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Herbs & Botanicals · Herbs · Aged-bark laxative with a long history, almost no modern trials, and firm limits on how long to use it

Cascara Sagrada

Q: Does cascara sagrada work for constipation?

It has been used for well over a century and the EU accepts it for short-term occasional constipation, but the EU's own report found no controlled trial of cascara bark alone. Whether it works is therefore based on long use, expert opinion and the better studies of related laxatives such as senna, not on trials of cascara itself. Certainty is insufficient.

Q: How long can I take cascara sagrada?

The EU says not more than 1 week. If symptoms continue, see a doctor or pharmacist. It should be tried only if diet changes or fibre have not worked. Ask a doctor or pharmacist about amounts.

Q: What did the FDA decide about cascara sagrada in 2002?

In a final rule published on 9 May 2002, the FDA said that aloe and cascara sagrada used as stimulant laxatives in over-the-counter drug products are not generally recognized as safe and effective, or are misbranded. So cascara is no longer an accepted over-the-counter laxative ingredient in the US. Only the abstract of the rule was read, so the reasons and what it meant for supplements are not covered here.

Q: Why must the bark be aged? Can I use fresh bark?

No. The EU report says fresh bark contains forms that cause vomiting, and that drying and ageing change them into forms that do not. A chemistry paper says some of these laxative plants must be stored for at least a year to avoid severe diarrhoea and dehydration. Use only the dried, aged bark in a labelled product.

Q: Is cascara habit-forming, and what happens to potassium?

The EU warns that using stimulant laxatives for more than a short time may lead to poor bowel function and dependence, but its own report says it is not clear from the evidence whether that really happens; long-term use is avoided as a precaution. Overuse can also cause loss of fluid and potassium, and in the elderly or people with kidney disease this matters more. If you need a laxative every day, see a doctor to find the cause.

Q: Which medicines does cascara interact with?

The EU says to consult a doctor before using cascara if you take digoxin or other heart glycosides, rhythm medicines, medicines that prolong the QT interval, water pills (diuretics), steroid tablets or liquorice root. The reason is low potassium, which can strengthen digoxin and upset the heartbeat. This rests on expert guidance and drug logic; no cascara-specific case report was found. A review also says anthranoid laxatives may reduce the absorption of other medicines.

Q: Is cascara safe in pregnancy or when breastfeeding?

No. The EU contraindicates it in both, because related compounds showed genotoxic effects in lab tests and small amounts of the active metabolite rhein reach breast milk. The US LactMed record says breastfeeding mothers should avoid it because it might cause loose stools in the infant. A 1998 review took a more relaxed view, but the newer sources are stricter.

Q: Can children take cascara sagrada?

No. The EU says it must not be used under age 12, there are no studies in children, and a 2021 review of non-drug approaches to childhood constipation noted significant safety concerns for cascara and insufficient evidence. Ask a paediatrician about safer options.

Q: Can cascara damage the liver?

It can in reported cases. LiverTox says cascara is generally safe and well tolerated but can cause clinically apparent liver injury at high doses taken longer than recommended. Case reports come from the US and Denmark, and a Spanish liver registry listed 2 cascara cases among 13 herbal liver injuries. No frequency is known. Stop and see a doctor the same day for yellow skin or eyes, dark urine or pale stools.

Q: Does cascara cause melanosis coli or colon cancer?

Long use can darken the colon lining (melanosis coli), which usually fades after stopping and, in a 2025 clinical reference, is not associated with a higher colon cancer risk. Cancer from cascara itself is an open question: one rat study found weak tumour promotion at a high dose, another found none, and a 2022 meta-analysis of anthraquinone laxatives gave a non-significant link (OR 1.41; 95% CI 0.94-2.11). The EU calls the concern unresolved, which is one reason for the 1-week limit.

Frangula purshiana (DC.) J.G.Cooper (also called Rhamnus purshiana DC.) · also called Cascara sagrada, cascara, cascara buckthorn, sacred bark, chittam bark, bearwood, cáscara sagrada (Spanish), nerprun cascara (French), Cascararinde (German)

Cascara sagrada is the dried, aged bark of a buckthorn tree from the Pacific coast of North America. Its active compounds, the cascarosides, are turned by bowel bacteria into forms that speed the large bowel and keep water in it, and a bowel movement follows after about 8 to 12 hours. The EU accepts it for short-term occasional constipation, but the EU's own report found no controlled trial of cascara bark alone. In 2002 the US FDA ruled that cascara sagrada is not generally recognized as safe and effective as an over-the-counter laxative ingredient. Fresh bark causes vomiting, which is why the bark is aged.

General information, not medical advice. Last substantive update October 25, 2026 · Not medically reviewed. A named clinician has not signed off on this page. How this page is made

About Cascara Sagrada

Cascara sagrada is the dried, aged bark of a buckthorn tree and a stimulant laxative. The EU accepts it for short-term occasional constipation, for no more than 1 week, and not in pregnancy, breastfeeding or under age 12, but it found no controlled trial of cascara alone. In 2002 the US FDA ruled that cascara sagrada is not generally recognized as safe and effective as an over-the-counter laxative ingredient. Fresh bark causes vomiting. Long or heavy use can cause dependence, potassium loss, a dark colon lining and, in reported cases, liver injury.

What it is

Cascara sagrada (Spanish for "sacred bark") is the dried, aged bark of Frangula purshiana, a tree of the buckthorn family that grows on the Pacific coast of North America from British Columbia to California. The older name Rhamnus purshiana is still widely used, and the EU monograph uses it too.

Do not confuse it with sea buckthorn, which is a different plant, or with the "cascara" drink sold from dried coffee cherries, which is a different product with no link to the bark.

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Traditional and current uses

The EU assessment says the bark was brought into medicine in 1877 and used as a laxative in Europe from about 1880. Old books also record it as a bitter stomach tonic, for "sick headache" from a sluggish bowel, for jaundice, for rheumatic complaints and, on the skin, for scabies. None of these old uses has been tested.

Today the EU lists it as well-established use for short-term occasional constipation. In the US the FDA ruled in 2002 that cascara sagrada, like aloe, is not generally recognized as safe and effective as an over-the-counter laxative ingredient; only the abstract of that rule was read, so the reasons and what followed were not.

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What is in it and how it works

The main compounds are the cascarosides, sugar-bound forms of anthrone compounds. They pass through the stomach and small bowel mostly unchanged. Bacteria in the large bowel turn them into an active form, mainly emodin anthrone, which speeds the bowel and keeps water and salts in it. A bowel movement comes after about 8 to 12 hours.

The bark must be aged. Fresh bark contains forms that cause vomiting; drying and ageing oxidise them. A chemistry paper adds that some of these laxative plants must be stored for at least a year to avoid severe diarrhoea. Related compounds in the bark (emodin and aloe-emodin) have shown genotoxic effects in the lab, which is why pregnancy is excluded.

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What the research shows

There is very little. The EU assessment report (2020) says there are no controlled clinical studies of cascara bark alone, no dose-finding studies and no clinical safety studies. The only clinical work is on combination products, and the one trial found, from 1991, used a cascara-and-saline laxative with a smaller amount of the standard wash-out solution before a colonoscopy; it showed no clinically important difference from the other plans.

The acceptance of cascara as a laxative rests on long use, expert opinion, animal work and the better trials of senna. No modern study of cascara in older people, in children or for any other use was found, and the gallbladder and antiviral findings are from one small study and a test tube. Because of this, every benefit here is rated "insufficient" or "against".

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At a glance

Traditional uses history, not proof

Bark laxative: the EU lists it as well-established use for short-term occasional constipation, based on long use rather than trials.
Old books also record it as a stomach tonic, for "sick headache", jaundice and rheumatic complaints; none has been tested.
Brought into medicine in 1877 and used in Europe as a laxative from about 1880, per the EU assessment report.

Studied for research

Occasional constipation in adults, insufficient evidence (no controlled trial of cascara alone)
Constipation in older people and in children, insufficient evidence (children: not to be used under 12)
Bowel cleaning before a colonoscopy as part of a combination product, insufficient evidence
Gallbladder contraction in healthy volunteers, antiviral effect in a test tube, insufficient evidence
Detox and weight loss: no benefit shown, against

Main compounds

Cascarosides A to F, anthrone glycosides that are laxative prodrugs
Aloins and chrysaloins, minor related glycosides
Emodin anthrone (the active form made in the bowel), emodin and aloe-emodin, which show genotoxic findings in some lab tests

Common forms

Dried, aged bark as a tea
Standardised bark extracts in tablets, capsules and liquids
Combination laxatives (older products)

Research links: EU herbal monograph on cascara bark (European Medicines Agency) · EU assessment report on cascara bark (European Medicines Agency) · FDA final rule on aloe and cascara sagrada in over-the-counter laxatives, 2002 (abstract) · LiverTox record on cascara (abstract) · LactMed record on cascara sagrada (abstract) · EFSA opinion on hydroxyanthracene derivatives in food, 2018 · Research Library · Genes & Biomarkers Library

The plant and its history

Accepted scientific name: Frangula purshiana (DC.) J.G.Cooper
Naming authority: GBIF backbone, usageKey 8286637, status ACCEPTED (match confidence 97 on the name Frangula purshiana). Published in Trans. Amer. Med. Assoc. 10: 228 (1857) per GBIF.
Synonyms: Rhamnus purshiana (Pursh) DC. (the older and still widely used name; GBIF key 3039464, a synonym); Frangula purshiana (DC.) A.Gray (GBIF key 3039463; the form used in the EU monograph); Rhamnus alnifolia Pursh (heterotypic synonym); Cardiolepis obtusa Raf.; Rhamnus purshiana var. hirtella Schelle
Common names: Cascara (English); Cascara buckthorn (English); Cascara false buckthorn (English); Pursh's buckthorn (English); Western buckthorn (English); Bearberry (English); Bearwood (English); Chittam bark (English); cáscara sagrada ("sacred bark") (Spanish); Cascararinde (German); Nerprun cascara (French); cáscara sagrada (Portuguese)
Botanical family: Rhamnaceae (the buckthorn family, order Rosales). The EU monograph still uses the older genus name Rhamnus and gives Frangula purshiana as an alternative.
Classification: Plantae > Tracheophyta > Magnoliopsida (dicots) > Rosales > Rhamnaceae > Frangula > Frangula purshiana
Native range: The EU assessment report (citing a 1972 textbook) says the trees are native to the Pacific coast of North America from British Columbia to California. Not checked against a flora.
Habitat: Not described in the sources read.
What the plant looks like: Roots: Not described in the sources read.; Stems: The bark is the part used.; Leaves: Not described in the sources read.; Flowers: Not described in the sources read.; Fruit: Not described in the sources read.
Cultivation: Not described in the sources read.
Harvest and processing: The EU assessment says cascara is the dried, whole or fragmented bark. Fresh bark causes vomiting; during drying and ageing the compounds that cause this are oxidised to forms that do not (Van Os 1976, as cited in the EU report). The European Pharmacopoeia sets a minimum of 8.0% hydroxyanthracene glycosides, at least 60% of them cascarosides. Standardised dry extracts (8.0-25.0% hydroxyanthracene glycosides) are made with boiling water or at least 60% ethanol.
Look-alikes and adulterants: Name: Frangula alnus Mill. (alder buckthorn, also Rhamnus frangula); Note: A different accepted species (GBIF key 3039454) whose bark is also used as a laxative. A 2025 chemical fingerprint found cascara and frangula clustered closely together (p41441021).; Name: Rhamnus cathartica L. (European buckthorn); Note: A different accepted species (GBIF key 3039491). LactMed groups it with alder and California buckthorn as having potent cathartic anthraquinones (p30000918).; Name: Rhamnus californica Eschsch.; Note: GBIF lists the name as a synonym (accepted key 7095707). The EU assessment says a cascara, probably Rhamnus californica, was known to early Mexican and Spanish priests of California, while Rhamnus purshiana was described in 1805.; Name: Sea buckthorn (Hippophae rhamnoides L.); Note: A different plant in another family (Elaeagnaceae; GBIF key 3039285). LactMed warns not to confuse it with the cathartic buckthorns.; Name: "Cascara" coffee-cherry drink; Note: Studies on "instant cascara" describe a beverage made from dried coffee cherry. It is not cascara sagrada bark (p38201895).
Sustainability and conservation: Not checked.

Traditional use and history history, not clinical proof

Tradition or era	Documented use	Source
Naming, 1805 to 1877	The EU assessment says the dried, aged bark is historically called "cascara sagrada" (Spanish for "sacred bark"). It says a cascara, probably Rhamnus californica, was known to early Mexican and Spanish priests of California; Rhamnus purshiana was described in 1805 and its bark was introduced into medicine in 1877 by Dr J. H. Bundy.	s-ema-ar-cascara-2020
Late 19th century physicians	An 1884 British Medical Journal article reports 305 cases of habitual and temporary constipation treated with cascara sagrada. Only the title is available in PubMed; the content was not read.	p20750858
Europe from about 1880 and pharmacopoeias	The EU report says use as a laxative is known in Europe from 1880, and that the British Pharmaceutical Codex (1911), Hagers Handbuch (1927), Martindale (1967) and the US dispensatory (Remington and Wood, 1918, "vegetable cathartic") record it.	s-ema-ar-cascara-2020
Other old uses	The Eclectic Materia Medica (1922) used cascara for "sick headache" from a sluggish bowel, stomach and duodenal catarrh, and jaundice; Clarke (1900-1902) for rheumatic complaints; Martindale (1967) as a bitter stomach tonic in small doses before meals; Dragendorff (1967) noted fresh bark is emetic and the dried bark laxative, and mentioned external use for scabies. All are as summarised by the EU report.	s-ema-ar-cascara-2020
Modern monographs	German Commission E (1993), ESCOP (1999) and the WHO (2002) published monographs on cascara bark, and German authorities started a pharmacovigilance action on anthranoid laxatives in June 1996 (all as listed in the EU report; the originals were not read). The EU herbal monograph dates from 7 September 2007 and was revised on 6 May 2020.	s-ema-hmpc-cascara-2020
US regulation, 2002	The FDA final rule of 9 May 2002 said aloe and cascara sagrada as stimulant laxative ingredients in OTC drug products are not generally recognized as safe and effective, or are misbranded (abstract read only).	p12001972
Indigenous and other early use (NOT verified)	Statements that Indigenous peoples of the Pacific coast used the bark before European contact were not found in the sources read, and are not claimed here.	s-ema-ar-cascara-2020

Traditional use shows how a plant was used. It does not show that a supplement works or is safe today.

What is inside, and how it may work

What the plant contains and how those compounds act in cells and animals. Laboratory and animal mechanisms are not proven effects in people.

