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Senna: Drug information

Senna: Drug information
(For additional information see "Senna: Patient drug information" and see "Senna: Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: US
  • Ex-Lax Maximum Strength [OTC];
  • Ex-Lax [OTC];
  • Geri-kot [OTC];
  • GoodSense Laxative Pills [OTC];
  • GoodSense Senna Laxative [OTC];
  • OneLAX Senna [OTC];
  • Perdiem Overnight Relief [OTC];
  • Senexon [OTC] [DSC];
  • Senna Laxative [OTC];
  • Senna Smooth [OTC];
  • Senna-GRX [OTC] [DSC];
  • Senna-Lax [OTC];
  • Senna-Tabs [OTC];
  • Senna-Time [OTC];
  • Sennazon [OTC];
  • Senno [OTC] [DSC];
  • Senokot Extra Strength [OTC];
  • Senokot Laxative Gummies [OTC];
  • Senokot [OTC]
Pharmacologic Category
  • Laxative, Stimulant
Dosing: Adult

Note: Several types of senna products are available on the market and multiple formulations exist that are not equivalent; products composed of sennosides are considered OTC medications; senna pod concentrate and senna leaf extract are considered dietary supplements and are not interchangeable on a mL-to-mL (or mg-to-mg) basis with other senna products that contain sennosides; close attention must be paid to the product description and concentration when ordering or administering.

Constipation

Constipation: Oral:

Sennosides:

Syrup (8.8 mg sennosides/5 mL): 10 to 15 mL (17.6 mg to 26.4 mg sennosides) once daily; maximum: 15 mL (26.4 mg sennosides) twice daily.

Tablets:

8.6 mg sennosides/tablet: Two tablets (17.2 mg sennosides) once daily; maximum: 4 tablets (34.4 mg sennosides) twice daily

15 mg sennosides/tablet: Two tablets (30 mg sennosides) once or twice daily

17.2 mg sennosides/tablet: One tablet (17.2 mg sennosides) once daily; maximum: 2 tablets (34.4 mg sennosides) twice daily

25 mg sennosides/tablet: Two tablets (50 mg sennosides) once or twice daily

Senna leaf extract syrup (176 mg/5 mL senna leaf extract): Note: Senna leaf extract is considered a dietary supplement and is not interchangeable on a mL-to-mL (or mg-to-mg) basis with other senna products that contain sennosides.

10 to 15 mL (352 to 528 mg senna leaf extract) once daily (preferably at bedtime); may increase to 10 to 15 mL (352 to 528 mg senna leaf extract) twice daily if needed; maximum daily dose: 30 mL/day

Dosing: Pediatric

(For additional information see "Senna: Pediatric drug information")

Note: Several types of senna products are available on the market and multiple formulations exist that are not equivalent; pay close attention to the product description and concentration when ordering, dispensing, or administering. Products composed of sennosides are considered OTC medications; senna pod concentrate and senna leaf extract are considered dietary supplements and are not interchangeable on a mL to mL (or mg to mg) basis with other senna products that contain sennosides. Approved ages for generic products may vary; consult labeling for specific information.

Constipation

Constipation:

Note: Other agents (eg, polyethylene glycol 3350) are preferred for constipation maintenance therapy. Stimulant laxatives (eg, senna) may be used as additional or second-line therapy for short-term use (NASPGHAN [Tabbers 2014]).

Sennosides:

Syrup (8.8 mg sennosides/5 mL):

Children <2 years: Very limited data available: Oral: 1.25 to 2.5 mL (2.2 to 4.4 mg sennosides) per day; maximum daily dose: 5 mL (8.8 mg sennosides) per day (Blackmer 2010). Note: Use with caution in young children (particularly those not toilet trained); senna may cause perianal skin breakdown and blistering if the stool is left in contact with the skin for a prolonged time and/or if high doses are administered (Cogley 2017; Vilanova-Sanchez 2018).

Children 2 to <6 years: Oral: 2.5 to 3.75 mL (4.4 to 6.6 mg sennosides) at bedtime; maximum daily dose: 3.75 mL (6.6 mg sennosides) twice daily. Note: Use with caution in young children (particularly those not toilet trained); senna may cause perianal skin breakdown and blistering if the stool is left in contact with the skin for a prolonged time and/or if high doses are administered (Cogley 2017; Vilanova-Sanchez 2018).

Children 6 to <12 years: Oral: 5 to 7.5 mL (8.8 to 13.2 mg sennosides) at bedtime; maximum daily dose: 7.5 mL (13.2 mg sennosides) twice daily.

