Purgative
PREGNANCY RECOMMENDATION: Limited Human Data—Probably Compatible
BREASTFEEDING RECOMMENDATION: Limited Human Data—Probably Compatible
PREGNANCY SUMMARY
Cascara sagrada is an anthraquinone purgative. Although the data are limited, there is no evidence that drugs in this class pose a risk to the embryo–fetus.
FETAL RISK SUMMARY
In a large prospective study, 53 mother–child pairs were exposed to cascara sagrada during the 1st trimester (1, pp. 384–387). Although the numbers are small, no evidence for an increased risk of malformations was found. For anytime use during pregnancy, 188 exposures were recorded (1, pp. 438, 442, 497). The relative risk for benign tumors was higher than expected, but independent confirmation is required (1, pp. 438, 442, 497).
A 1977 study found that more than 50% of the women taking laxatives during pregnancy had taken a laxative of the anthraquinone type (2). Danthron (1:8 dihydroxyanthraquinone) was administered to nine women shortly before induction of labor. Presence of the laxative and/or its metabolite was documented in the amniotic fluid and in the urine of the newborns. No fetal adverse effects were noted (2).
BREASTFEEDING SUMMARY
Most reviewers acknowledge the presence of anthraquinones (e.g., cascara and danthron) in breast milk and warn of the consequences for the nursing infant (3–5). A comprehensive review described the excretion of laxatives into human milk, but little is known about the presence of these agents in breast milk (6). Two reports suggest an increased incidence of diarrhea in infants when nursing mothers are given cascara sagrada or senna for postpartum constipation (7,8). However, the American Academy of Pediatrics classifies cascara and danthron as compatible with breastfeeding (9).
References
1.Heinonen OP, Slone D, Shapiro S. Birth Defects and Drugs in Pregnancy. Littleton, MA: Publishing Sciences Group, 1977.
2.Blair AW, Burdon M, Powell J, Gerrard M, Smith R. Fetal exposure to 1:8 dihydroxyanthraquinone. Biol Neonate 1977;31:289–93.
3.Knowles JA. Breast milk: a source of more than nutrition for the neonate. Clin Toxicol 1974;7:69–82.
4.O’Brien TE. Excretion of drugs in human milk. Am J Hosp Pharm 1974;31:844–54.
5.Edwards A. Drugs in breast milk—a review of the recent literature. Aust J Hosp Pharm 1981;11:27–39.
6.Stewart JJ. Gastrointestinal drugs. In: Wilson JT, ed. Drugs in Breast Milk. Balgowlah, Australia: ADIS Press, 1981:65–71.
7.Tyson RM, Shrader EA, Perlman HH. Drugs transmitted through breast milk. Part I. Laxatives. J Pediatr 1937;11:824–32.
8.Greenleaf JO, Leonard HSD. Laxatives in the treatment of constipation in pregnant and breast-feeding mothers. Practitioner 1973;210:259–63.
9.Committee on Drugs, American Academy of Pediatrics. The transfer of drugs and other chemicals into human milk. Pediatrics 2001;108:776–89.