Main compounds

Compound	Family	Where it is concentrated	Activity studied	Level of evidence
Cascaroside A PubChem 442727	anthrone C- and O-glycoside (hydroxyanthracene family)	Bark The EU and European Pharmacopoeia standard is at least 8.0% hydroxyanthracene glycosides (expressed as cascaroside A), at least 60% of them cascarosides.	Main laxative prodrug. Cascarosides A and B are the 8-O-beta-D-glucosides of 10-desoxyglucosyl aloe-emodin anthrone; gut bacteria release the active anthrone. ^{9 10 32}	Authoritative guidance
Cascaroside B PubChem 14605093	anthrone C- and O-glycoside (diastereomer of cascaroside A)	Bark	Laxative prodrug, mirror-image form of cascaroside A. ^{9 10 32}	Authoritative guidance
Cascarosides C and D PubChem 46173832	chrysaloin glycosides (chrysophanol anthrone O-glucosides)	Bark Cascarosides together are 60-70% of the total hydroxyanthracene complex in dried bark (HagerRom 2003 as cited in the EU report).	Laxative prodrugs. PubChem CIDs: cascaroside C 46173832, cascaroside D 46173831. ^{10 32}	Authoritative guidance
Cascarosides E and F	emodin anthrone O-glucosides	Bark	Laxative prodrugs listed in the EU report; no PubChem CID was verified here. ¹⁰	Authoritative guidance
Aloin A and B (barbaloin) and chrysaloins PubChem 9866696	anthrone C-glycosides	Bark 10-30% of the total hydroxyanthracene complex (aloins A and B with chrysaloins A and B), per the EU report. Chrysaloin PubChem CID 15582573 (C21H22O8).	Minor laxative prodrugs; also found in aloe. ^{10 32}	Authoritative guidance
10-Hydroxycascarosides A and B (oxanthrones)	oxanthrone glycosides	Aged bark	Oxidised forms made when anthrones are stored; a chemistry paper says some of these laxative plants must be stored at least a year to avoid severe diarrhoea and dehydration. ⁶	Laboratory research
Emodin anthrone (emodin-9-anthrone) PubChem 122635	anthrone (active metabolite)	Made in the large bowel	The EU says this is the main active metabolite made by large-bowel bacteria from cascarosides; it stimulates bowel movement and changes water and salt transport. ^{9 10 32}	Authoritative guidance
Emodin PubChem 3220	anthraquinone aglycone	Bark Measured in bark extracts together with aloe-emodin and cascarosides A and B (p35562848); numbers not in the abstract.	Genotoxic in some lab tests; in a 2-year NTP study equivocal evidence of cancer in female rats and male mice; the EU cites its effects on oestrus cycle and kidneys in mice. ^{35 29 9 32}	Animal research
Aloe-emodin, chrysophanol, physcion PubChem 10207	anthraquinone aglycones	Bark Part of the 10-20% mix of O-glycosides and their aglycones (EU report). PubChem CIDs: chrysophanol 10208, physcion 10639.	Aloe-emodin is named by EFSA as genotoxic in the body; the EU cites aloe-emodin and emodin as the reason pregnancy is contraindicated. ^{10 8 32}	Authoritative guidance
Rhein PubChem 10168	anthraquinone (metabolite)	Made in the body	Found in urine of two volunteers after powdered cascara extract although it was not in the extract; the EU says active metabolites such as rhein pass in small amounts into breast milk. ^{48 9 32}	Human data
Bicascarosides (dimers)	bianthraquinone glycosides	Fluid extracts Up to 20% of total anthracene glycosides in fluid extracts can be dimerised.	No laxative activity; absorbed in the gut and excreted very slowly. ⁵⁰	Laboratory research

Mechanisms, receptors and pathways

Target or pathway	Gene or receptor	What was found	Level
Activation in the large bowel	Gut bacteria and their glycosidase enzymes	Cascarosides are largely not split by human digestive enzymes in the upper gut. Bacteria in the large bowel convert them mainly to emodin-9-anthrone. Cascarosides were not metabolised by germ-free rat caecal extract (lab). ^{9 10 49}	Authoritative guidance
Faster movement of the large bowel	Colon motility	The EU names stimulation of motility and faster colonic transit as the first mechanism. In conscious dogs, a standardised cascara extract placed in the colon caused a bowel movement at 60 mg/kg, and cascara did not change overall colonic spike activity at 10-60 mg/kg (animal). ^{9 5}	Animal research
Water and salt transport in the colon	Epithelial sodium and chloride movement, tight junctions	The EU names a second mechanism: less absorption of water and electrolytes (Na+, Cl-) and a leakier lining with more secretion of water and electrolytes into the colon. The movement happens after a delay of 8-12 hours. ^{9 10}	Authoritative guidance
Nitric oxide pathway	Nitric oxide synthase (constitutive and inducible)	In rats, cascara (800 mg/kg) raised constitutive nitric oxide synthase activity in the colon and was linked to induction of the inducible form (12% of the total); blocking nitric oxide synthase with L-NAME cut diarrhoea and fluid secretion, and dexamethasone reduced cascara diarrhoea (animal). ^{21 20}	Animal research
Prostaglandin E	Prostaglandin E synthesis in the gut	In rats, cascara did not clearly raise gut prostaglandin E on its own, but did raise it in the colon after indomethacin pre-treatment (Cohen 1982 as described by the EU; animal). The authors suggested contact laxatives may act partly through prostaglandins. ¹⁰	Animal research
Gallbladder contraction	Not known	In healthy volunteers, 54 mg of cascaroside A in a fluid extract caused significant gallbladder contraction (human, small study, second-hand). ¹²	Human data
Cell damage and cell death by anthraquinones	Apoptosis proteins (not named in the abstract)	Cascarosides carrying sugar groups were less toxic than sugar-free anthraquinones in three human cell lines; a plant-cell test found chromosome damage with bark extracts (lab). ^{7 43}	Laboratory research
Virus inactivation	Enveloped viruses (herpes simplex virus type 1)	Hot glycerine extract of Rhamnus purshiana inactivated herpes simplex virus type 1 in the dish; the active parts were anthraquinones (lab, second-hand). ⁴⁴	Laboratory research

Absorption, metabolism and elimination

Absorption: The beta-O-linked glycosides are not split by human digestive enzymes and are not absorbed to a large extent in the upper gut. Bacteria in the large bowel turn them into the active emodin-9-anthrone. How much emodin-9-anthrone is absorbed is not known; for senna, less than 10% of a related compound was absorbed in animals (EU monograph). A review argues that anthrone C-glycosides such as those in cascara are absorbed much less than anthraquinones.
Distribution: Active metabolites such as rhein pass in small amounts into breast milk. Animal experiments show low placental passage of rhein (from other hydroxyanthracene laxatives). Radiolabel animal work shows tissue clearance except in the kidneys, which keep anthranoid equivalents.
Metabolism: Absorbed anthraquinone aglycones become glucuronides and sulfates. Rhein and traces of chrysophanol were found in the urine of two volunteers after 60 or 100 mg of powdered cascara extract, although rhein was not in the extract, suggesting the body converts other compounds into it.
Elimination: Metabolites appear in urine and bile. Urine can turn yellow or red-brown. Bicascarosides (dimers) in fluid extracts are excreted very slowly.
Bioavailability: Low for the glycosides; the laxative effect comes from compounds made inside the large bowel, with a delay of 8-12 hours before a bowel movement. The EU assessment says there are no pharmacokinetic data for cascara preparations as such and limited data otherwise.

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Isolated compounds versus whole extracts

Cascara products range from the dried bark (as tea) to standardised extracts and tablets, and in the past to combination laxatives. A 2018 study found that cascarosides carrying sugars were less toxic to cells than sugar-free anthraquinones, and suggested enriching cascara extracts in cascarosides. Fluid extracts can lose part of their active glycosides as inactive dimers during storage. Isolated emodin has been tested for cancer in animals, but bark has not been tested the same way, and the EU treats the cascara carcinogenicity question as unresolved.

Nutritional composition

Cascara bark is a medicine, not a food, so no nutrient table applies.

8benefits and uses looked at

50studies and sources checked

Not enough evidencebest evidence rating found

2lab markers tracked in trials

7 not enough evidence1 evidence against

What was looked at

The 8 benefits and uses checked for Cascara Sagrada, each with how strong the evidence is. Tap one to open it.

Occasional constipation in adults: short-term reliefNot enough evidence
Constipation in older peopleNot enough evidence
Bowel cleaning before a colonoscopy (cascara in a combination product)Not enough evidence
Constipation in childrenNot enough evidence
Gallbladder emptying (healthy volunteers)Not enough evidence
Detox, "colon cleanse" and weight-loss useEvidence against
Other old uses: stomach tonic, headache from a sluggish bowel, jaundice, rheumatic complaints, scabiesNot enough evidence
Killing viruses in the lab (herpes simplex)Not enough evidence

Lab markers tracked in the studies

Bowel cleansing score at colonoscopyGallbladder volume after dosing

What is Cascara Sagrada good for?

The main proposed uses and how strong the human evidence is for each. No use reaches even 'low': 'insufficient' means there are no usable controlled trials of cascara itself, and 'against' means the evidence points away from the use.

Occasional constipation in adults: short-term reliefNot enough evidenceThe EU accepts cascara for short-term occasional constipation, but its own report found no controlled clinical study of cascara bark alone. The acceptance rests on long use, expert opinion and trials of related laxatives such as senna. A laxative effect after about 8 to 12 hours is expected from how the compounds work. Constipation in older peopleNot enough evidenceA 1997 review of laxatives in people aged 55 and over included trials that used cascara, but the results part of the abstract is cut off, so what it found for cascara could not be read. Bowel cleaning before a colonoscopy (cascara in a combination product)Not enough evidenceIn a 1991 trial of 271 patients, a cascara-and-saline laxative plus a smaller amount of the standard wash-out solution cleaned the bowel about as well as other plans (poor preparation in 12%, against 8% and 14%). It was a combination, so cascara's own effect is unknown. Constipation in childrenNot enough evidenceNo studies exist. The EU says not to use cascara under age 12, and a 2021 review noted significant safety concerns for cascara in children. Gallbladder emptying (healthy volunteers)Not enough evidenceIn one small study described in the EU report, a higher amount of cascara extract made the gallbladders of healthy volunteers contract. It is a body effect, not a proven benefit, and only a second-hand description was read. Detox, "colon cleanse" and weight lossEvidence againstNo study shows that cascara helps weight loss or removes toxins. A 2023 commentary warns of toxicity and bowel-lining damage with long-term use of aggressive laxative herbs such as cascara, and the EU limits use to one week. Other old uses: stomach tonic, headache, jaundice, rheumatic complaintsNot enough evidenceOld books list these uses, but there are no modern studies, and cascara has been linked to liver injury, so it is not a remedy for jaundice. Killing herpes virus in the labNot enough evidenceIn a 1991 test-tube study an extract from the bark inactivated herpes simplex virus. There are no animal or human studies, so it is not a treatment.

Benefits, one by one

Each card is a research question, not a promise. Tap a goal to filter. Open a card to see the studies, doses and limits.

Occasional constipation in adults: short-term relief

Not enough evidence

Cascara bark has been used as a laxative for well over a century, and the EU accepts it for short-term relief of occasional constipation. But no controlled trial of cascara alone was found, so the evidence that it works rests on long use, expert opinion and its likeness to better-studied laxatives such as senna.

6 studiesDried, aged bark as tea or in capsules, tablets, liquid extracts. The…

Studies, doses and limits

What the trials found

The EU assessment report (2020) says there are no controlled clinical studies of cascara bark alone, no dose-finding studies and no clinical safety studies. It says the only clinical investigations of cascara as a laxative are of combination products. Its conclusion that cascara works is taken from long use, expert opinion and trials of related laxatives, mainly senna. An animal study in dogs found that a standardised cascara extract placed in the colon caused a bowel movement at 60 mg/kg. Reviews of constipation treatments list cascara among the products covered but the abstracts read give no result for it.

Results

No result from a controlled human trial of cascara alone could be found. The EU calls the use "well-established" because of long use and approved products, not because of trial data.

Why this rating

No controlled trial of cascara alone exists according to the EU assessment (2020). Accepting the use depends on experience and on trials of related laxatives, which may not carry over fully.

Form and dose studied

Dried, aged bark as tea or in capsules, tablets, liquid extracts. The EU standard is based on the amount of hydroxyanthracene compounds (cascarosides), not on the weight of bark. Amounts are not discussed on this page; ask a doctor or pharmacist.

Who was studied

Adults and teenagers over 12 with occasional constipation, per the EU. Not for children under 12, pregnancy or breastfeeding.

Limits

Evidence is mainly authority and tradition. The EU limits use to 1 week because of the safety questions. Nothing is known about long-term benefit.

Why researchers looked

Constipation is very common, and cascara bark is one of the oldest plant laxatives sold in Europe and North America.

Traditional use

The EU assessment says the dried, aged bark was brought into medicine in 1877 and used as a laxative in Europe from about 1880. It appears in the British Pharmaceutical Codex (1911), the US Dispensatory (1918), the German Commission E (1993), an ESCOP monograph (1999) and a WHO monograph (2002), as listed in the EU report.

Proposed mechanism Authoritative guidance

The cascarosides in the bark pass through the stomach and small bowel mostly unchanged. Bacteria in the large bowel turn them into an active form (mainly emodin anthrone). This speeds the movement of the bowel and keeps water and salts in the bowel instead of letting them be absorbed. A bowel movement follows after about 8 to 12 hours.

A proposed mechanism does not show that the effect happens in people.

Short-term use only (EU: not more than 1 week). Cramps and loose stools are likely if the amount is too large. See the Safety tab.

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Constipation in older people

Not enough evidence

A 1997 review of laxatives in people aged 55 and over included trials that used cascara, but the part of the abstract that gives the results was cut off, so what it found for cascara could not be read.

3 studiesNot described in the abstract.

Studies, doses and limits

What the trials found

The 1997 UK review (Petticrew) covered ten placebo-controlled trials (367 patients, mean age about 74, mostly in nursing homes or hospitals) and ten head-to-head trials. Cascara is named among the main laxatives tested. The abstract is cut off before the results, so the finding for cascara cannot be stated. A 1995 Italian hospital survey found anthranoid laxatives (senna, cascara, rhein, aloe) were used by 1.9% of patients in hospital, behind lactulose, but that is about use, not benefit.

Results

Not readable for cascara.

Why this rating

The cascara result of the review could not be read and the trials are old and were done in institutions.

Form and dose studied

Not described in the abstract.

Who was studied

People aged 55 and over with chronic constipation, mostly in institutions.

Limits

Abstract cut off; 1990s or older trials; combined with other laxatives in the review.

Why researchers looked

Constipation is common in older people, especially in care homes, and stimulant laxatives are widely used there.

Traditional use

The EU report notes only that pads should be changed more often in incontinent adults using these laxatives.

Proposed mechanism Authoritative guidance

Same as for other adults: the active forms are made in the large bowel and speed the bowel while keeping water in it.

A proposed mechanism does not show that the effect happens in people.

The EU says to check potassium in the elderly after any overuse, and to take extra care if heart medicines or water pills are used.

^{39 36 10}

Bowel cleaning before a colonoscopy (cascara in a combination product)

Not enough evidence

In a Norwegian trial, a cascara-and-saline laxative plus a smaller amount of the usual wash-out solution cleaned the bowel about as well as the full wash-out solution or a senna regimen. Because it was a combination, this says little about cascara by itself.

2 studiesCascara-Salax (PicoSalax) combination product plus Golytely. Not a pl…

Studies, doses and limits

What the trials found

A randomised trial of 271 colonoscopy patients compared three plans: (I) a diet plus senna laxative and a saline enema, (II) 4 litres of polyethylene glycol (Golytely), and (III) a cascara-and-saline laxative combination (PicoSalax) plus a smaller amount of Golytely. Patients rated taste and convenience the same. Poor preparation scores were 14%, 8% and 12% for I, II and III. Outpatients had a significantly cleaner bowel on Golytely than on the senna plan (p = 0.02); the cascara plan did not differ from either. The authors concluded there were no clinically important differences. The EU report says the cascara combination was inferior to a polyethylene glycol and salts solution in bowel-cleansing investigations and that the effect of cascara alone cannot be assessed.

Results

Similar cleanliness for the three plans; no way to tell what cascara itself added.

Effect sizes as reported

Inadequate preparation: 14% (senna plan), 8% (Golytely), 12% (cascara combination). No P value for the cascara comparisons beyond "no difference".

Why this rating

One 1991 trial of a combination product; cascara cannot be separated from the other ingredients, and the EU report calls the cascara combination inferior to the standard solution.

