Sennae folium

Senna leaf is the common name for the leaf of the plant Senna alexandrina Mill. (Cassia senna L.; Cassia angustifolia Vahl).

The HMPC conclusions cover senna leaf preparations that are obtained by drying and comminuting (reducing into tiny pieces) the leaves. The dried, comminuted leaves may also be put in a solvent (such as ethanol) to dissolve compounds and form an extract. All senna leaf preparations are standardised to contain a defined amount of anthraquinones, which are substances linked with the activity of senna leaf.

Herbal medicines containing senna leaf preparations are usually available as herbal tea to be drunk, and in solid or liquid forms to be taken by mouth.

Senna leaf preparations may also be found in combination with other herbal substances in some herbal medicines. These combinations are not covered in this summary.

The HMPC concluded that senna leaf preparations can be used short term for occasional constipation.

Senna leaf medicines should only be used in adults and adolescents over the age of 12 years and should not be taken for longer than one week. Usually it is sufficient to take senna leaf medicines two to three times a week. If symptoms continue or get worse while taking the medicine, a doctor or pharmacist should be consulted. Patients taking certain medicines should consult a doctor before taking senna leaf preparations at the same time. Detailed instructions on how to take senna leaf medicines and who can use them can be found in the package leaflet that comes with the medicine.

Senna leaf medicines contain anthraquinones. These stimulate bowel movements, encouraging the bowels to empty. They also alter the absorption of water and salt from the bowels. This increases the amount of water in the material in the gut and so softens it and allows it to pass along the gut more easily.

The HMPC conclusions on the use of these senna leaf medicines for occasional constipation are based on their ‘well-established use’. This means that there are bibliographic data providing scientific evidence of their effectiveness and safety when used in this way, covering a period of at least 10 years in the EU.

In its assessment, the HMPC considered laboratory studies, experts reports, extensive clinical experience as well as several studies in mostly elderly patients with long-term or severe constipation. These studies compared senna medicines, taken with fibres, with other treatments for constipation (such as lactulose). Overall, these studies showed that senna medicines taken with fibres were at least as effective as the comparator at treating constipation.

For detailed information on the studies assessed by the HMPC, see the HMPC assessment report.

Side effects with senna leaf medicines include allergic reactions (such as itching and rash), abdominal (belly) pain, spasm and diarrhoea. Long-term use may cause colouration of the lining of the intestine, which usually resolves when the patient stops taking the medicine, imbalance of water and salt in the body, presence of proteins and blood in the urine and yellow or red-brown colour of the urine. The frequency of these side effects is not known.

Senna leaf medicines must not be taken by patients with blockages or stenosis (narrowing) of the intestines, intestinal atony (loss of strength or movement in bowel muscles), appendicitis, inflammatory bowel diseases (Crohn’s disease, ulcerative colitis), unexplained abdominal pain or severe dehydration. They must also not be taken during pregnancy, when breastfeeding or by children under 12 years of age.

Long-term use of laxatives like senna leaf should be avoided, as use for more than a short time may lead to the bowels not working properly and cause dependence on laxatives.

Further information on the risks associated with these senna leaf medicines, including the appropriate precautions for their safe use, can be found in the monograph which is published on the Agency’s website under the section ‘Documents’.

Any applications for the licensing of medicines containing senna leaf have to be submitted to the national authorities responsible for medicinal products, which will assess the application for the herbal medicine and take into account the scientific conclusions of the HMPC.

Information on the use and licensing of senna leaf medicines in EU Member States should be obtained from the relevant national authorities.

Further information on the HMPC assessment of senna leaf medicines, including details of the Committee’s conclusions, can be found in the section ‘Documents’ . For more information about treatment with senna leaf medicines, read the package leaflet that comes with the medicine or contact your doctor or pharmacist.

 For more information about treatment with senna leaf medicines, read the package leaflet that comes with the medicine or contact your doctor or pharmacist.