Cascara

What are other names for this remedy?

Type of medicine: natural remedy

Scientific and common names: Rhamnus purshianus, Frangula purshiana, Californian buckthorn, sacred bark, cascara sagrada, bitter bark, buckthorn, chittem bark, dogwood bark, purshiana bark, rhamni purshianae cortex, sagrada bark, yellow bark

What is cascara?

Cascara is a shrub. Dried bark from the shrub is used to make medicine.

What is it used for?

Cascara has been used to treat:

• gallstones
• liver disease

Cascara has been used to relieve constipation. However, the US Food and Drug Administration (FDA) does not allow cascara to be used in laxative medicines because there is no proof that it is safe or effective.

The FDA does not approve uses for natural remedies. The FDA does not inspect or regulate natural remedies the way they do prescription medicines.

How is it taken?

Cascara sagrada can be taken as capsules, tablets, or tinctures by mouth. Check the label on the package for the specific dose. Drink at least 8 glasses of water per day while taking any laxative product.

What if I overdose?

Symptoms of an acute overdose have not been reported.

What should I watch out for?

Do not take cascara if you have:

• appendicitis
• Crohn's disease
• stomach pain or ulcers
• ulcerative colitis

Cascara is safe for most adults when used for a short time. Do not take it for more than 1 to 2 weeks. Using this remedy for a long time may make you unable to have a bowel movement without laxatives. Do not take more than directed. Do not use cascara with another laxative. If you are still constipated, contact your healthcare provider.

Cascara might make other drugs taken by mouth less effective. Cascara stimulates the bowel and might keep medicines from being absorbed properly.

Cascara can lower potassium levels in the body. Taking cascara with certain medicines might cause the level of potassium in your blood to be too low. Some of these medicines include other laxatives, steroid medicines, and certain diuretics.

Do not use cascara in children less than 2 years old. Talk with your provider before giving this remedy to any child.

Females of childbearing age: Do not take this remedy if you are pregnant or breast-feeding.

Cascara may make your urine a reddish, brown, or pink color. This is not harmful.

Talk to your healthcare provider or pharmacist about any natural remedy that you are using or thinking about using. If your provider does not tell you how to take it, follow the directions that come with the package. Do not take more or take it longer than recommended. Ask about anything you do not understand. Remember:

• Natural remedies are not always safe.
• You should not take them if you are pregnant or breast-feeding without your healthcare provider's approval. They should not be taken by infants, children, or older adults without your provider's approval.
• They affect your body and may interact with prescription medicines that you take.
• Natural remedies are not standardized and may be contaminated. They may have different strengths and effects.

What are the possible side effects?

Along with its desirable effects, this remedy may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the remedy. Tell your healthcare provider if you have any side effects that continue or get worse.

Serious: Muscle weakness, lightheadedness, bloody diarrhea, irregular heartbeat, swelling in your legs or feet, blood in the urine.

Other: Abdominal pain, nausea, vomiting.

What products might interact with this remedy?

When you take this remedy with other medicines, it can change the way the remedy or the medicines work. Vitamins and certain foods may also interact. Using these products together might cause harmful side effects. Before taking this remedy, talk to your healthcare provider if you are taking:

• corticosteroids such as prednisone, dexamethasone, hydrocortisone (Cortef), prednisolone (Prelone), and methylprednisolone (Medrol)
• digoxin (Lanoxin)
• diuretics (water pills) such as chlorothiazide (Diuril), hydrochlorothiazide (Microzide, Oretic), chlorthalidone (Thalitone), furosemide (Lasix), bumetanide (Bumex), torsemide (Demadex), and metolazone (Zaroxolyn)
• herbal remedies such as horsetail, aloe, buckthorn, licorice, rhubarb, and yellow dock root
• laxatives such as senna, bisacodyl (Dulcolax), and castor oil

Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

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Keep all natural remedies and medicines out of the reach of children.

This advisory includes select information only. The information was obtained from scientific journals, study reports, and other documents. The author and publisher make no warranty, expressed or implied, as to the information. The advisory may not include all side effects associated with a remedy or interactions with other medicines. Nothing herein shall constitute a recommendation for the use of any remedy. Ask your healthcare provider or pharmacist for more information.

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