Form and dose studied

Cascara-Salax (PicoSalax) combination product plus Golytely. Not a plain bark product.

Who was studied

Adults having colonoscopy in Norway, in-patients and out-patients.

Limits

Old trial, combination product, product no longer comparable with today's preparations.

Why researchers looked

A clean bowel is needed to see the lining at a colonoscopy, and stimulant laxatives are sometimes used with or instead of large-volume wash-out drinks.

Traditional use

The trial below tested a cascara combination product from the early 1990s.

Proposed mechanism Pharmacological theory

Cascara adds a stimulating effect on the large bowel, and the saline laxative and wash-out solution add water and salts that flush the bowel.

A proposed mechanism does not show that the effect happens in people.

Bowel preparation should be directed by the clinic that is doing the exam. Do not use cascara alone for this purpose.

^{3 10}

Constipation in children

Not enough evidence

There are no studies of cascara in constipated children, and the EU says it must not be used under age 12. A 2021 review found significant safety concerns for cascara and insufficient evidence.

3 studiesNot applicable.

Studies, doses and limits

What the trials found

The EU assessment says there are no systematic clinical data on cascara as a laxative in children and no data on its use in children at all. A 2021 review of non-drug approaches for childhood constipation said that, other than senna, studies of botanicals showed significant safety concerns (in particular Aloe vera with aloin and Cascara sagrada) and insufficient evidence.

Results

No benefit has been shown; safety concerns raised.

Why this rating

No trials; the only statements are authority and review opinions, and they raise safety concerns.

Who was studied

Children: contraindicated under 12 in the EU.

Limits

No data.

Why researchers looked

Parents sometimes look for plant laxatives for children with constipation.

Traditional use

The EU report lists a German tea product for people from age 10 on the market; the current EU monograph contraindicates use under 12.

Proposed mechanism Authoritative guidance

Same as in adults.

A proposed mechanism does not show that the effect happens in people.

Do not give cascara to children under 12. Ask a paediatrician about safer ways to treat constipation.

^{9 10 40}

Gallbladder emptying (healthy volunteers)

Not enough evidence

One small trial in healthy volunteers found that a higher dose of cascara fluid extract made the gallbladder contract. This is a physical effect, not a proven benefit for any condition.

2 studiesCascara fluid extract in the study (not a consumer product).

Studies, doses and limits

What the trials found

In the Foert 1994 study, as described in the EU assessment report, 20 healthy volunteers took 2 ml and 20 took 3 ml of a cascara fluid extract (36 mg or 54 mg cascaroside A) against placebo, and gallbladder volume was measured by ultrasound for 120 minutes. The 54 mg dose caused significant gallbladder contraction, more quickly but less strongly than a test meal. Only this description was read, not the original paper.

Results

Higher dose: gallbladder contracted. Result at the lower dose not given.

Effect sizes as reported

No numbers beyond the dose are available.

Why this rating

One small study in healthy people, read second-hand, and no clinical outcome.

Form and dose studied

Cascara fluid extract in the study (not a consumer product).

Who was studied

Healthy volunteers with normal gallbladder emptying.

Limits

Second-hand description; no patients; unknown meaning.

Why researchers looked

Older texts used cascara for "liver sluggishness" and jaundice, which prompted a test of its effect on the gallbladder.

Traditional use

The EU report says the Eclectic Materia Medica (1922) described cascara in gastric and duodenal catarrh, with jaundice, and in diarrhoea with "hepatic torpor".

Proposed mechanism Preliminary mechanism

Not known; the EU report gives no explanation.

A proposed mechanism does not show that the effect happens in people.

Do not take cascara for gallbladder or liver problems. Liver injury is a reported risk (see Safety).

^{12 10}

Detox, "colon cleanse" and weight-loss use

Evidence against

No study shows that cascara helps weight loss or removes toxins. A 2023 review warns that long use of aggressive laxative herbs such as cascara can damage the bowel, and the EU limits use to one week.

3 studiesNot applicable.

Studies, doses and limits

What the trials found

No trial of cascara for weight loss or detox was found. A 2018 lab study notes that anthraquinones are used in non-prescription supplements for weight loss and that long-term side effects remain relevant. A 2023 commentary on pseudoscientific detox approaches discusses toxicity and damage to the bowel lining with long-term use of aggressive laxative herbs such as Cascara sagrada, rhubarb and senna; its authors work for a supplement company and a diagnostic lab.

Results

No benefit shown; harm warned about.

Why this rating

No evidence of benefit and authoritative warnings against long or repeated use; rated against for this purpose by the compiler, not by a formal grade.

Who was studied

Not studied.

Limits

The 2023 piece is an opinion paper; no trial exists to test the claim.

Why researchers looked

Stimulant laxatives are sold in some cleanse and weight-loss products.

Traditional use

Not a traditional use in the sources read.

Proposed mechanism Pharmacological theory

A laxative empties the bowel and loses water, which can lower the scale weight for a short time; it does not remove body fat.

A proposed mechanism does not show that the effect happens in people.

Repeated laxative use can cause low potassium, dehydration, dependence and other problems. Talk to a doctor if weight or eating worries are leading to laxative use.

^{37 7 9}

Other old uses: stomach tonic, headache from a sluggish bowel, jaundice, rheumatic complaints, scabies

Not enough evidence

Older books describe other uses of cascara, but none has been tested in modern studies.

1 studiesNot applicable.

Studies, doses and limits

What the trials found

No clinical studies of these uses were found.

Results

No data.

Why this rating

Only historical statements in old books, as summarised in the EU report.

Who was studied

Not studied.

Limits

Not verified in the original books; second-hand from the EU report.

Why researchers looked

These are historical uses listed in textbooks of the 19th and 20th centuries.

Traditional use

The EU report lists: use as a bitter stomach tonic in small doses before meals (Martindale 1967); "sick headache" from a sluggish bowel, stomach and duodenal catarrh, and jaundice (Eclectic Materia Medica 1922); rheumatic complaints (Clarke, 1900-1902); and external use for scabies (Dragendorff 1967, preparation not specified).

Proposed mechanism Pharmacological theory

No mechanism is given for these uses.

A proposed mechanism does not show that the effect happens in people.

Do not use cascara for jaundice or liver complaints: it has been linked to liver injury.

¹⁰

Killing viruses in the lab (herpes simplex)

Not enough evidence

In a test tube, hot glycerine extracts of several plants including cascara inactivated herpes simplex virus. This has not been tested in animals or people.

2 studiesHot glycerine extract in the lab.

Studies, doses and limits

What the trials found

No human or animal data. The only finding is a 1991 test-tube study, read second-hand through the EU assessment report.

Results

All plant extracts inactivated herpes simplex virus type 1 in the dish.

Why this rating

Test-tube result only, read second-hand.

Form and dose studied

Hot glycerine extract in the lab.

Limits

Cannot be applied to people; the EU report itself notes that anthraquinone glycosides should be ineffective.

Why researchers looked

Anthraquinones from several plants are known to disrupt the coat of some viruses.

Proposed mechanism Laboratory research

The EU report says the active compounds were identified as anthraquinones, and that in related work with aloe-emodin, electron microscopy showed partly disrupted virus coats.

A proposed mechanism does not show that the effect happens in people.

Not a treatment for any infection.

^{44 10}

Connections to the rest of health

How Cascara Sagrada connects to the rest of our health knowledge graph. Every link says what kind of connection it is. A safety link (for example to the liver) is a warning, not a benefit. A study that merely mentions a topic never creates a benefit link.

Explore every connection: goals, body systems, organs, symptoms, genes

Kind of connection Connected to Search

A. Wellness goals

Connected to	Kind of connection	Evidence status	Context	Studies
Digestive support	Traditional use	Not enough evidence	Short-term relief of occasional constipation. Occasional constipation in adults: short-term relief: Cascara bark has been used as a laxative for well over a century, and the EU accepts it for short-term relief of occasional constipation. But no controlled trial of cascara alone was found, so the evidence that it works rests on long use, expert opinion and its likeness to better-studied laxatives such as senna. Preparation or compound: Cascara bark	^{9 10 5 30 4 1 39 36}
Gut Health	Traditional use	Not enough evidence	Occasional constipation in adults: short-term relief: Cascara bark has been used as a laxative for well over a century, and the EU accepts it for short-term relief of occasional constipation. But no controlled trial of cascara alone was found, so the evidence that it works rests on long use, expert opinion and its likeness to better-studied laxatives such as senna.	^{9 10 5 30 4 1}
Digestive Support	Potential benefit	Not enough evidence	Bowel cleaning before a colonoscopy (cascara in a combination product): In a Norwegian trial, a cascara-and-saline laxative plus a smaller amount of the usual wash-out solution cleaned the bowel about as well as the full wash-out solution or a senna regimen. Because it was a combination, this says little about cascara by itself. Detox, "colon cleanse" and weight-loss use: No study shows that cascara helps weight loss or removes toxins. A 2023 review warns that long use of aggressive laxative herbs such as cascara can damage the bowel, and the EU limits use to one week.	^{3 10 37 7 9}
Digestive Support	Contraindication	Not enough evidence	Constipation in children: There are no studies of cascara in constipated children, and the EU says it must not be used under age 12. A 2021 review found significant safety concerns for cascara and insufficient evidence.	^{9 10 40}
Digestive Support	Biological association	Not enough evidence	Gallbladder emptying (healthy volunteers): One small trial in healthy volunteers found that a higher dose of cascara fluid extract made the gallbladder contract. This is a physical effect, not a proven benefit for any condition.	^{12 10}
Weight Management	Potential benefit	Evidence against	Detox, "colon cleanse" and weight-loss use: No study shows that cascara helps weight loss or removes toxins. A 2023 review warns that long use of aggressive laxative herbs such as cascara can damage the bowel, and the EU limits use to one week.	^{37 7 9}
Immune Support	Preliminary mechanism	Not enough evidence	Killing viruses in the lab (herpes simplex): In a test tube, hot glycerine extracts of several plants including cascara inactivated herpes simplex virus. This has not been tested in animals or people.	^{44 10}

B. Body systems

Connected to	Kind of connection	Evidence status	Context	Studies
Digestive system	Traditional use	Not enough evidence	Stimulant laxative; long use and EU well-established use for short-term constipation, but no controlled trial of cascara alone. Preparation or compound: Cascara bark, cascarosides	^{9 10}
Cardiovascular system	Drug or supplement interaction	Authoritative guidance	Potassium loss can upset heart rhythm and strengthen digoxin. Preparation or compound: Cascara bark with digoxin, diuretics, steroids or liquorice	^{9 10}
Reproductive system	Contraindication	Authoritative guidance	Not for pregnancy or breastfeeding. Preparation or compound: Cascara bark	^{9 10 24}
Immune system	Adverse effect or risk	Case report	Hives and rash are listed; one pharmacy worker developed occupational asthma and rhinitis. Preparation or compound: Cascara powder	^{9 17}
Digestive System	Biological association	Not enough evidence	Studied for: Occasional constipation in adults: short-term relief Studied for: Constipation in older people	^{9 10 5 30 4 1 39 36 3 40 12 37 7}
Immune System	Biological association	Not enough evidence	Studied for: Killing viruses in the lab (herpes simplex)	^{44 10}

C. Body parts and organs

Connected to	Kind of connection	Evidence status	Context	Studies
Gut	Adverse effect or risk	Authoritative guidance	Cramps and loose stools; dark colon lining (melanosis coli) with long use; dependence is a precaution. Preparation or compound: Cascara bark	^{9 10 45}
Liver	Adverse effect or risk	Case report	Case reports and LiverTox note liver injury, mainly at high doses or long use; no frequency known. Preparation or compound: Cascara bark products	^{26 33 22 34 16}
Kidneys	Adverse effect or risk	Authoritative guidance	Protein and blood in urine with long use (EU); kidney changes in rats; electrolyte imbalance in kidney disease. Preparation or compound: Cascara bark; anthranoid laxatives	^{9 41}

I. Biomarkers

Connected to	Kind of connection	Evidence status	Context	Studies
Bowel cleansing score at colonoscopy	Biological association	Not enough evidence	Measured in trials: no-change. A lab change is not the same as a health benefit.	³
Gallbladder volume after dosing	Biological association	Not enough evidence	Measured in trials: lowered. A lab change is not the same as a health benefit.	¹²

K. Biological pathways

Connected to	Kind of connection	Evidence status	Context	Studies
Nitric oxide synthesis in the colon	Preliminary mechanism	Animal	Cascara raised nitric oxide synthase activity in rat colon; blocking it cut cascara-induced diarrhoea.	^{21 20}
Prostaglandin E in the gut	Preliminary mechanism	Animal	Prostaglandin changes after contact laxatives in rats; cascara effect small without indomethacin.	¹⁰
Bacterial activation of cascarosides in the large bowel	Preliminary mechanism	Authoritative guidance	Gut bacteria convert cascarosides to emodin anthrone; without bacteria (germ-free rats) cascarosides were not metabolised.	^{9 10}
Apoptosis (programmed cell death)	Preliminary mechanism	In vitro	Anthraquinones induced cell death in cell lines; a 2025 clinical reference says cell death in the colon lining is the route to melanosis coli.	^{7 45}

L. Active compounds

Connected to	Kind of connection	Evidence status	Context	Studies
Cascaroside A	Biological association	Authoritative guidance	Main laxative prodrug. Cascarosides A and B are the 8-O-beta-D-glucosides of 10-desoxyglucosyl aloe-emodin anthrone; gut bacteria release the active anthrone. Preparation or compound: Bark	^{9 10 32}
Cascaroside B	Biological association	Authoritative guidance	Laxative prodrug, mirror-image form of cascaroside A. Preparation or compound: Bark	^{9 10 32}
Cascarosides C and D	Biological association	Authoritative guidance	Laxative prodrugs. PubChem CIDs: cascaroside C 46173832, cascaroside D 46173831. Preparation or compound: Bark	^{10 32}
Cascarosides E and F	Biological association	Authoritative guidance	Laxative prodrugs listed in the EU report; no PubChem CID was verified here. Preparation or compound: Bark	¹⁰
Aloin A and B (barbaloin) and chrysaloins	Biological association	Authoritative guidance	Minor laxative prodrugs; also found in aloe. Preparation or compound: Bark	^{10 32}
10-Hydroxycascarosides A and B (oxanthrones)	Biological association	In vitro	Oxidised forms made when anthrones are stored; a chemistry paper says some of these laxative plants must be stored at least a year to avoid severe diarrhoea and dehydration. Preparation or compound: Aged bark	⁶
Emodin anthrone (emodin-9-anthrone)	Biological association	Authoritative guidance	The EU says this is the main active metabolite made by large-bowel bacteria from cascarosides; it stimulates bowel movement and changes water and salt transport. Preparation or compound: Made in the large bowel	^{9 10 32}
Emodin	Biological association	Animal	Genotoxic in some lab tests; in a 2-year NTP study equivocal evidence of cancer in female rats and male mice; the EU cites its effects on oestrus cycle and kidneys in mice. Preparation or compound: Bark	^{35 29 9 32}
Aloe-emodin, chrysophanol, physcion	Biological association	Authoritative guidance	Aloe-emodin is named by EFSA as genotoxic in the body; the EU cites aloe-emodin and emodin as the reason pregnancy is contraindicated. Preparation or compound: Bark	^{10 8 32}
Rhein	Biological association	Human	Found in urine of two volunteers after powdered cascara extract although it was not in the extract; the EU says active metabolites such as rhein pass in small amounts into breast milk. Preparation or compound: Made in the body	^{48 9 32}
Bicascarosides (dimers)	Biological association	In vitro	No laxative activity; absorbed in the gut and excreted very slowly. Preparation or compound: Fluid extracts	⁵⁰

Each connection is stored with the ingredient, the connected record, the kind of connection, the evidence status, the supporting studies, the preparation or compound involved, and a review date (last reviewed October 25, 2026).

