Senna
Common name
Senna leaf, Senna pods
ID
HD0056
Scientific name of the plant
Senna alexandrina, synonyms Cassia acutifolia, Cassia angustifolia, Cassia senna, Cassia lanceolata
Anatomical part for use
leaf, fruit
Human use
Constipation
Summary
Senna, the sennas, is a large genus of flowering plants in the legume family (Fabaceae, subfamily Caesalpinioideae, tribe Cassieae). This diverse genus is native throughout the tropics, with a small number of species in temperate regions. The number of species is estimated to be from about 260 to 350. The type species for the genus is Senna alexandrina. About 50 species of Senna are known in cultivation. (Source: Wiki)
Evidence Level
Level 4 (Individual reports repeated observed over 5 years among different countries)
Hepatotoxicity reports in literature
- Senna-induced hepatitis in a poor metabolizer : (Source)
- Acute liver failure with renal impairment related to the abuse of senna anthraquinone glycosides : (Source)
- Subacute cholestatic hepatitis likely related to the use of senna for chronic constipation : (Source)
- Hepatitis after chronic abuse of senna : (Source)
- Portal vein thrombosis related to Cassia angustifolia : (Source)
Hepatotoxicity Description
Use of senna in the recommended doses for a limited period of time has been associated with few side effects, most of which are mild and transient and related to its laxative action. With longer term and higher dose use of senna, however, adverse events have been described including several cases of clinically apparent liver injury. The time to onset of liver injury was usually after 3 to 5 months of use, and the pattern of serum enzyme elevations was hepatocellular. The liver injury was usually mild-to-moderate in severity and resolved rapidly with discontinuation. In at least one instance, reexposure led to rapid recurrence of liver injury. Immunoallergic features and autoimmune markers were not present in the published cases.
In addition, a related plant commonly known as coffee senna or Cassia orientalis has been linked to many instances of acute, severe toxicity with encephalopathy, myopathy and hepatic dysfunction. Outbreaks of “hepato-myo-encephopathy” of unknown cause among children occurred yearly in Uttar Pradesh, India typically between September and November. Investigation eventually identified Cassia occidentalis ingestion as the probable cause, typically occurring in children who eat the leaves or pods of the common flowering weed. While Cassia occidentalis has also been used to prepare tea, the amount ingested was minimal. In children, and rarely in adults, the presentation was precipitous with nausea, vomiting, tremor, abnormal and violent behavior, grimacing and self-mutilation followed by stupor and coma at which time serum aminotransferase and bilirubin levels were typically elevated. In severe instances, the liver injury was progressive, serum ammonia and INR levels rose and patients developed coma, convulsions and status epilepticus that was unresponsive to therapy. Autopsies revealed hepatic necrosis and cholestasis. A similar pattern of symptoms and injury occurs in animals that consume Cassia occidentalis. Whether this syndrome has a similar pathogenesis to the rare instance of hepatic injury attributed to typical senna (Cassia acutifolia or angustifolio) that is used as a laxative is unknown. (Source: LiverTox)
Common name
Senna leaf, Senna pods
ID
HD0056
Scientific name of the plant
Senna alexandrina, synonyms Cassia acutifolia, Cassia angustifolia, Cassia senna, Cassia lanceolata
Anatomical part for use
leaf, fruit
Human use
Constipation
Summary
Senna, the sennas, is a large genus of flowering plants in the legume family (Fabaceae, subfamily Caesalpinioideae, tribe Cassieae). This diverse genus is native throughout the tropics, with a small number of species in temperate regions. The number of species is estimated to be from about 260 to 350. The type species for the genus is Senna alexandrina. About 50 species of Senna are known in cultivation. (Source: Wiki)
Evidence Level
Level 4 (Individual reports repeated observed over 5 years among different countries)
Hepatotoxicity reports in literature
- Senna-induced hepatitis in a poor metabolizer : (Source)
- Acute liver failure with renal impairment related to the abuse of senna anthraquinone glycosides : (Source)
- Subacute cholestatic hepatitis likely related to the use of senna for chronic constipation : (Source)
- Hepatitis after chronic abuse of senna : (Source)
- Portal vein thrombosis related to Cassia angustifolia : (Source)
Hepatotoxicity Description
Use of senna in the recommended doses for a limited period of time has been associated with few side effects, most of which are mild and transient and related to its laxative action. With longer term and higher dose use of senna, however, adverse events have been described including several cases of clinically apparent liver injury. The time to onset of liver injury was usually after 3 to 5 months of use, and the pattern of serum enzyme elevations was hepatocellular. The liver injury was usually mild-to-moderate in severity and resolved rapidly with discontinuation. In at least one instance, reexposure led to rapid recurrence of liver injury. Immunoallergic features and autoimmune markers were not present in the published cases. In addition, a related plant commonly known as coffee senna or Cassia orientalis has been linked to many instances of acute, severe toxicity with encephalopathy, myopathy and hepatic dysfunction. Outbreaks of “hepato-myo-encephopathy” of unknown cause among children occurred yearly in Uttar Pradesh, India typically between September and November. Investigation eventually identified Cassia occidentalis ingestion as the probable cause, typically occurring in children who eat the leaves or pods of the common flowering weed. While Cassia occidentalis has also been used to prepare tea, the amount ingested was minimal. In children, and rarely in adults, the presentation was precipitous with nausea, vomiting, tremor, abnormal and violent behavior, grimacing and self-mutilation followed by stupor and coma at which time serum aminotransferase and bilirubin levels were typically elevated. In severe instances, the liver injury was progressive, serum ammonia and INR levels rose and patients developed coma, convulsions and status epilepticus that was unresponsive to therapy. Autopsies revealed hepatic necrosis and cholestasis. A similar pattern of symptoms and injury occurs in animals that consume Cassia occidentalis. Whether this syndrome has a similar pathogenesis to the rare instance of hepatic injury attributed to typical senna (Cassia acutifolia or angustifolio) that is used as a laxative is unknown. (Source: LiverTox)