monitor therapy
Digoxin: Senna may enhance the adverse/toxic effect of Digoxin. Risk C: Monitor therapy
Polyethylene Glycol-Electrolyte Solution: Senna may enhance the adverse/toxic effect of Polyethylene Glycol-Electrolyte Solution. Risk C: Monitor therapy
Sodium Sulfate: Laxatives (Stimulant) may enhance the adverse/toxic effect of Sodium Sulfate. Specifically, the risk of mucosal ulceration or ischemic colitis may be increased. Risk X: Avoid combination
Use of senna should be limited during pregnancy due to an increased risk of adverse events, such as electrolyte abnormalities. When dietary changes and lifestyle modifications are insufficient, agents other than senna are recommended for the treatment of constipation in pregnant women (Body 2016; Gomes 2018).
Fluid status, frequency of bowel movements, serum electrolytes if severe diarrhea occurs
The anthraquinone group of stimulant laxatives includes the plant-derived agents such as senna. Stimulant laxatives typically induce defecation by stimulating peristaltic activity on the intestine by direct action on intestinal mucosa or nerve plexus, therefore increasing motility.
Onset of action: Oral: Within 6 to 24 hours
Metabolism: Hepatic
Excretion: Feces (via bile); urine
Chewable (Ex-Lax Oral)
15 mg (per each): $0.18
Chewable (Senokot Laxative Gummies Oral)
8.7 mg (per each): $0.23
Syrup (Senna Oral)
176 mg/5 mL (per mL): $0.05 - $0.07
Tablets (Ex-Lax Maximum Strength Oral)
25 mg (per each): $0.23
Tablets (Perdiem Overnight Relief Oral)
15 mg (per each): $0.15
Tablets (Senna Smooth Oral)
15 mg (per each): $0.22
Tablets (Senokot Extra Strength Oral)
17.2 mg (per each): $0.48
Tablets (Senokot Oral)
8.6 mg (per each): $0.23
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