Evidence at a glance: what changed in 2 lab markers

Tap a number to show only those markers. Counts are markers, not people.

Other11

The evidence

The research centre for Cascara Sagrada. Every record here was checked against PubMed or the publisher's page; we never list a study we have not verified.

Evidence by outcome

Occasional constipation in adults: short-term relief 6 studies Not enough evidence Constipation in older people 3 studies Not enough evidence Bowel cleaning before a colonoscopy (cascara in a combination product) 2 studies · 271 people in trials Not enough evidence Constipation in children 3 studies Not enough evidence Gallbladder emptying (healthy volunteers) 2 studies Not enough evidence Detox, "colon cleanse" and weight-loss use 3 studies Evidence against Other old uses: stomach tonic, headache from a sluggish bowel, jaundice, rheumatic complaints, scabies 1 study Not enough evidence Killing viruses in the lab (herpes simplex) 2 studies Not enough evidence

Bars show how many studies we found for each outcome, not how well it works. People are added up across trials only (reviews are not added, to avoid double counting).

How we rate evidence

High certainty

Several well-run trials or reviews agree; further research is unlikely to change the picture much.

Moderate certainty

Good trials point the same way, but some doubt remains.

Low certainty

Small, short or inconsistent trials. The finding could change with better research.

Very low certainty

Very little or very weak human data. Treat as a possibility only.

Mixed findings

Trials or reviews disagree with each other.

Not enough evidence

Not enough human research to say either way.

Evidence against

Good research found no benefit, or found harm.

We take the reviewers' own risk-of-bias and GRADE statements where they exist, and otherwise judge from study size, design, consistency, directness and whether a product matches what is sold. Many publications do not make evidence high. Method note: We searched PubMed, read the EU herbal monograph and the EU assessment report on cascara bark in full, the abstracts of the LiverTox, LactMed and FDA records, and checked plant names in GBIF and NCBI taxonomy and compounds in PubChem. Only abstracts were read for nearly all studies, and a few older studies were read only as described in the EU report. Some sources were not verified: the full LiverTox chapter, the FDA rule beyond its abstract, the full EFSA opinion, and the Commission E, ESCOP, WHO and NCCIH texts. Certainty ratings are the compiler's own reading, not formal grades. No study is cited that we could not verify.

