Cascara sagrada means ‘sacred bark’ in Spanish. The bark of this tree, which grows mostly on the west coast of the United States and parts of South America,1
is mainly used to treat
constipation. Cascara sagrada can be found as an ingredient in over-the-counter laxatives.2
In addition to relieving constipation, cascara sagrada has also been used by Native Americans to treat liver problems,
joint and muscle pain, gonorrhea,
indigestion, upset stomach, and dysentery (infection in the intestines that causes pain, fever, and
Cascara sagrada bark contains anthraquinones. Anthraquinones are substances found in plants that give them their color. Because of this, they have been used as dyes. Certain anthraquinones in cascara sagrada, called cascarosides A and B, are also responsible for the bark’s laxative effect. When a person ingests the bark, the cascarosides interact with bacteria living in the large intestine to form substances that stimulate the intestine to move the bowels.3
Cascara sagrada is available as an over-the-counter laxative in the forms of tablets,
capsules, and liquids.
In its raw form, the bark cannot safely be used until it is at least one year old or heated to above 212°F (100°C). Bark that is young or untreated has too strong of a laxative effect and produces severe intestinal spasm and cramping.3
The recommend dose of cut or powdered aged bark is 1-2 grams per day (containing 20-30 milligrams of
cascaroside A). However, since few people consume the raw bark, dosages vary considerably
depending on the product containing cascara sagrada. Therefore, it is best
to check the product label for the appropriate dosage.
Make sure to read the label if you are considering the laxative for a child, as there
may be instructions specific to children. Cascara should not be used by children under 12
unless specifically recommended by their physician.
Overdosing on laxatives can cause
nausea, vomiting, abdominal cramping, and dehydration. Taking too much cascara sagrada may also lead to abdominal pain, diarrhea, collapse, bloody stools, and in extreme cases, electrolyte abnormalities and heart rhythm disturbances.6
Cascara sagrada is most often used to treat constipation.
In a review of laxatives used in the treatment of chronic diarrhea, researchers were unable to uncover any studies on the effectiveness of cascara sagrada alone or in combination with other laxatives.11
The evidence for its benefit
is based on its traditional use and the known effects of cascaroside anthraquinones on bowel
A few case reports have linked cascara sagrada to serious liver problems.5,8,7
Cascara sagrada should be avoided in cases of intestinal blockage, inflammatory bowel
ulcerative colitis), appendicitis, or abdominal pain of unknown origin.10
Since little safety information is available, women who are pregnant or lactating and children under 12 years old should not use cascara sagrada.3
Some people taking cascara sagrada may develop a dependency on the laxative.3
Frequent use may also cause a change in color of the stools and urine, however this is not harmful.3,4
Harmless pigmentation inside the colon may also occur.
Chronic use, meaning using the laxative for more than seven days, may lead to fluid and
electrolyte loss (eg, potassium) and loss of proper intestinal muscle contractions. This
effect may be increased if you are taking heart medicines, diuretics, corticosteroids, or
Taber's Cyclopedic Medical Dictionary. 20th ed. FA Davis Company; 2005.
BMA A-Z Family Medical Encyclopedia. 2004.
Peterson Field Guide to Western Medicinal Plants & Herbs. 2002.
Stimulant laxatives. PubMed Health website. Available at:
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000099. Reviewed February 1, 2009. Accessed September 17, 2010.
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 Dec;95(12):3634-7.
JR, Malagelada C. Nausea and vomiting. In: Feldman M, Friedman LS, Brandt LJ, eds.
Sleisenger & Fordtran’s Gastrointestinal and Liver Disease. 8th ed. Philadelphia, PA: Saunders Elsevier; 2006:chap 8.
Jacobsen C, Semb S,
Kromann-Andersen H. Toxic hepatitis following
consumption of the herbal medicinal product cascara sagrada.
Ugeskr Laeger. 2009 Nov 9;171(46):3367-9.
Pittler MH, Ernst E. Systematic review: hepatoxic
events associated with herbal medicinal products.
Aliment Pharmacol Ther. 2003;18:451-471.
Go for natural laxative relief, but best if not from senna or cascara.
Environmental Nutrition; 2002 May; 25(5):7.
Cascara. Memorial Sloan-Kettering
Cancer Center website. Available at:
http://www.mskcc.org/mskcc/html/69165.cfm. Updated August 24, 2010. Accessed September 20, 2010.
Frizelle F, Barclay M. Constipation in adults.
(Online). 2007 Aug
Last reviewed December 2015 by EBSCO CAM Review Board
EBSCO Information Services is fully accredited by URAC. URAC is an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification and commendation.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © EBSCO Information Services. All rights reserved.