Cascara Sagrada
Cascara sagrada is a stimulant laxative from cascara tree bark. The FDA reclassified it as non-GRASE for OTC laxative use in 2002 (21 CFR 310.545) because manufacturers failed to submit adequate safety data. It remains available as a dietary supplement under DSHEA — a regulatory loophole — but credible medical sources (NIH LiverTox, MSKCC, WHO) recommend AT MOST 1–2 weeks of occasional use, not chronic intake. Documented harms include hepatotoxicity case reports, electrolyte loss (especially potassium), and laxative dependence.
Quick decision guide
May help most
Generally not recommended. If used at all, only for very short-term occasional constipation in an adult, ideally with a clinician's input — and only after first-line options (fiber, fluid, osmotic laxatives like polyethylene glycol) are inadequate.
Common dosing range
Historical herbal doses: 20–30 mg hydroxyanthracene derivatives once at bedtime (the European standard for short-term use), or 1 cup tea from 2 g of aged bark. DO NOT use freshly stripped bark — it must be aged ≥1 year (or heat-treated) to allow conversion of toxic intermediates.
When to expect effects
Bowel movement typically 6–12 hours after a single dose.
Watch out for
FDA-banned for OTC use. Hepatotoxicity cases reported. Dependence and electrolyte loss with chronic use. Avoid in pregnancy, breastfeeding, children, inflammatory bowel disease, intestinal obstruction, undiagnosed abdominal pain.
Evidence snapshot
What is it
Is it worth it for you?
Use this as a quick fit check, not a diagnosis.
Worth considering if…
Probably skip if…
Evidence at a glance
| Goal | Effect | Best fit | Time |
|---|---|---|---|
Short-term occasional constipation Limited Evidence | Bowel movement 6–12 hours after a single 20–30 mg hydroxyanthracene dose | Adults with acute, occasional constipation who've ruled out serious causes and have no contraindication | 6–12 hours after dose |
Short-term occasional constipation
- Effect
- Bowel movement 6–12 hours after a single 20–30 mg hydroxyanthracene dose
- Best fit
- Adults with acute, occasional constipation who've ruled out serious causes and have no contraindication
- Time
- 6–12 hours after dose
Evidence for 1 use
AI-assisted evidence assessment — talk to your doctor before relying on any single supplement.
Short-term occasional constipation
Supplement benefitCascara's cascarosides are hydrolyzed by colonic bacteria to active anthrones that irritate the colon wall, accelerate peristalsis, and inhibit water absorption. A bowel movement typically follows 6–12 hours after an evening dose. Effectiveness is well-established mechanistically and historically, but the FDA's 2002 rule was that manufacturers had not submitted enough modern safety AND effectiveness data to keep it on the OTC market. WHO, MSKCC, and standard European herbal monographs limit use to ≤1–2 weeks.
Bottom line: Works for one-shot acute constipation. But polyethylene glycol (MiraLAX), psyllium, and magnesium hydroxide are safer, evidence-backed, FDA-approved alternatives — start there.
How it works
How to take it
What to track
Bottom line: If you've reached for cascara, you've usually skipped over safer options. Try polyethylene glycol (MiraLAX) or psyllium fiber first. If you do use cascara, keep it to ≤1–2 weeks and stop at the first sign of liver or electrolyte trouble.
5 commercial forms
Compare the main delivery options and what they’re best suited for.
Standardized cascara extract (capsule/tablet)
Most commonAged bark extract standardized to cascarosides. Typically 20–30 mg hydroxyanthracene derivatives per dose. Marketed as a dietary supplement under DSHEA after the FDA's 2002 OTC ban.
Standardized dosing; predictable laxative effect 6–12 hours after dose.
Liquid fluid extract / tincture
Variable strengthAlcohol or glycerin extract of aged bark. Strength varies by manufacturer; harder to dose precisely than a standardized capsule.
Faster onset than capsule; dosing less standardized.
Aged-bark tea
TraditionalTraditional preparation: ~2 g aged bark steeped in hot water. Less standardized than commercial extracts; same precautions and same FDA OTC ban.
Variable potency depending on bark age and brewing time.
Multi-ingredient 'colon cleanse' or 'detox' blends
AvoidCascara combined with senna, rhubarb, aloe, and bulk fibers. Marketed for daily or chronic use — directly contradicts safety guidance. Stacked stimulant laxatives compound dependence and electrolyte risk.
Unpredictable interactions between stacked laxatives.
Fresh cascara bark (foraged or homemade)
DangerousFreshly stripped bark contains toxic anthrone intermediates causing severe vomiting and intestinal cramping. Must be aged at least 1 year or heat-treated. Foraged use is NOT safe.
Unsafe — contains toxic intermediates.