Study library: every study we checked 50

Design Research type Plant part Year from Search

Study	Design	People	Product, dose, length	Result
Akram 2022 Herbal Medicine for the Management of Laxative Activity. Curr Pharm Biotechnol · PMID 34387161 · DOI	Narrative review	Review of plants with laxative activity	Many plants, including Cascara sagrada (Rhamnaceae) unspecified - - · vs -	Lists Cascara sagrada among plants with laxative activity and says further well-designed clinical studies are needed to prove and improve the efficacy of herbal medicine for constipation. Laxative activity listed; clinical proof called lacking Methods, limits and funding Outcomes: Laxative activity in lab and animal models Limitations: Mostly lab and animal models; abstract only. Read: abstract
Borrelli 2001 Effect of bisacodyl and cascara on growth of aberrant crypt foci and malignant tumors in the rat colon. Life Sci · PMID 11693267 · DOI	Animal research animal	Rats given azoxymethane (a cancer-causing chemical), 10 groups, 13 weeks	Cascara (140 and 420 mg/kg) and bisacodyl (4.3 and 43 mg/kg) bark - - · vs -	Cascara alone did not cause lesions or tumours and did not change the number of azoxymethane-induced lesions or tumours. Bisacodyl at the higher dose increased tumours. The authors found no promoting or initiating activity of a laxative and diarrhoea-causing dose of cascara. No tumour promotion by cascara in this rat study Methods, limits and funding Outcomes: Aberrant crypt foci and colon tumours Limitations: Rat study; limited detail on the cascara preparation (the EMA report says the same); conflicts with the 1996 study. Read: abstract
Børkje 1991 Effectiveness and acceptability of three bowel cleansing regimens. Scand J Gastroenterol · PMID 2011703 · DOI	Controlled trial	271 Colonoscopy patients (271 in all, in- and out-patients) in Norway	Three bowel-cleaning regimens: (I) diet plus senna laxative plus a saline enema (88 people); (II) 4 litres of polyethylene glycol (Golytely) (90 people); (III) a cascara-and-saline laxative combination (Cascara-Salax, PicoSalax) plus a smaller amount of Golytely (the rest, about 93) bark in a combination product - Single preparation for colonoscopy · vs -	No difference in how patients rated taste or convenience. Inadequate preparation scores: 14% (senna regimen), 8% (Golytely) and 12% (cascara combination). Outpatients had a significantly cleaner colon with Golytely than with the senna regimen (p = 0.02); there was no difference between the senna regimen and the cascara combination, or between Golytely and the cascara combination. Outpatients were cleaner than inpatients (p < 0.001). No clinically important difference between the three regimens Methods, limits and funding Outcomes: Cleanliness of the colon, patient views on taste and convenience Limitations: The cascara arm was a combination product with saline laxative and Golytely, so the effect of cascara itself cannot be separated; 1991 products. Read: abstract
Cirillo 2015 Constipation and Botanical Medicines: An Overview. Phytother Res · PMID 26171992 · DOI	Narrative review	Adults with constipation (review)	Botanical laxatives: senna, cascara, frangula, aloe, rhubarb unspecified - - · vs -	The abstract says the authors reviewed cascara among the most common botanical laxatives. It gives no results for cascara. Overview only Methods, limits and funding Outcomes: Overview of botanical laxatives Limitations: Only the abstract was read. Read: abstract
D'Angelo (as cited in EMA/HMPC/909434/2019) 1993 Colonic motility in conscious dogs given cascara extract and related compounds (D'Angelo, 1993, as described in the EMA assessment report) Original not read; described in EMA assessment report · Source	Animal research animal	Conscious dogs	Standardised cascara extract (40% cascarosides A-D) given into the colon, plus aloin and aloe-emodin compounds bark - - · vs -	All compounds at 30-60 mg/kg caused defaecation except the extract, which worked only at 60 mg/kg; the extract and aloin took longer to act than the active forms (they need gut bacteria). Laxative effect in dogs Methods, limits and funding Outcomes: Defaecation and colon spike activity Limitations: Animal study, extract placed directly in the colon; described second-hand. Read: summary-only
Demarque 2017 New cascarosides from Rhamnus purshiana and fragmentation studies of the class by ion trap mass spectrometry. Rapid Commun Mass Spectrom · PMID 28440576 · DOI	Laboratory research in-vitro	Compounds isolated from Rhamnus purshiana bark (mass spectrometry)	Cascarosides A-D (anthrones) and 10-hydroxycascarosides A and B (oxanthrones) bark - - · vs -	Method paper. The introduction says some of these laxative plants must be stored for at least a year so that anthrones are oxidised to oxanthrones, to avoid severe diarrhoea and dehydration. New natural products were identified. Chemistry method; supports the need to age the bark Methods, limits and funding Outcomes: Chemical fragmentation patterns to tell anthrones from oxanthrones Limitations: Chemistry only; the one-year storage statement is background in the abstract, not a finding of the study. Read: abstract
Demarque 2018 Cytotoxicity of Structurally Diverse Anthranoids and Correlation with Mechanism of Action and Side Effects. J Pharm Pharm Sci · PMID 30321134 · DOI	Laboratory research in-vitro	Human and tumour cell lines (NOK-SI, HeLa, T98G)	Cascarosides isolated from Rhamnus purshiana bark extract and the whole extract bark extract - - · vs -	Cascarosides with sugar groups were less toxic to cells than sugar-free anthraquinones. The authors suggest cascara extracts enriched in cascarosides may be better for laxative use. Sugar-bearing cascarosides less toxic in the dish Methods, limits and funding Outcomes: Cell survival and signals of cell death (apoptosis) Limitations: Cell-line study; results cannot be translated into a human risk; exact numbers not in the abstract. Read: abstract
EFSA Panel on Food Additives and Nutrient Sources added to Food (ANS) 2018 Safety of hydroxyanthracene derivatives for use in food (EFSA Journal 2018;16(1):e05090) EFSA Journal · Source	Authoritative guidance	Expert panel review of hydroxyanthracene derivatives in food and supplements	Hydroxyanthracene derivatives (emodin, aloe-emodin, danthron, aloe extracts and related plant extracts) unspecified - - · vs -	Panel said hydroxyanthracene derivatives should be treated as genotoxic and carcinogenic unless specific data show otherwise (rhein given as an example), and could not give a daily intake with no concern. No data on cascara supplements were received, so cascara products were not assessed. Food-safety view on a chemical group; says nothing specific about cascara bark as a medicine. Methods, limits and funding Outcomes: Genotoxicity, carcinogenicity, colorectal cancer data, intake advice Limitations: Read only through a summarised fetch of the PMC page (first part); the full text was not read line by line. Read: summary-only
EMA Committee on Herbal Medicinal Products (HMPC) 2020 European Union herbal monograph on Rhamnus purshiana DC., cortex (Final, Revision 1), EMA/HMPC/726270/2016 European Medicines Agency · Source	Authoritative guidance	Adolescents, adults and elderly (the monograph); children under 12, pregnancy and breastfeeding excluded	Cascara bark (Rhamnus purshiana DC. = Frangula purshiana), standardised bark and preparations bark - - · vs -	Well-established use for short-term occasional constipation; not more than 1 week; contraindicated under 12 years, in pregnancy and breastfeeding, and in bowel blockage and inflammatory bowel disease; warnings on dependence, potassium loss and several medicine interactions. Regulatory view, based on long use and on data from related laxatives (senna, aloe), not on controlled trials of cascara. Methods, limits and funding Outcomes: Well-established use, warnings, contraindications, interactions, undesirable effects, overdose Limitations: Based on experts and on related laxatives; no controlled trials of cascara bark alone (see the assessment report). Read: full-text
EMA Committee on Herbal Medicinal Products (HMPC); rapporteurs W. Knoss 2020 Assessment report on Rhamnus purshiana DC., cortex (Final, Revision 1), EMA/HMPC/909434/2019 European Medicines Agency · Source	Authoritative guidance	Review of market products, history, lab, animal and human data on cascara bark	Cascara bark (Rhamnus purshiana DC. = Frangula purshiana), standardised bark and preparations bark - - · vs -	Finds no controlled clinical studies of cascara bark alone; efficacy rests on long use, expert opinion and related laxatives. Describes one liver case (RUCAM +2, unlikely), one melanosis coli report, urticaria and an occupational allergy. Concludes the benefit/risk is positive only for short-term occasional constipation (maximum 1 week). Authoritative summary of a thin evidence base; carcinogenicity of cascara called unresolved. Methods, limits and funding Outcomes: Documented use, non-clinical data, clinical data, safety, benefit-risk Limitations: Original papers are described, not re-read here; text was read in full (22 pages) but the cited originals (Foert 1994, D'Angelo 1993, Schmidt 1955 and others) were not. Read: full-text
EMA/HMPC/909434/2019 2020 Case reports described in the EMA assessment report (melanosis coli, urticaria, nephritis with a mixed herbal product) European Medicines Agency · Source	Case series	Single patients reported to the German authority and in the literature	Cascara alone or in mixtures bark - - · vs -	Melanosis coli in a 42-year-old woman after 4 years of a cascara-only product; urticaria with a cascara and saline-laxative combination; acute tubulo-interstitial nephritis in a woman who took a 10-herb product (Aloe vera and cascara suspected but causality could not be assessed). Case reports, not rates Methods, limits and funding Outcomes: Melanosis coli, urticaria, kidney inflammation Limitations: Single cases; mixtures; causality unclear. Read: full-text
Foert et al. (as cited in EMA/HMPC/909434/2019) 1994 Cascara fluid extract and gallbladder emptying in healthy volunteers (Foert et al., 1994, as described in the EMA assessment report) Original not read; described in EMA assessment report · Source	Controlled trial	Healthy volunteers with normal gallbladder emptying; 20 people got 2 ml and 20 got 3 ml of extract	Cascara fluid extract, 2 ml (36 mg cascaroside A) or 3 ml (54 mg cascaroside A) bark - - · vs -	The 54 mg cascaroside A dose caused a significant gallbladder contraction, quicker but weaker than after a test meal. The result for the 36 mg dose is not given in the report. Gallbladder contraction at the higher dose Methods, limits and funding Outcomes: Gallbladder volume by ultrasound, compared with placebo Limitations: Described second-hand; no numbers beyond those quoted; the clinical meaning is unknown. Read: summary-only
Fugh-Berman 2000 Herb-drug interactions. Lancet · PMID 10675182 · DOI	Narrative review	Review of herb-drug interactions	Many herbs; anthranoid-containing plants (including senna and cascara) and soluble fibres unspecified - - · vs -	The abstract says anthranoid-containing plants (including senna and cascara) and soluble fibres can decrease the absorption of drugs, and that many herb-drug reports are sketchy and lack analysis of the products. It also says liquorice can potentiate oral and topical corticosteroids. Possible reduced absorption of other medicines; liquorice and steroids interact Methods, limits and funding Outcomes: Drug absorption Limitations: Only the abstract was read; no data for cascara given in it; 1999 review. Read: abstract
GBIF Secretariat 2026 GBIF Backbone Taxonomy: Frangula purshiana (DC.) J.G.Cooper (usageKey 8286637) GBIF API (api.gbif.org), checked 2026-10-25 · Source	Database plant	Plant name	Frangula purshiana whole plant - - · vs -	Accepted species Frangula purshiana (DC.) J.G.Cooper, family Rhamnaceae, order Rosales. Rhamnus purshiana (Pursh) DC. is a synonym. Name check Methods, limits and funding Outcomes: Accepted name, synonyms, family, common names Limitations: Name database only. Read: full-text
Gallego-Barceló 2023 Evaluation of the Effects of Instant Cascara Beverage on the Brain-Gut Axis of Healthy Male and Female Rats. Nutrients · PMID 38201895 · DOI	Animal research animal	Healthy male and female rats	Instant "cascara" beverage made from dried coffee cherry (not cascara sagrada bark) coffee cherry husk - - · vs -	The abstract describes instant cascara as a beverage obtained from dried coffee cherry. It is a different product from cascara sagrada bark and is not used as evidence on this page. Name mix-up example Methods, limits and funding Outcomes: Effects on the brain-gut axis Limitations: Rat study of a coffee-cherry drink; listed only to show that the word cascara is used for another product. Read: abstract
García-Cortés 2008 [Liver injury induced by "natural remedies": an analysis of cases submitted to the Spanish Liver Toxicity Registry]. Rev Esp Enferm Dig · PMID 19159172 · DOI	Case series	13 Spanish Liver Toxicity Registry, 521 cases of drug-induced liver injury (1994-2006), of which 13 were linked to herbal remedies or supplements	Herbal remedies and dietary supplements, including Rhamnus purshianus (2 cases) bark - - · vs -	Camellia sinensis caused 3 of the 13 herbal cases, and Rhamnus purshianus (cascara) and isoflavone products 2 each. Nine of 13 were women (mean age 45); 9 had jaundice; 12 of 13 were hepatocellular injury. Three people were given the product again. 2 of 13 herbal liver injury cases were cascara Methods, limits and funding Outcomes: Type, severity and outcome of liver injury Limitations: Registry counts, not rates among users; Spanish-language paper, abstract only. Read: abstract
Giavina-Bianchi PF Jr 1997 Occupational respiratory allergic disease induced by Passiflora alata and Rhamnus purshiana. Ann Allergy Asthma Immunol · PMID 9396980 · DOI	Case series	One pharmacy worker in Brazil	Cascara sagrada and passion flower dust handled without protection bark - - · vs -	Skin tests, Western blot and a bronchial challenge showed IgE-mediated occupational asthma and rhinitis caused by Passiflora alata and Rhamnus purshiana. Occupational allergy to cascara and passion flower in one worker Methods, limits and funding Outcomes: Allergic asthma and rhinitis Limitations: Single case; handling powder at work, not taking the product. Read: abstract
Hagemann 1998 Gastrointestinal medications and breastfeeding. J Hum Lact · PMID 10205441 · DOI	Narrative review	Breastfeeding women and gastrointestinal medicines	Cascara, senna and other gut medicines unspecified - - · vs -	The review says cascara, senna and several other products were the only ones identified by the American Academy of Pediatrics as compatible with breastfeeding at that time, and that unabsorbed laxatives are the safest first choice. 1990s view that cascara is compatible with breastfeeding Methods, limits and funding Outcomes: Compatibility with breastfeeding Limitations: Published 1998; later sources (LactMed 2021, EU 2020) say to avoid cascara while breastfeeding. Read: abstract
I 1999 Mycotoxicological control on raw material and tablets of cascara sagrada (Rhamnus purshiana). Mycotoxin Res · PMID 23605186 · DOI	Laboratory research in-vitro	19 Argentine market: 9 raw bark samples and 10 lots of tablets	Cascara sagrada dried bark and tablets bark - - · vs -	Bark supports mould toxin growth in the lab. Natural aflatoxins were found in 2 of 9 raw bark samples (aflatoxin B1 10 and 19 ug/kg; the second also G1 6 and B2 1.46 ug/kg) and in 1 of 10 tablet lots (B1 5.42, B2 0.32 ug/kg). Aflatoxin found in some samples Methods, limits and funding Outcomes: Aflatoxin Limitations: Small 1999 survey from one country; the authors say quality control must include aflatoxin tests. Read: abstract
Izzo 1996 NG-nitro-L-arginine methyl ester reduces senna- and cascara-induced diarrhoea and fluid secretion in the rat. Eur J Pharmacol · PMID 8773457 · DOI	Animal research animal	Rats	Cascara (800 mg/kg by mouth) and senna (60 mg/kg), with and without a nitric-oxide blocker (L-NAME) bark extract - - · vs -	L-NAME (2.5-25 mg/kg) reduced diarrhoea from both laxatives, and L-arginine reversed this; L-NAME also reduced the fluid secretion. The inactive mirror-image compound D-NAME had no effect. Nitric oxide possibly involved in cascara diarrhoea and fluid secretion Methods, limits and funding Outcomes: Diarrhoea and net fluid secretion Limitations: Rat study at a high dose; abstract only. Read: abstract
Izzo 1997 The role of constitutive and inducible nitric oxide synthase in senna- and cascara-induced diarrhoea in the rat. Eur J Pharmacol · PMID 9105882 · DOI	Animal research animal	Rats	Cascara (800 mg/kg by mouth) compared with senna (60 mg/kg) bark extract - - · vs -	Cascara and senna raised constitutive nitric oxide synthase activity in the rat colon; induction of the inducible form (12% of the total) was linked to cascara but not senna. Dexamethasone, which blocks the inducible form, reduced cascara-induced (but not senna-induced) diarrhoea. Nitric oxide appears to be involved in cascara diarrhoea in rats Methods, limits and funding Outcomes: Nitric oxide synthase activity in the colon; diarrhoea and colonic fluid secretion Limitations: Rat study at a high dose; the cascara extract was not described in the abstract. Read: abstract
Jacobsen 2009 [Toxic hepatitis following consumption of the herbal medicinal product Cascara Sagrada]. Ugeskr Laeger · PMID 19925744	Case series	One patient in Denmark (Danish-language report)	Herbal product containing Cascara sagrada bark - - · vs -	Severe toxic hepatitis with beginning liver failure after four weeks of using a cascara sagrada product. The authors say a similar case was reported in the US, that cascara is in 30-40 herbal products in Denmark, and recommend that such products be withdrawn from the market. Severe toxic hepatitis in one patient Methods, limits and funding Outcomes: Liver injury Limitations: Single case; product dose not given in the abstract; the withdrawal call is the authors' recommendation, not a regulator's decision. Read: abstract
Khatri 2023 A Multi-Disciplinary Approach to Managing End-Stage Renal Disease in Anorexia Nervosa: A Case Report. Clin Med Insights Case Rep · PMID 37113798 · DOI	Case series	One woman, 54, with anorexia nervosa and long-term laxative abuse	Over-the-counter stimulant laxatives (type not specified) unspecified - - · vs -	Years of laxative abuse led to chronic low potassium and end-stage kidney disease thought to be caused by it (no biopsy). The authors warn about easy access to over-the-counter stimulant laxatives. Low potassium from laxative abuse can damage the kidneys Methods, limits and funding Outcomes: Low potassium and kidney failure Limitations: Single case; the laxative was not named; not cascara-specific. Read: abstract
LactMed (NICHD) 2021 Cascara Sagrada. LactMed (NICHD), record updated 2021-05-17 · PMID 30000387	Authoritative guidance	Database entry on breastfeeding	Cascara sagrada bark - - · vs -	Maternal cascara intake might cause loose stools in some breastfed infants and should be avoided; other cathartics are preferred. Avoid while breastfeeding Methods, limits and funding Outcomes: Effects in breastfed infants Limitations: Only the abstract of the database record was read. Read: abstract
LactMed (NICHD) 2021 Buckthorn. LactMed (NICHD), record updated 2021-06-21 · PMID 30000918	Authoritative guidance	Database entry on breastfeeding	Buckthorn bark, stems and leaves (European, alder and California buckthorn, Rhamnus purshiana) bark - - · vs -	The bark of these buckthorns contains anthraquinones with strong cathartic action. Maternal intake might cause loose stools in breastfed infants and use should be avoided. Do not confuse with sea buckthorn. Notes that supplements may differ from their labels. Avoid while breastfeeding Methods, limits and funding Outcomes: Effects in breastfed infants Limitations: Only the abstract of the database record was read. Read: abstract
LiverTox (NIDDK) 2017 Cascara. LiverTox (NIDDK), record updated 2017-01-23 · PMID 31643443	Authoritative guidance	Database entry on drug-induced liver injury	Cascara bark - - · vs -	Cascara is described as a popular herbal medication and over-the-counter therapy for constipation. It is generally safe and well tolerated but can cause clinically apparent liver injury when used in high doses for longer than recommended periods. Liver injury possible at high doses taken longer than advised Methods, limits and funding Outcomes: Liver injury Limitations: Only the abstract of the database record was read; the likelihood score and case list were not. Read: abstract
Lombardi 2022 Anthraquinone laxatives use and colorectal cancer: A systematic review and meta-analysis of observational studies. Phytother Res · PMID 35040201 · DOI	Meta-analysis	Observational studies: 8 in the systematic review, 5 in the meta-analysis of colorectal cancer	Anthraquinone laxatives (senna, cascara, aloe, rhubarb and others) compared with other or no laxatives unspecified - - · vs -	A history of anthraquinone laxative use was associated with colorectal cancer (OR 1.41; 95% CI 0.94-2.11), not statistically significant; OR 1.51 (0.97-2.34) after removing outlier studies. Evidence quality was moderate to low. The authors conclude no link can be established but the trend justifies better studies. OR 1.41 (95% CI 0.94-2.11) (0.94-2.11) Methods, limits and funding Outcomes: Colorectal cancer Limitations: Observational, mixed laxatives, small number of studies; not cascara-specific. Read: abstract
Mereto 1996 Evaluation of the potential carcinogenic activity of Senna and Cascara glycosides for the rat colon. Cancer Lett · PMID 8625286 · DOI	Animal research animal	Rats (colon) given a cancer-causing chemical (DMH) or not	Standardised cascara glycosides (cascarosides A-D; 0.05% or 0.1% of the diet) and senna glycosides, for 56 days standardised glycosides - - · vs -	The glycosides alone did not cause early lesions. In rats also given DMH and the highest glycoside dose, the average number of crypts per focus (a predictor of tumour outcome) was higher than with DMH alone. The authors suggest senna and cascara glycosides may act as weak promoters. Possible weak tumour-promoting effect at high doses in rats Methods, limits and funding Outcomes: Aberrant crypt foci (early colon changes) Limitations: 56-day rat study with a cancer-causing chemical; surrogate markers, not tumours. Read: abstract
Migues 2022 Determination of anthraquinones in Rhamnus purshiana using high-performance liquid chromatography coupled to diode array detector and simple ultraviolet spectroscopic analysis. J Sep Sci · PMID 35562848 · DOI	Laboratory research in-vitro	Commercial bark extracts of Rhamnus purshiana	Cascaroside A, cascaroside B, emodin and aloe-emodin measured by HPLC and by a simple UV method bark extract - - · vs -	The two methods did not differ significantly, and the samples differed from one another in their anthraquinone content. Content varies between extracts Methods, limits and funding Outcomes: Measuring anthraquinones for quality control Limitations: Method paper; no safety or benefit data. Read: abstract
Mueller-Lissner 2010 Constipation in adults. BMJ Clin Evid · PMID 21418672	Systematic review	51 Adults with idiopathic chronic constipation; 51 reviews, trials or observational studies	Interventions including cascara, senna, bisacodyl, fibre and others unspecified - - · vs -	The abstract lists cascara among the interventions covered but gives no result for it. The grade for cascara was not read. No cascara result readable from the abstract Methods, limits and funding Outcomes: Effects and safety of constipation treatments (GRADE) Limitations: Only the abstract was read; evidence searched to October 2009. Read: abstract
NCBI 2026 NCBI Taxonomy: Frangula purshiana (taxid 55262) NCBI Taxonomy via E-utilities, checked 2026-10-25 · Source	Database plant	Plant name	Frangula purshiana whole plant - - · vs -	Species Frangula purshiana, taxid 55262; synonym Rhamnus purshiana; family Rhamnaceae. Name check Methods, limits and funding Outcomes: Accepted name, synonym, lineage Limitations: Name database only. Read: full-text
NCBI PubChem 2026 PubChem compound records for cascarosides and related anthraquinones PubChem PUG REST, checked 2026-10-25 · Source	Database compound	Compound identifiers	Cascaroside A, B, C, D, aloin, chrysaloin, emodin, aloe-emodin, chrysophanol, physcion, rhein, emodin anthrone bark - - · vs -	CIDs: cascaroside A 442727, B 14605093, C 46173832, D 46173831, aloin 9866696, chrysaloin 15582573, emodin 3220, aloe-emodin 10207, chrysophanol 10208, physcion 10639, rhein 10168, emodin anthrone 122635. Identifier check Methods, limits and funding Outcomes: CIDs and formulas Limitations: Identifiers only; no activity data read. Read: full-text
Nadir 2000 Cascara sagrada-induced intrahepatic cholestasis causing portal hypertension: case report and review of herbal hepatotoxicity. Am J Gastroenterol · PMID 11151906 · DOI	Case series	One patient (cholestatic hepatitis with portal hypertension)	Cascara sagrada aged bark capsules (per EMA report) - - · vs -	Cascara sagrada was associated with cholestatic hepatitis complicated by portal hypertension. The authors believe an anthracene glycoside or another constituent was responsible. Cholestatic hepatitis in one patient Methods, limits and funding Outcomes: Liver injury Limitations: Single case; the cause could not be proven. The EMA assessment report (not this abstract) gives details and rates the link unlikely on the RUCAM scale (+2) because of confounders. Read: abstract
Nakasone 2015 A Serendipitous Find: A Case of Cholangiocarcinoma Identified Incidentally After Acute Liver Injury Due to Cascara sagrada Ingestion. Hawaii J Med Public Health · PMID 26114074	Case series	One patient in Hawaii	Large quantities of Cascara sagrada bark - - · vs -	Acute hepatitis (abdominal pain, jaundice, clay-coloured stools, dark urine) after large amounts of cascara; the work-up found an extrahepatic bile duct cancer (cholangiocarcinoma). The abstract says anthranoid laxatives can, in rare instances, produce a hepatitis that resolves when the supplement is stopped, and that the symptoms can mimic other liver and bile disease including cholangiocarcinoma. Hepatitis picture that overlapped with a bile duct cancer found during work-up Methods, limits and funding Outcomes: Liver injury and an incidental cancer Limitations: Single case; the cancer was found incidentally and is not claimed to be caused by cascara; "rare" is the authors' word, with no frequency given. Read: abstract
National Toxicology Program 2001 NTP Toxicology and Carcinogenesis Studies of EMODIN (CAS NO. 518-82-1) Feed Studies in F344/N Rats and B6C3F1 Mice. Natl Toxicol Program Tech Rep Ser · PMID 12563347	Animal research animal	Rats and mice	Emodin (a compound in cascara and other laxative plants) in feed for up to 2 years single compound - - · vs -	No evidence of carcinogenic activity in male rats or female mice. Equivocal evidence in female rats (a marginal rise in Zymbal gland carcinoma) and in male mice (a low rate of uncommon kidney tumours). Kidney tube pigment and nephropathy increased. Emodin was mutagenic in one bacterial strain with liver enzymes and caused chromosome damage in cultured hamster cells, while the animal micronucleus tests were mostly negative. Equivocal evidence of cancer in 2 of 4 animal groups Methods, limits and funding Outcomes: Cancer and kidney effects Limitations: Tested a single compound, not cascara bark. Read: abstract
Pahor 1995 Age and laxative use in hospitalized patients. A report of the "Gruppo Italiano di Farmacovigilanza nell'Anziano--GIFA". Aging (Milano) · PMID 7548263	Observational	3257 3257 hospitalised patients in 58 Italian hospitals (GIFA), 1991	Laxatives of all types, including anthranoid laxatives (senna, cascara, rhein, aloe) unspecified - - · vs -	Laxative use was 11.5% during the hospital stay. Lactulose was most used (6.7%), followed by anthranoid laxatives such as senna, cascara, rhein and aloe (1.9% in hospital, 3.3% before admission). Older age was independently linked to laxative use. Anthranoid laxatives used by 1.9% of patients in hospital Methods, limits and funding Outcomes: Which laxatives were used Limitations: A survey of use, not of benefit or harm; cascara is not separated from senna, rhein and aloe. Read: abstract
Paul 2023 Pseudoscientific and Unhealthy Approaches to Gastrointestinal Health and Detoxification in Natural Medicine. Integr Med (Encinitas) · PMID 37101734	Narrative review	Commentary on gut health and detox practices in natural medicine	Aggressive laxative herbs such as Cascara sagrada, rhubarb and senna unspecified - - · vs -	Discusses potential toxicity and damage to the bowel lining from long-term use of aggressive laxative herbs, and warns against non-scientific cleansing approaches. Caution against long-term use for cleansing Methods, limits and funding Outcomes: Toxicity and mucosal damage with long-term use Limitations: Opinion piece. Both authors are linked to a supplement company (Designs for Health) and one to a diagnostic lab; abstract only. Funding and conflicts: Authors linked to a supplement company and a diagnostic laboratory (per abstract affiliations) Read: abstract
Peloso 2025 UPLC-MS/MS Analysis of Hydroxyanthracene Derivatives in Botanical Food Products and Supplements: Surveillance of the Italian Market. Foods · PMID 40238473 · DOI	Laboratory research in-vitro	43 43 botanical food products and supplements from the Italian market (aloe, senna, cassia, rhubarb, frangula; some contained cascara)	Botanical supplements measured for hydroxyanthracene compounds mixed products - - · vs -	About one third (33%) had detectable levels. The highest values, up to 1352.9 mg/kg of aloin A+B, were found in solid supplements from senna, cascara, rhubarb and frangula; aloe-emodin up to 213.4 mg/kg and emodin up to 259.7 mg/kg (in a senna product); no sample contained danthron. Large variation in what is in supplements Methods, limits and funding Outcomes: Levels of aloins, aloe-emodin, emodin and danthron Limitations: Italian market only; the abstract does not separate cascara products from the others. Read: abstract
Petticrew 1997 Systematic review of the effectiveness of laxatives in the elderly. Health Technol Assess · PMID 9483163	Systematic review	367 People aged 55 or older with chronic constipation (about 74 years mean); 10 placebo-controlled trials (367 patients) and 10 head-to-head trials	Bulk, osmotic, stimulant and softener laxatives; main agents included bran, psyllium, cascara, docusate, lactulose and lactitol unspecified - - · vs -	Cascara is named among the main laxatives in the trials. The abstract is cut off before the results, so no cascara-specific finding was read. No cascara result readable from the abstract Methods, limits and funding Outcomes: Bowel movements per week, symptom relief, stool consistency, pain Limitations: Abstract truncated; trials were 1990s or older, mostly in care homes and hospitals. Read: abstract
Santucci 2021 Non-pharmacologic approach to pediatric constipation. Complement Ther Med · PMID 33737146 · DOI	Narrative review	Children with functional constipation; review of non-drug approaches	Supplements, fibre, botanicals, mind-body and movement approaches, including Aloe vera with aloin and Cascara sagrada unspecified - - · vs -	Data on non-drug approaches for childhood constipation were sparse. The abstract says that, other than senna, studies of botanicals showed significant safety concerns (in particular Aloe vera with aloin and Cascara sagrada) and insufficient evidence. Safety concerns and insufficient evidence for cascara in children Methods, limits and funding Outcomes: Safety and efficacy of non-drug approaches in children Limitations: Abstract only; the studies behind the statement were not read. Read: abstract
Schmidt (as cited in EMA/HMPC/909434/2019) 1955 Single and 3-month dose toxicity of cascara in rats (Schmidt, 1955, as described in the EMA assessment report) Original not read; described in EMA assessment report · Source	Animal research animal	Rats	Cascara sagrada (no preparation details given) bark - - · vs -	No deaths after a single oral dose of 6 g/kg. At 600 mg/kg a day for 3 months, rats had protein deposits in kidney tubules and fatty liver; lab tests were negative. The amount of active compounds was not given. Kidney and liver changes in rats after 3 months Methods, limits and funding Outcomes: Death after one large dose; kidney and liver findings after 3 months Limitations: Old study, no preparation details; described second-hand. Read: summary-only
Siegers 1993 Anthranoid laxative abuse--a risk for colorectal cancer? Gut · PMID 8174962 · DOI	Observational	4144 Patients having colorectal endoscopy: retrospective n = 3049 and prospective n = 1095	Anthranoid laxatives (aloe, cascara, frangula, rheum) and pseudomelanosis coli unspecified - - · vs -	In the prospective study pseudomelanosis coli was seen in 6.9% of people with a normal colon, 9.8% with adenomas (p = 0.068) and 18.6% with carcinomas. From these data the authors calculated a relative risk of 3.04 for colorectal cancer from anthranoid laxative abuse. Relative risk 3.04 (95% CI 1.18-4.90) for abuse of anthranoid laxatives, calculated by the authors (1.18-4.90) Methods, limits and funding Outcomes: Pseudomelanosis coli and colorectal tumours Limitations: Observational, indirect (pseudomelanosis used as a marker of use), 1993; covers several anthranoid laxatives and "abuse", not cascara alone. Read: abstract
Silva Souza 2025 Phytotoxicity and cytogenotoxic effects of extracts from the medicinal bark of Rhamnus purshiana DC. (Rhamnaceae). J Toxicol Environ Health A · PMID 39964315 · DOI	Laboratory research in-vitro	Lettuce seeds (plant test) exposed to bark extracts	Lyophilised and spray-dried extracts of Rhamnus purshiana bark bark extract - - · vs -	Extracts (45.65-72.17 ug/ml anthraquinones as cascaroside A) slowed root growth, reduced cell division and caused chromosome damage (aneugenic). The freeze-dried extract raised mitotic abnormalities by 300%. Plant-cell damage in a test system Methods, limits and funding Outcomes: Root growth, cell division and chromosome damage Limitations: A plant test, not human cells; human relevance unknown, but the authors call for caution in supplements. Read: abstract
Sydiskis et al. (as cited in EMA/HMPC/909434/2019) 1991 Antiviral action of anthraquinone-containing plant extracts (Sydiskis et al., 1991, as described in the EMA assessment report) Original not read; described in EMA assessment report · Source	Laboratory research in-vitro	Cell culture and virus	Hot glycerine extracts of several plants including Rhamnus purshiana bark - - · vs -	All plant extracts inactivated the virus in the dish; the active parts were identified as anthraquinones. Virus killed in a test tube Methods, limits and funding Outcomes: Inactivation of herpes simplex virus type 1 Limitations: Lab study only; no animal or human data; described second-hand. Read: summary-only
Tian 2025 Melanosis Coli. · PMID 29630198	Authoritative guidance	Clinical reference on melanosis coli	Plant anthraquinone laxatives (senna, rhubarb, cascara, aloe) unspecified - - · vs -	Melanosis coli is lipofuscin (not melanin) deposited in the colon lining, mainly from plant anthraquinone laxatives, which cause cell death in the lining as they become active. It is found at colonoscopy, usually clears after stopping the laxative, and is not associated with an increased risk of colon cancer. Reversible colon discolouration; not linked to colon cancer in this source Methods, limits and funding Outcomes: Dark colon lining (melanosis coli) Limitations: Reference article (StatPearls); abstract only. Read: abstract
Tinti 2023 Hydroxyanthracene derivates citotoxicity: A differential evaluation between single molecule and whole plant extract. Front Plant Sci · PMID 37113593 · DOI	Laboratory research in-vitro	Commercial extracts and raw materials of five plants (senna, cascara, frangula, rhubarb) and human colon cancer cells (Caco-2)	Single hydroxyanthracene molecules compared with whole plant extracts bark extract - - · vs -	The authors report large variability in the composition of botanical supplements containing these compounds, and compared single molecules with whole extracts in colon-cell cultures. The abstract gives no cascara-specific numbers. Composition varies widely between products Methods, limits and funding Outcomes: Composition variability and cell toxicity Limitations: Cell-culture work; abstract gives no figures for cascara. Read: abstract
US Food and Drug Administration 2002 Status of certain additional over-the-counter drug category II and III active ingredients. Final rule. Federal Register 67(90):31125-7 · PMID 12001972	Authoritative guidance	US regulation of over-the-counter (OTC) laxative ingredients	Aloe and cascara sagrada (bark, extract, fluidextract, casanthranol) in OTC drug products bark - - · vs -	FDA final rule of 9 May 2002: the stimulant laxative ingredients aloe and cascara sagrada in OTC drug products are not generally recognized as safe and effective, or are misbranded. Cascara sagrada no longer an accepted OTC laxative ingredient in the US Methods, limits and funding Outcomes: Safety and effectiveness status Limitations: Only the abstract was read: the reasons, effective date and any later changes were not. Read: abstract
Vyth and Kamp (as cited in EMA/HMPC/909434/2019) 1979 Rhein in urine after powdered cascara extract (Vyth and Kamp, 1979, as described in the EMA assessment report) Original not read; described in EMA assessment report · Source	Human pk	2 volunteers	Powdered cascara extract, 60 mg or 100 mg by mouth bark - - · vs -	Rhein and traces of chrysophanol were found in urine, although rhein was not in the extract, so the body appears to convert other compounds into it. Absorbed breakdown products found Methods, limits and funding Outcomes: Compounds in urine Limitations: Two people only; described second-hand. Read: summary-only
de Witte 1990 The metabolism of anthranoid laxatives. Hepatogastroenterology · PMID 2289777	Narrative review	Review of how the body handles anthranoid laxatives (animal and human data)	Anthranoid laxatives including cascara (anthrone C-glycosides) and senna (dianthrone O-glycosides) unspecified - - · vs -	Glycosides reach the large bowel unabsorbed, where bacteria release the active form. After absorption the compounds become glucuronides and sulfates found in urine and bile. Animal radiolabel work showed tissue clearance except in the kidneys. The authors argue that anthrone C-glycosides (as in cascara) and dianthrone O-glycosides (as in senna) are preferable to anthraquinones because they are absorbed much less. Active forms made in the large bowel; kidney retention seen in animals Methods, limits and funding Outcomes: Metabolism Limitations: 1990 review; abstract only. Read: abstract
de Witte 1991 Bicascarosides in fluid extracts of cascara. Planta Med · PMID 1798797 · DOI	Laboratory research in-vitro	Cascara fluid extracts (laboratory analysis)	Fluid extracts of cascara fluid extract - - · vs -	Up to 20% of the anthracene glycosides in fluid extracts were turned into dimers during preparation and storage. The dimers have no laxative activity, are absorbed in the gut and are excreted very slowly. Extracts can contain inactive, absorbable dimers Methods, limits and funding Outcomes: Chemical make-up of extracts Limitations: Chemistry study from 1991; abstract only. Read: abstract

