What is the recommended dose and frequency of Senna (ex-lax)

From the Guidelines

Senna is recommended to be taken orally at a dose of 8-9 mg (1 tablet) once daily, typically at bedtime, for constipation relief, as this dose is commonly found in commercially available products and is lower than the dose used in clinical trials, which may reduce the risk of adverse events. The dose of 1 g by mouth daily for 4 weeks, as used in the clinical trial by Moshita et al. 1, is higher than that typically used in clinical practice and may increase the risk of adverse events such as abdominal pain, cramping, or diarrhea. Some key points to consider when using senna include:

• Effects generally occur within 6-12 hours, making evening dosing ideal for morning bowel movements
• For occasional constipation, senna should be used for no more than 1 week unless directed by a healthcare provider
• Senna contains plant compounds called sennosides that are activated by gut bacteria to stimulate intestinal contractions
• Side effects may include abdominal cramping, diarrhea, or electrolyte imbalances with prolonged use
• Pregnant women, nursing mothers, and those with intestinal blockage, undiagnosed abdominal pain, or inflammatory bowel conditions should consult a healthcare provider before using senna, as sennosides are not recommended in pregnant women due to potential genotoxic effects in animals 1. It is essential to drink plenty of fluids while taking senna and discontinue use if severe abdominal pain or diarrhea occurs. The combination of efficacy, impact on quality of life, availability over-the-counter, and low cost makes senna an attractive first-line option for individuals with chronic idiopathic constipation, as stated in the american gastroenterological association-american college of gastroenterology clinical practice guideline 1.

From the FDA Drug Label

Directions ■ take preferably at bedtime or as directed by a doctor. adults and children 12 years and over ■ 1 capsule once a day. Maximum 2 capsules twice a day. children 6 to under 12 years ■ maximum 1 capsule twice a day children under 6 years ■ ask a doctor

The recommended dose and frequency of Senna (ex-lax) is:

• Adults and children 12 years and over: 1 capsule once a day, with a maximum of 2 capsules twice a day.
• Children 6 to under 12 years: maximum 1 capsule twice a day.
• Children under 6 years: should ask a doctor for guidance. 2

From the Research

Recommended Dose and Frequency of Senna

The recommended dose and frequency of Senna (ex-lax) can vary depending on the individual and the specific condition being treated.

• According to a study published in the Journal of Pediatric Surgery in 2018 3, the dose of Senna was not significantly different in patients who presented minor side effects, with a median dose of 15mg/day [4.4-150] vs. 17.5mg/day [1.5-150].
• A randomized controlled trial published in the Journal of Pediatric Surgery in 2017 4 used a maximum daily dose of Senna (sennosides A and B) of 38.7mg.
• A study published in Pharmacology in 1993 5 used a daily dose of 14.8g of a bulk laxative containing Senna.
• A study published in the Journal of Ethnopharmacology in 2023 6 used a dose of 2.6mg/kg of sennoside A, the core functional component of rhubarb, and found that it had a significant laxative effect at 7 days of administration.

Administration and Usage

• The study published in the Journal of Pediatric Surgery in 2018 3 found that patients who developed blisters had higher doses of Senna, with a median dose of 60mg/day [12-100] vs. 17.5mg/day [1.5-150].
• The study published in the Journal of Ethnopharmacology in 2023 6 found that sennoside A should be used in regular dosages for less than one week, as it provides significant relief of constipation and exhibits no colonic damage within 7 days of administration.
• The study published in Pharmacology in 1988 7 stated that standardized Senna is the most physiological of all the non-fibre laxatives and is safe when used in appropriate dosage avoiding loose stools.

Special Considerations

• The study published in the Journal of Pediatric Surgery in 2018 3 found that pediatric caregivers should advise families of the rare side effect of skin blistering and educate them to change the diaper frequently in children who are not toilet-trained to reduce stool to skin exposure.
• The study published in the Journal of Ethnopharmacology in 2023 6 found that sennoside A affects the structure and function of gut microbes, and that the alpha diversity showed that the abundance and diversity of gut microorganisms reached the highest value after 7 days of administration.