Safety
Know the common side effects, key cautions, and who should avoid it.
Common side effects
Serious risks
FDA reclassified cascara as 'not generally recognized as safe and effective' for OTC laxative use in 2002 (21 CFR 310.545). It can no longer be marketed as an OTC laxative drug, although it remains legal under DSHEA as a dietary supplement. This is the most important regulatory signal: the FDA concluded the safety data submitted by manufacturers was inadequate.
HEPATOTOXICITY — published case reports of clinically apparent acute liver injury (cholestatic hepatitis pattern) after weeks-to-months of cascara use. Latency is typically several months. NIH LiverTox lists cascara among the anthraquinone laxatives with documented hepatotoxic case-report signal. STOP cascara and seek medical evaluation for jaundice, dark urine, light-colored stools, RUQ pain, or persistent nausea.
ELECTROLYTE DISTURBANCE — especially hypokalemia (low potassium) with chronic use. Can be dangerous in patients on digoxin (toxicity risk), diuretics, or with cardiac arrhythmia history. May cause muscle weakness, cramps, and arrhythmia.
LAXATIVE DEPENDENCE AND ATONIC COLON — prolonged stimulant laxative use trains the colon to depend on the irritant for motility. Stopping after months of use can cause severe rebound constipation.
MELANOSIS COLI — dark pigmentation of the colon lining visible on colonoscopy, caused by chronic anthraquinone exposure. Cosmetic only and reversible after stopping, but it's a marker that you've been using these laxatives too long.
FRESH UNAGED BARK — cascara bark must be aged at least 1 year (or heat-treated) before use; freshly stripped bark contains toxic anthrone intermediates causing severe vomiting and intestinal cramping. Commercial products use aged or heat-treated bark; foraged bark is not safe.
Who should avoid it
- Pregnant or breastfeeding individuals — anthraquinones may pass into breast milk and have caused diarrhea in nursing infants. WHO contraindicates use in pregnancy.
- Children under 12 — not appropriate. Children 12–18 should not use without a clinician.
- Anyone with inflammatory bowel disease (Crohn's, ulcerative colitis), bowel obstruction or stenosis, atonic colon, appendicitis, undiagnosed abdominal pain, severe dehydration, or recent bowel surgery.
- Anyone with existing liver disease, on hepatotoxic medications, or with a history of drug-induced liver injury.
- Anyone on digoxin (potassium loss potentiates digoxin toxicity), diuretics (compound electrolyte loss), or warfarin (electrolyte and absorption changes).
Pregnancy & breastfeeding
AVOID during pregnancy and breastfeeding. WHO explicitly contraindicates anthranoid laxatives including cascara in pregnancy. Anthraquinones may pass into breast milk and have caused diarrhea in nursing infants. Use polyethylene glycol (MiraLAX) or psyllium fiber instead — both are pregnancy-safe.
Bottom line: Cascara is FDA-banned for OTC laxative sale, has documented hepatotoxicity case reports, and causes electrolyte loss and dependence with chronic use. Polyethylene glycol (MiraLAX) and psyllium fiber are safer first-line options for constipation.
Interactions
Cascara causes potassium loss; low potassium dramatically increases digoxin toxicity (arrhythmia). Avoid combination.
Compounded electrolyte loss (especially potassium). Avoid combination or monitor electrolytes closely.
Diarrhea can alter vitamin K absorption and INR; cascara may also affect drug absorption through accelerated transit. Avoid the combination if possible.
Both cause potassium loss; chronic combination increases risk of severe hypokalemia.
Compounded cramping, electrolyte loss, and dependence risk. Do not stack stimulant laxatives.
Accelerated intestinal transit can reduce absorption of co-administered drugs. Separate cascara dosing from other medications.
Choosing a product
What to look for on the label — and what to be skeptical of.
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Frequently asked questions
Is cascara sagrada safe to take long-term?⌄
No. Stimulant laxatives like cascara should be used only for short-term constipation, ideally less than one week. Long-term use can cause electrolyte loss and laxative dependence.
Why is cascara no longer in OTC laxatives?⌄
The FDA removed it from OTC laxative monographs in 2002 because manufacturers did not submit required safety and effectiveness data. It remains available as a supplement.
Does cascara turn urine a different color?⌄
Yes, the anthraquinones can give urine a reddish or yellowish-brown tint. This is harmless and disappears when you stop the supplement.
References by claim
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Coming to App StoreDisclaimer: These statements have not been evaluated by the FDA. This page is educational, not a substitute for personalized medical advice. Evidence grades are AI-assisted assessments — talk to your doctor before starting any new supplement, especially if you’re pregnant, breastfeeding, on medications, or managing a chronic condition.