What we do not know yet

What the evidence supports: nothing reaches even low certainty. All uses are rated insufficient except detox and weight loss, which is rated against. The EU found no controlled trial of cascara alone.
What is uncertain: whether cascara works at all beyond what is known from senna, how often liver injury, dependence or low potassium happen, whether it raises cancer risk, and breastfeeding safety, where older and newer sources disagree.
What has not been studied: any modern trial in adults, older people or children, long-term use, people with liver, kidney or heart disease, and food or alcohol interactions.
What we could not verify: the full LiverTox chapter (abstract only), the FDA rule beyond its abstract, the EFSA opinion in full, and the German Commission E, ESCOP, WHO and NCCIH texts.
Products: no survey of heavy metals or pesticides in cascara products was found; aflatoxin was found in some bark samples in one small survey from 1999.

How new research is added

New studies are found by a saved PubMed search and are placed in a review queue. A person reads each one before it changes any evidence rating or safety wording. New publications never change ratings automatically.

Lab markers

What changed in blood or saliva tests during trials. A changed number is not the same as feeling or being healthier, and we give no "normal ranges".

Other 2

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Bowel cleansing score at colonoscopy

No clear change in trials

How clean the bowel lining looks to the doctor performing a colonoscopy, with an "inadequate" mark when the view is not good enough.

Not enough evidence

Results and what it means

Why it was measured

The main measure of whether a bowel preparation worked.

Statistical vs. clinical meaning

A procedure-quality measure, not a health outcome. Cascara cannot be separated from the combination.

Safety implication

Stimulant laxatives with a wash-out solution can cause cramps and fluid loss; the clinic gives instructions.

Study	Result	People	Product
³	Scores indicating inadequate preparation: 14% senna plan, 8% Golytely, 12% cascara combination; no clinically important difference. Outpatients cleaner than inpatients (p < 0.001).	271 colonoscopy patients, Norway	Cascara-and-saline laxative (PicoSalax) plus a smaller amount of Golytely, against Golytely or senna

▼

Gallbladder volume after dosing

Lowered in trials

The size of the gallbladder measured by ultrasound; a smaller size means it has squeezed bile out.

Not enough evidence

Results and what it means

Why it was measured

Used to test whether a substance makes the gallbladder contract.

Statistical vs. clinical meaning

A physical effect in healthy people; it is not a health benefit and its clinical meaning is unknown.

Safety implication

Not studied in people with gallbladder disease.

Study	Result	People	Product
¹²	Significant gallbladder contraction after 54 mg cascaroside A (3 ml extract); effect more rapid but less intense than a test meal. Result for 36 mg not stated.	Healthy volunteers, 20 per dose group	Cascara fluid extract vs placebo

¹²

Safety

What studies and official sources say about side effects, medicines and who should check first. Each point shows what kind of evidence it comes from.

Main points to know 10

Short-term use only: the EU says no more than 1 week. The EU herbal monograph (2020) allows cascara bark only for short-term occasional constipation. It says not to use it for more than 1 week, and that usually it is enough to take it two to three times in that week. If symptoms continue, see a doctor or pharmacist. Cascara should be tried only if a change of diet or a bulk-forming fibre has not worked. Authoritative guidance ^{9 10}
US FDA, 2002: cascara sagrada is no longer an accepted over-the-counter laxative ingredient. In a final rule published on 9 May 2002, the FDA said that the stimulant laxative ingredients aloe and cascara sagrada (including casanthranol and cascara sagrada bark, extract and fluidextract) in over-the-counter drug products are not generally recognized as safe and effective, or are misbranded. The effect is that cascara sagrada is no longer an accepted over-the-counter laxative ingredient in the US. Only the abstract of the rule was read: the reasons given, the date it took effect, what it meant for sale and the later situation for supplements were not. Authoritative guidance ⁴⁷
Use aged bark only: fresh bark causes vomiting. The EU report says fresh bark contains forms that cause unwanted vomiting (emetic effects). During drying and ageing these are oxidised to forms that do not. The EU standard (European Pharmacopoeia) is for dried bark, and the historical drug name "cascara sagrada" means the dried, aged bark. A chemistry paper adds that some of these laxative plants must be stored for at least a year to avoid severe diarrhoea and dehydration. Fresh bark should not be used. Authoritative guidance ^{10 6}
Stimulant laxatives can cause belly cramps, loose stools and loss of fluid and potassium. Overuse gives griping pain and severe diarrhoea with loss of fluid and salts, especially potassium. The EU says to give plenty of fluid and to check electrolytes, particularly in the elderly. People with kidney disease should be aware of possible electrolyte imbalance. A case report of years of non-specific stimulant laxative abuse links long-term low potassium to kidney failure (laxative type not named). Authoritative guidance ^{9 10 23}
Long use: dependence, a dark colon lining (melanosis coli), and what is not settled. The EU monograph warns that using a stimulant laxative for more than a brief period may lead to impaired bowel function and dependence on laxatives. The EU assessment adds that it is not clear from the evidence whether dependence really happens, and keeps the warning as a precaution. Chronic use can darken the colon lining (pseudomelanosis coli); this usually clears after stopping, and a clinical reference says it is not associated with an increased risk of colon cancer. A 2023 commentary warns against long-term use of aggressive laxative herbs such as cascara for cleansing. Authoritative guidance ^{9 10 45 37}
Several medicines make low potassium worse; ask a doctor first. The EU says people taking heart glycosides such as digoxin, rhythm medicines, medicines that prolong the heart-rhythm interval (QT), water pills (diuretics), steroid tablets or liquorice root must consult a doctor before taking cascara. Low potassium from laxative overuse strengthens digoxin-type medicines and upsets heart rhythm. Authoritative guidance ^{9 10}
Not for pregnancy, breastfeeding or children under 12. The EU contraindicates cascara in pregnancy (lab data show a genotoxic risk for related compounds such as emodin and aloe-emodin), in breastfeeding (small amounts of the active metabolite rhein reach breast milk) and under age 12. The US LactMed record also says to avoid it while breastfeeding because it might cause loose stools in the infant. A 1998 review was more relaxed, citing the American Academy of Pediatrics list of that time. Authoritative guidance ^{9 10 24 25 18}
Liver injury has been reported. LiverTox says cascara is generally safe and well tolerated but can cause clinically apparent liver injury when used in high doses for longer than recommended. There are published case reports from the US and Denmark, and 2 of 13 herbal liver injury cases in a Spanish registry were linked to cascara. The EU assessment judged one of the best-known cases as unlikely to be caused by cascara on a standard scale because of other medicines and alcohol. No frequency is known. Case report ^{26 33 22 34 16 10}
Cancer questions are not settled. Related compounds in cascara (emodin, aloe-emodin) have shown genotoxic effects in the lab. EFSA said in 2018 that hydroxyanthracene derivatives should be treated as genotoxic and carcinogenic unless specific data show otherwise, but it received no data on cascara. For cascara itself, one rat study found weak tumour-promoting signs at a high dose and another found none; the EU calls the concern unresolved. A 2022 meta-analysis of observational studies found a non-significant link between anthraquinone laxatives and colorectal cancer (OR 1.41; 95% CI 0.94-2.11). Short use is the way to limit this risk. Authoritative guidance ^{8 28 2 27 10}
What is in a product can vary a lot. A survey of Italian supplements found hydroxyanthracene compounds above the detection limit in a third of 43 products, with the highest levels in solid supplements from senna, cascara, rhubarb and frangula. Aflatoxin was found in some cascara bark samples in a small Argentine survey. A fluid extract can hold up to 20% of its active glycosides as inactive dimers. Cascara in a "cascara" coffee-cherry drink is a different product. Laboratory research ^{38 19 50 46}

Side effects 9

Effect	How often	Severity and recovery	Evidence
Abdominal pain, cramps and loose or liquid stools The EU monograph says frequency is not known. These effects are especially likely in people with irritable bowel and with an overdose; the dose should be reduced.	Not established	mild to moderate Usually eases when the amount is lowered or stopped	Authoritative guidance ⁹
Fluid and electrolyte loss (low potassium) with long use or overdose Low potassium can cause heart and muscle problems, especially with digoxin, diuretics or steroids. Kidney disease raises the risk of imbalance.	Not established	moderate to serious Reversible with fluids and electrolyte replacement	Authoritative guidance ^{9 10}
Dark colon lining (pseudomelanosis coli) The German authority reported melanosis coli in a 42-year-old woman after 4 years of a cascara-only product. A clinical reference says it is not associated with an increased risk of colon cancer, while a 1993 study found it more often in people with colorectal adenomas and, in its prospective part, cancer.	Not established	mild (no symptoms) Usually fades after stopping	Case report ^{9 10 45 11}
Albuminuria and blood in the urine with long use Listed in the EU monograph under kidney and urinary tract symptoms from long-term use; frequency not known.	Not established	unknown Not stated	Authoritative guidance ⁹
Yellow or red-brown urine The colour depends on urine acidity and is not clinically significant per the EU. Still, dark urine with yellow skin or eyes should be checked as a possible liver sign (see urgent signs).	Not established	harmless Clears after the metabolites leave the body	Authoritative guidance ⁹
Allergy: itching, hives, rash; occupational asthma and rhinitis Hypersensitivity is listed in the EU monograph. A pharmacy worker developed IgE-mediated asthma and rhinitis from handling cascara and passion flower dust, shown by skin tests, Western blot and a bronchial challenge.	Not established	mild to serious Stops when the cause is removed	Case report ^{9 10 17}
Nausea and vomiting from fresh (unaged) bark The EU assessment says the compounds in fresh bark cause unwanted emetic effects; they are oxidised away when the bark is dried and aged.	Not established	moderate Stops when the bark is no longer used	Authoritative guidance ¹⁰
Skin irritation from stool contact in incontinent adults The EU says pads should be changed more often when cascara bark is given to incontinent adults.	Not established	mild Resolves with more frequent pad changes	Authoritative guidance ⁹
Kidney inflammation after a mixed 10-herb product (cause unclear) A woman with sickle-cell disease developed acute tubulo-interstitial nephritis after 5 days of a mixed herbal product that included Aloe vera and cascara. The EU assessment says the causality cannot be assessed.	Not established	serious in the one case Kidney function improved after dialysis in the one case	Case report ¹¹

Liver

LiverTox (abstract read) says cascara is generally safe and well tolerated but can cause clinically apparent liver injury when used in high doses for longer than recommended periods. Published cases include cholestatic hepatitis with portal hypertension (US, 2000), severe toxic hepatitis with beginning liver failure after four weeks (Denmark, 2009) and acute hepatitis after large amounts (Hawaii, 2015). The EU monograph says chronic overdoses of anthranoid medicines may lead to toxic hepatitis. In animals, rats given 600 mg/kg a day for 3 months developed fatty liver, with negative lab tests. The EU assessment report examined the US case with the RUCAM score and judged the link "unlikely" (+2) because of other medicines, moderate alcohol use and the short onset. ^{26 33 22 34 16 41 10 9}

How often. No frequency was found. The Hawaii abstract uses the word "rare" without giving any number, and the registry counts have no denominator of users.

Monitoring. No agency monitoring advice was read. Stop and see a doctor the same day for yellow skin or eyes, dark urine, pale stools, strong tiredness, itching or pain in the upper right belly.

This is a safety connection. It is not evidence that Cascara Sagrada supports liver health.

Medicines and supplements 6

With	Why it matters	Importance	Evidence	What to do
Digoxin and other heart glycosides prescription	Long-term laxative overuse lowers potassium, and low potassium strengthens the action of heart glycosides.	The EU says patients taking cardiac glycosides must consult a doctor before taking cascara. No case report with cascara was found.	Pharmacological theory Low certainty ^{9 10}	Do not use cascara with digoxin unless the doctor who manages your heart medicine agrees.
Heart rhythm medicines (antiarrhythmics such as quinidine) and medicines that prolong the QT interval prescription	Low potassium interferes with rhythm medicines and can add to QT risk.	The EU lists these in its precautions and in its interaction section.	Pharmacological theory Low certainty ^{9 10}	Ask your doctor before use.
Water pills (diuretics) prescription	Both lose potassium. The EU assessment says the effect is worst with thiazide and loop diuretics and is not expected with potassium-sparing diuretics such as amiloride, but says patients cannot always tell which kind they take, so all diuretics are named.	May worsen low potassium.	Pharmacological theory Low certainty ^{9 10}	Ask your doctor or pharmacist before use.
Steroid tablets (adrenocorticosteroids) prescription	Steroids can also lower potassium; the loss adds up with laxative-related loss.	The EU says concomitant use may enhance potassium loss.	Pharmacological theory Low certainty ^{9 10}	Ask your doctor before use.
Liquorice root herb	Liquorice also lowers potassium. A 2000 review also says liquorice can strengthen the action of steroid tablets and creams.	The EU says concomitant use may enhance potassium loss.	Pharmacological theory Low certainty ^{9 10 13}	Do not combine without medical advice.
Other medicines taken by mouth at the same time prescription	A review says anthranoid-containing plants (including senna and cascara) and soluble fibres can decrease the absorption of drugs.	The abstract gives no data or examples for cascara; the review also says many herb-drug reports are sketchy.	Pharmacological theory Very low certainty ¹³	Ask a pharmacist about spacing medicines that must be absorbed well.

Who should check first 12

Situation	Advice	Evidence
Allergy to cascara or its constituents	Avoid. Listed as a contraindication (hypersensitivity).	Authoritative guidance ⁹
Blocked bowel or narrowing of the bowel (obstruction, stenosis), atony	Do not use.	Authoritative guidance ⁹
Appendicitis	Do not use.	Authoritative guidance ⁹
Inflammatory bowel disease (Crohn's disease, ulcerative colitis)	Do not use.	Authoritative guidance ⁹
Belly pain of unknown cause	Do not use. See a doctor.	Authoritative guidance ⁹
Severe dehydration with water and salt loss	Do not use.	Authoritative guidance ⁹
Pregnancy	Do not use. The EU gives lab (genotoxicity) data on related compounds and a theoretical risk of uterine stimulation; there are no human data for cascara.	Authoritative guidance ^{9 10}
Breastfeeding	Do not use. The EU cites small amounts of rhein reaching milk; LactMed says it might cause loose stools in the infant. A 1998 review took a more relaxed view; the newer sources are used here.	Authoritative guidance ^{9 10 24 18}
Children under 12 years	Do not use. No safety or efficacy data; a 2021 review noted significant safety concerns.	Authoritative guidance ^{9 10 40}
Faecal impaction, or undiagnosed, acute or lasting stomach and bowel complaints (pain, nausea, vomiting)	Do not use unless a doctor advises: these can be signs of a bowel blockage (ileus).	Authoritative guidance ⁹
Kidney disease	Not a contraindication, but the EU warns that electrolyte imbalance is possible. Ask a doctor.	Authoritative guidance ⁹
Liquid products that contain alcohol	The EU requires an ethanol label statement for such products; relevant for people who avoid alcohol.	Authoritative guidance ⁹

Overdose, product quality and regulators

Summary. Used briefly as labelled, cascara is judged by the EU to have a positive benefit-risk balance for occasional constipation. Information on its toxicity is thin: the EU says there are no clinical safety studies and only limited animal data, and relies on related compounds and other laxatives.

Animal. Rats: no deaths after a single oral dose of 6 g/kg (cascara, details not given); at 600 mg/kg a day for 3 months, protein deposits in kidney tubules and fatty liver, with negative lab tests (Schmidt 1955, as described in the EU report; amount of active compounds not stated). Colon tumour studies in rats are mixed (see genotoxicity).

Human doses studied. No dose-finding or clinical safety study of cascara bark was found (EU assessment). The EU monograph uses preparations equal to 10-30 mg hydroxyanthracene derivatives (as cascaroside A) once at night, and says the correct dose is the smallest that gives a soft stool. A reported liver case involved twice the recommended amount.

High dose or long term signals. Dependence, electrolyte loss, albuminuria and blood in the urine, and a dark colon lining (EU monograph, long use); toxic hepatitis with chronic overdose (EU).

Overdose response. Griping pain and severe diarrhoea with loss of fluid and electrolytes; treatment is supportive with generous fluids and monitoring of electrolytes, particularly potassium, which matters most in the elderly (EU).

Genotoxicity. The EU says several hydroxyanthracene compounds were mutagenic and genotoxic in several test-tube systems, but this was not proven in living animals. In plant cells, bark extracts caused chromosome damage (lettuce seed test, 2025). The EU also says limited genotoxicity studies of cascara bark exist. EFSA treats hydroxyanthracene derivatives as genotoxic unless data show otherwise, and had no cascara data.

Carcinogenicity. Rats given standardised cascara glycosides plus a cancer-causing chemical had more crypts per early lesion at the highest dose (weak promoter, 1996); a 2001 rat study found no initiation or promotion by cascara. The EU calls the concern unresolved for lack of confirming studies. The NTP found equivocal evidence of cancer in 2 of 4 animal groups for emodin, a compound found in cascara. In people, a 1993 study estimated a relative risk of 3.04 (95% CI 1.18-4.90) from abuse of anthranoid laxatives (several types), and a 2022 meta-analysis found OR 1.41 (95% CI 0.94-2.11), not statistically significant. None of these is a study of cascara alone.

Toxic plant parts. The bark is the part used. Fresh bark is emetic. Leaves, stems and fruit are not used as medicine in the sources read. LactMed notes that buckthorn bark, stems and leaves all contain anthraquinones with potent cathartic properties. Do not confuse with sea buckthorn (Hippophae rhamnoides), which is a different plant.

No survey of heavy metals or pesticides in cascara products was found. Aflatoxin, variable active content and look-alike names are the issues found.

Aflatoxin in bark and tablets. In an Argentine survey, aflatoxin B1 was found in 2 of 9 raw bark samples (10 and 19 ug/kg) and in 1 of 10 tablet lots (5.42 ug/kg), with G1 and B2 in some. The bark grew mould toxin well in the lab. ¹⁹

Wide differences in hydroxyanthracene content. Of 43 Italian botanical products (aloe, senna, cassia, rhubarb, frangula; some with cascara) 33% had detectable levels; solid supplements had up to 1352.9 mg/kg of aloin A+B, with no danthron found. Another study reports large variability in composition between commercial extracts, and a third found differing content between cascara extracts. ^{38 46 29}

Inactive dimers in fluid extracts. Up to 20% of active glycosides in cascara fluid extracts can be turned into dimers during preparation and storage; they have no laxative activity, are absorbed, and are excreted very slowly. ⁵⁰

Name mix-ups. PubMed papers on "instant cascara" describe a beverage made from dried coffee cherry, which is a different product from cascara sagrada bark. LactMed says sea buckthorn is a different plant from the cathartic buckthorns and that supplements may differ from their labels. ^{25 15}

Body	Action	Date
European Medicines Agency, Committee on Herbal Medicinal Products (HMPC) (European Union)	EU herbal monograph (EMA/HMPC/726270/2016, final revision 1): well-established use for short-term occasional constipation; not more than 1 week; contraindicated under 12, in pregnancy and breastfeeding; warnings on dependence, potassium and several medicines. source	2020-05-06
European Medicines Agency, HMPC (European Union)	Assessment report (EMA/HMPC/909434/2019): no controlled clinical studies of cascara alone; concern about genotoxicity and carcinogenicity "unresolved"; benefit/risk positive for short-term occasional constipation. source	2020-05-06
US Food and Drug Administration (United States)	Final rule: aloe and cascara sagrada (bark, extract, fluidextract, casanthranol) as stimulant laxative ingredients in OTC drug products are not generally recognized as safe and effective, or are misbranded. source	2002-05-09
NIH LiverTox (United States)	Record on cascara: generally safe and well tolerated, but can cause clinically apparent liver injury in high doses used longer than recommended. source	2017-01-23
NIH LactMed (United States)	Cascara sagrada: maternal intake might cause loose stools in some breastfed infants and should be avoided; other cathartics are preferred. A separate Buckthorn record says the same for the buckthorn laxatives. source	2021-05-17

When to get medical help

Swelling of the face, lips or throat, trouble breathing, wheezing or a widespread rash.
Yellow skin or eyes, dark urine, pale stools, strong itching or pain in the upper right belly (possible liver injury).
Severe or bloody diarrhoea, or diarrhoea that lasts for more than a day.
Dizziness, a very dry mouth, very little urine or fainting (dehydration).
Palpitations, an irregular heartbeat, severe muscle weakness or cramps (possible low potassium), especially on digoxin, water pills or steroids.
Severe belly pain, repeated vomiting, a swollen belly, or no stool or gas passed after taking it (possible blockage).
Blood in the stool or urine.
Constipation that returns as soon as the laxative is stopped, or a need to use laxatives every day.

Stop the supplement and contact a clinician or emergency service. In the US, Poison Control is 1-800-222-1222.

General information only, not medical advice. Ask a clinician or pharmacist before use, especially with medicines, in pregnancy or with a health condition. See the Natural Remedy Safety guide.

Frequently asked questions

Does cascara sagrada work for constipation?

It has been used for well over a century and the EU accepts it for short-term occasional constipation, but the EU's own report found no controlled trial of cascara bark alone. Whether it works is therefore based on long use, expert opinion and the better studies of related laxatives such as senna, not on trials of cascara itself. Certainty is insufficient.

^{9 10}

How long can I take cascara sagrada?

The EU says not more than 1 week. If symptoms continue, see a doctor or pharmacist. It should be tried only if diet changes or fibre have not worked. Ask a doctor or pharmacist about amounts.

⁹

What did the FDA decide about cascara sagrada in 2002?

In a final rule published on 9 May 2002, the FDA said that aloe and cascara sagrada used as stimulant laxatives in over-the-counter drug products are not generally recognized as safe and effective, or are misbranded. So cascara is no longer an accepted over-the-counter laxative ingredient in the US. Only the abstract of the rule was read, so the reasons and what it meant for supplements are not covered here.

⁴⁷

Why must the bark be aged? Can I use fresh bark?

No. The EU report says fresh bark contains forms that cause vomiting, and that drying and ageing change them into forms that do not. A chemistry paper says some of these laxative plants must be stored for at least a year to avoid severe diarrhoea and dehydration. Use only the dried, aged bark in a labelled product.

^{10 6}

Is cascara habit-forming, and what happens to potassium?

The EU warns that using stimulant laxatives for more than a short time may lead to poor bowel function and dependence, but its own report says it is not clear from the evidence whether that really happens; long-term use is avoided as a precaution. Overuse can also cause loss of fluid and potassium, and in the elderly or people with kidney disease this matters more. If you need a laxative every day, see a doctor to find the cause.

^{9 10}

Which medicines does cascara interact with?

The EU says to consult a doctor before using cascara if you take digoxin or other heart glycosides, rhythm medicines, medicines that prolong the QT interval, water pills (diuretics), steroid tablets or liquorice root. The reason is low potassium, which can strengthen digoxin and upset the heartbeat. This rests on expert guidance and drug logic; no cascara-specific case report was found. A review also says anthranoid laxatives may reduce the absorption of other medicines.

^{9 10 13}

Is cascara safe in pregnancy or when breastfeeding?

No. The EU contraindicates it in both, because related compounds showed genotoxic effects in lab tests and small amounts of the active metabolite rhein reach breast milk. The US LactMed record says breastfeeding mothers should avoid it because it might cause loose stools in the infant. A 1998 review took a more relaxed view, but the newer sources are stricter.

^{9 10 24 18}

Can children take cascara sagrada?

No. The EU says it must not be used under age 12, there are no studies in children, and a 2021 review of non-drug approaches to childhood constipation noted significant safety concerns for cascara and insufficient evidence. Ask a paediatrician about safer options.

^{9 40}

Can cascara damage the liver?

It can in reported cases. LiverTox says cascara is generally safe and well tolerated but can cause clinically apparent liver injury at high doses taken longer than recommended. Case reports come from the US and Denmark, and a Spanish liver registry listed 2 cascara cases among 13 herbal liver injuries. No frequency is known. Stop and see a doctor the same day for yellow skin or eyes, dark urine or pale stools.

^{26 33 22 16}

Does cascara cause melanosis coli or colon cancer?

Long use can darken the colon lining (melanosis coli), which usually fades after stopping and, in a 2025 clinical reference, is not associated with a higher colon cancer risk. Cancer from cascara itself is an open question: one rat study found weak tumour promotion at a high dose, another found none, and a 2022 meta-analysis of anthraquinone laxatives gave a non-significant link (OR 1.41; 95% CI 0.94-2.11). The EU calls the concern unresolved, which is one reason for the 1-week limit.

^{45 28 2 27 10}

Can cascara help with weight loss or a detox?

There is no evidence that it does. It empties the bowel and loses water, which does not remove fat, and a 2023 commentary warns of toxicity and bowel-lining damage with long-term use of aggressive laxative herbs such as cascara. If worries about weight or eating are behind laxative use, talk to a doctor.

^{37 9}

Is "cascara" coffee-cherry tea the same as cascara sagrada?

No. Studies on "instant cascara" describe a drink made from dried coffee cherry, a different product with different contents. The laxative cascara sagrada is the aged bark of a buckthorn tree.

^{15 10}

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Editorial transparency

Written by: AlternativeMed editorial team. Research compiled with AI assistance, then checked against PubMed records.
Medical review: None. This page has not been reviewed by a physician or pharmacist.
First published: 2026-10-25
Last substantive update: 2026-10-25
How we research: We searched PubMed, read the EU herbal monograph and the EU assessment report on cascara bark in full, the abstracts of the LiverTox, LactMed and FDA records, and checked plant names in GBIF and NCBI taxonomy and compounds in PubChem. Only abstracts were read for nearly all studies, and a few older studies were read only as described in the EU report. Some sources were not verified: the full LiverTox chapter, the FDA rule beyond its abstract, the full EFSA opinion, and the Commission E, ESCOP, WHO and NCCIH texts. Certainty ratings are the compiler's own reading, not formal grades. No study is cited that we could not verify.
How we rate evidence: See "How we rate evidence" in the Evidence tab.
Independence: No product is promoted on this page. No affiliate links are shown. If one is added later it will be labelled and kept apart from the evidence.

Sources 50

Each source was opened and checked. Where we read only the abstract, it says so. The small numbers in the text point here.

Akram M, Thiruvengadam M, Zainab R et al.. Herbal Medicine for the Management of Laxative Activity.. Curr Pharm Biotechnol. 2022. PMID 34387161. DOI 10.2174/1389201022666210812121328. (abstract)
Borrelli F, Mereto E, Capasso F et al.. Effect of bisacodyl and cascara on growth of aberrant crypt foci and malignant tumors in the rat colon.. Life Sci. 2001. PMID 11693267. DOI 10.1016/s0024-3205(01)01263-2. (abstract)
Børkje B, Pedersen R, Lund GM et al.. Effectiveness and acceptability of three bowel cleansing regimens.. Scand J Gastroenterol. 1991. PMID 2011703. DOI 10.3109/00365529109025026. (abstract)
Cirillo C, Capasso R. Constipation and Botanical Medicines: An Overview.. Phytother Res. 2015. PMID 26171992. DOI 10.1002/ptr.5410. (abstract)
D'Angelo (as cited in EMA/HMPC/909434/2019). Colonic motility in conscious dogs given cascara extract and related compounds (D'Angelo, 1993, as described in the EMA assessment report). Original not read; described in EMA assessment report. 1993. (summary-only)
Demarque DP, Pinho DR, Callejon DR et al.. New cascarosides from Rhamnus purshiana and fragmentation studies of the class by ion trap mass spectrometry.. Rapid Commun Mass Spectrom. 2017. PMID 28440576. DOI 10.1002/rcm.7883. (abstract)
Demarque DP, Silva RMP, Santos LF et al.. Cytotoxicity of Structurally Diverse Anthranoids and Correlation with Mechanism of Action and Side Effects.. J Pharm Pharm Sci. 2018. PMID 30321134. DOI 10.18433/jpps30077. (abstract)
EFSA Panel on Food Additives and Nutrient Sources added to Food (ANS). Safety of hydroxyanthracene derivatives for use in food (EFSA Journal 2018;16(1):e05090). EFSA Journal. 2018. (summary-only)
EMA Committee on Herbal Medicinal Products (HMPC). European Union herbal monograph on Rhamnus purshiana DC., cortex (Final, Revision 1), EMA/HMPC/726270/2016. European Medicines Agency. 2020. (full-text)
EMA Committee on Herbal Medicinal Products (HMPC); rapporteurs W. Knoss, J. Wiesner. Assessment report on Rhamnus purshiana DC., cortex (Final, Revision 1), EMA/HMPC/909434/2019. European Medicines Agency. 2020. (full-text)
EMA/HMPC/909434/2019. Case reports described in the EMA assessment report (melanosis coli, urticaria, nephritis with a mixed herbal product). European Medicines Agency. 2020. (full-text)
Foert et al. (as cited in EMA/HMPC/909434/2019). Cascara fluid extract and gallbladder emptying in healthy volunteers (Foert et al., 1994, as described in the EMA assessment report). Original not read; described in EMA assessment report. 1994. (summary-only)
Fugh-Berman A. Herb-drug interactions.. Lancet. 2000. PMID 10675182. DOI 10.1016/S0140-6736(99)06457-0. (abstract)
GBIF Secretariat. GBIF Backbone Taxonomy: Frangula purshiana (DC.) J.G.Cooper (usageKey 8286637). GBIF API (api.gbif.org), checked 2026-10-25. 2026. (full-text)
Gallego-Barceló P, Bagues A, Benítez-Álvarez D et al.. Evaluation of the Effects of Instant Cascara Beverage on the Brain-Gut Axis of Healthy Male and Female Rats.. Nutrients. 2023. PMID 38201895. DOI 10.3390/nu16010065. (abstract)
García-Cortés M, Borraz Y, Lucena MI et al.. [Liver injury induced by "natural remedies": an analysis of cases submitted to the Spanish Liver Toxicity Registry].. Rev Esp Enferm Dig. 2008. PMID 19159172. DOI 10.4321/s1130-01082008001100004. (abstract)
Giavina-Bianchi PF Jr, Castro FF, Machado ML et al.. Occupational respiratory allergic disease induced by Passiflora alata and Rhamnus purshiana.. Ann Allergy Asthma Immunol. 1997. PMID 9396980. DOI 10.1016/S1081-1206(10)63042-6. (abstract)
Hagemann TM. Gastrointestinal medications and breastfeeding.. J Hum Lact. 1998. PMID 10205441. DOI 10.1177/089033449801400321. (abstract)
I R, E V, G V et al.. Mycotoxicological control on raw material and tablets of cascara sagrada (Rhamnus purshiana).. Mycotoxin Res. 1999. PMID 23605186. DOI 10.1007/BF02945219. (abstract)
Izzo AA, Gaginella TS, Mascolo N et al.. NG-nitro-L-arginine methyl ester reduces senna- and cascara-induced diarrhoea and fluid secretion in the rat.. Eur J Pharmacol. 1996. PMID 8773457. DOI 10.1016/0014-2999(96)00023-4. (abstract)
Izzo AA, Sautebin L, Rombolà L et al.. The role of constitutive and inducible nitric oxide synthase in senna- and cascara-induced diarrhoea in the rat.. Eur J Pharmacol. 1997. PMID 9105882. DOI 10.1016/s0014-2999(97)00023-x. (abstract)
Jacobsen C, Semb S, Kromann-Andersen H. [Toxic hepatitis following consumption of the herbal medicinal product Cascara Sagrada].. Ugeskr Laeger. 2009. PMID 19925744. (abstract)
Khatri V, Bauschka M, Foley M et al.. A Multi-Disciplinary Approach to Managing End-Stage Renal Disease in Anorexia Nervosa: A Case Report.. Clin Med Insights Case Rep. 2023. PMID 37113798. DOI 10.1177/11795476231169385. (abstract)
LactMed (NICHD). Cascara Sagrada.. LactMed (NICHD), record updated 2021-05-17. 2021. PMID 30000387. (abstract)
LactMed (NICHD). Buckthorn.. LactMed (NICHD), record updated 2021-06-21. 2021. PMID 30000918. (abstract)
LiverTox (NIDDK). Cascara.. LiverTox (NIDDK), record updated 2017-01-23. 2017. PMID 31643443. (abstract)
Lombardi N, Crescioli G, Maggini V et al.. Anthraquinone laxatives use and colorectal cancer: A systematic review and meta-analysis of observational studies.. Phytother Res. 2022. PMID 35040201. DOI 10.1002/ptr.7373. (abstract)
Mereto E, Ghia M, Brambilla G. Evaluation of the potential carcinogenic activity of Senna and Cascara glycosides for the rat colon.. Cancer Lett. 1996. PMID 8625286. DOI 10.1016/0304-3835(96)04129-8. (abstract)
Migues VH, Mauricio J, Gomes AF et al.. Determination of anthraquinones in Rhamnus purshiana using high-performance liquid chromatography coupled to diode array detector and simple ultraviolet spectroscopic analysis.. J Sep Sci. 2022. PMID 35562848. DOI 10.1002/jssc.202200148. (abstract)
Mueller-Lissner SA, Wald A. Constipation in adults.. BMJ Clin Evid. 2010. PMID 21418672. (abstract)
NCBI. NCBI Taxonomy: Frangula purshiana (taxid 55262). NCBI Taxonomy via E-utilities, checked 2026-10-25. 2026. (full-text)
NCBI PubChem. PubChem compound records for cascarosides and related anthraquinones. PubChem PUG REST, checked 2026-10-25. 2026. (full-text)
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. PMID 11151906. DOI 10.1111/j.1572-0241.2000.03386.x. (abstract)
Nakasone ES, Tokeshi J. A Serendipitous Find: A Case of Cholangiocarcinoma Identified Incidentally After Acute Liver Injury Due to Cascara sagrada Ingestion.. Hawaii J Med Public Health. 2015. PMID 26114074. (abstract)
National Toxicology Program. NTP Toxicology and Carcinogenesis Studies of EMODIN (CAS NO. 518-82-1) Feed Studies in F344/N Rats and B6C3F1 Mice.. Natl Toxicol Program Tech Rep Ser. 2001. PMID 12563347. (abstract)
Pahor M, Mugelli A, Guralnik JM et al.. Age and laxative use in hospitalized patients. A report of the "Gruppo Italiano di Farmacovigilanza nell'Anziano--GIFA".. Aging (Milano). 1995. PMID 7548263. (abstract)
Paul C, Brady DM. Pseudoscientific and Unhealthy Approaches to Gastrointestinal Health and Detoxification in Natural Medicine.. Integr Med (Encinitas). 2023. PMID 37101734. (abstract)
Peloso M, Capriotti A, Accurso D et al.. UPLC-MS/MS Analysis of Hydroxyanthracene Derivatives in Botanical Food Products and Supplements: Surveillance of the Italian Market.. Foods. 2025. PMID 40238473. DOI 10.3390/foods14071229. (abstract)
Petticrew M, Watt I, Sheldon T. Systematic review of the effectiveness of laxatives in the elderly.. Health Technol Assess. 1997. PMID 9483163. (abstract)
Santucci NR, Chogle A, Leiby A et al.. Non-pharmacologic approach to pediatric constipation.. Complement Ther Med. 2021. PMID 33737146. DOI 10.1016/j.ctim.2021.102711. (abstract)
Schmidt (as cited in EMA/HMPC/909434/2019). Single and 3-month dose toxicity of cascara in rats (Schmidt, 1955, as described in the EMA assessment report). Original not read; described in EMA assessment report. 1955. (summary-only)
Siegers CP, von Hertzberg-Lottin E, Otte M et al.. Anthranoid laxative abuse--a risk for colorectal cancer?. Gut. 1993. PMID 8174962. DOI 10.1136/gut.34.8.1099. (abstract)
Silva Souza K, da Cunha Neto AR, Chagas-Paula DA et al.. Phytotoxicity and cytogenotoxic effects of extracts from the medicinal bark of Rhamnus purshiana DC. (Rhamnaceae).. J Toxicol Environ Health A. 2025. PMID 39964315. DOI 10.1080/15287394.2025.2466665. (abstract)
Sydiskis et al. (as cited in EMA/HMPC/909434/2019). Antiviral action of anthraquinone-containing plant extracts (Sydiskis et al., 1991, as described in the EMA assessment report). Original not read; described in EMA assessment report. 1991. (summary-only)
Tian C, Al Nasser Y. Melanosis Coli.. . 2025. PMID 29630198. (abstract)
Tinti L, Cicaloni V, Nezi P et al.. Hydroxyanthracene derivates citotoxicity: A differential evaluation between single molecule and whole plant extract.. Front Plant Sci. 2023. PMID 37113593. DOI 10.3389/fpls.2023.1166075. (abstract)
US Food and Drug Administration. Status of certain additional over-the-counter drug category II and III active ingredients. Final rule.. Federal Register 67(90):31125-7. 2002. PMID 12001972. (abstract)
Vyth and Kamp (as cited in EMA/HMPC/909434/2019). Rhein in urine after powdered cascara extract (Vyth and Kamp, 1979, as described in the EMA assessment report). Original not read; described in EMA assessment report. 1979. (summary-only)
de Witte P, Lemli L. The metabolism of anthranoid laxatives.. Hepatogastroenterology. 1990. PMID 2289777. (abstract)
de Witte P, Cuveele J, Lemli J. Bicascarosides in fluid extracts of cascara.. Planta Med. 1991. PMID 1798797. DOI 10.1055/s-2006-960145. (abstract)

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