Children ≥12 years and Adolescents: Oral: 10 to 15 mL (17.6 to 26.4 mg sennosides) at bedtime; maximum daily dose: 15 mL (26.4 mg sennosides) twice daily.

Tablets:

3 mg sennosides per chewable tablet (eg, Genexa Kids Senna Laxative):

Children 2 to <6 years: Oral: 1 tablet (3 mg sennosides) once or twice daily. Note: Use with caution in young children (particularly those not toilet trained); senna may cause perianal skin breakdown and blistering if the stool is left in contact with the skin for a prolonged time and/or if high doses are administered (Cogley 2017; Vilanova-Sanchez 2018).

Children 6 to <12 years: Oral: 2 tablets (6 mg sennosides) once or twice daily.

8.6 mg sennosides per tablet (eg, Senokot):

Children 2 to <6 years: Oral: 1/2 tablet (4.3 mg sennosides) at bedtime; maximum daily dose: 1 tablet (8.6 mg sennosides) twice daily. Note: Use with caution in young children (particularly those not toilet trained); senna may cause perianal skin breakdown and blistering if the stool is left in contact with the skin for a prolonged time and/or if high doses are administered (Cogley 2017; Vilanova-Sanchez 2018).

Children 6 to <12 years: Oral: 1 tablet (8.6 mg sennosides) at bedtime; maximum daily dose: 2 tablets (17.2 mg sennosides) twice daily.

Children ≥12 years and Adolescents: Oral: 2 tablets (17.2 mg sennosides) at bedtime; maximum daily dose: 4 tablets (34.4 mg sennosides) twice daily.

12 mg sennosides per tablet (eg, Genexa Senna Laxative):

Children 6 to <12 years: Oral: 1/2 tablet (6 mg sennosides) once or twice daily.

Children ≥12 years and Adolescents: Oral: 1 tablet (12 mg sennosides) once or twice daily.

15 mg sennosides per tablet (eg, Ex-Lax Regular Strength):

Children 6 to <12 years: Oral: 1 tablet (15 mg sennosides) once or twice daily.

Children ≥12 years and Adolescents: Oral: 2 tablets (30 mg sennosides) once or twice daily.

17.2 mg sennosides per tablet (eg, SenokotXTRA):

Children 6 to <12 years: Oral: 1/2 tablet (8.6 mg sennosides) at bedtime; maximum daily dose: 1 tablet (17.2 mg sennosides) twice daily.

Children ≥12 years and Adolescents: Oral: 1 tablet (17.2 mg sennosides) at bedtime; maximum daily dose: 2 tablets (34.4 mg sennosides) twice daily.

25 mg sennosides per tablet (eg, Ex-Lax Maximum Strength):

Children 6 to <12 years: Oral: 1 tablet (25 mg sennosides) once or twice daily.

Children ≥12 years and Adolescents: Oral: 2 tablets (50 mg sennosides) once or twice daily.

Senna pod concentrate liquid (Fletcher's Laxative for Kids; 167 mg/5 mL senna pod concentrate): Note: Senna pod concentrate is considered a dietary supplement and is not interchangeable on a mL to mL (or mg to mg) basis with other senna products.

Children 2 to <6 years: Oral: 5 to 10 mL (167 to 334 mg senna pod concentrate) once or twice daily. Note: Use with caution in younger children (particularly those not toilet trained); senna may cause perianal skin breakdown and blistering if the stool is left in contact with the skin for a prolonged time and/or if high doses are administered (Cogley 2017; Vilanova-Sanchez 2018).

Children ≥6 years and Adolescents ≤15 years: Oral: 10 to 15 mL (334 to 501 mg senna pod concentrate) once or twice daily.

Senna Leaf Extract Syrup (176 mg/5 mL senna leaf extract): Note: Senna leaf extract is considered a dietary supplement and is not interchangeable on a mL to mL (or mg to mg) basis with other senna products.

Children 2 to <6 years: Oral: 2.5 to 3.75 mL (88 to 132 mg senna leaf extract) once daily; maximum daily dose: 3.75 mL (132 mg senna leaf extract) twice daily. Note: Use with caution in younger children (particularly those not toilet trained); senna may cause perianal skin breakdown and blistering if the stool is left in contact with the skin for a prolonged time and/or if high doses are administered (Cogley 2017; Vilanova-Sanchez 2018).

Children ≥6 years to <12 years: Oral: 5 to 7.5 mL (176 to 264 mg senna leaf extract) once daily; maximum daily dose: 7.5 mL (264 mg senna leaf extract) twice daily.

Children ≥12 years and Adolescents: Oral: 10 to 15 mL (352 to 528 mg senna leaf extract) once daily; maximum daily dose: 15 mL (528 mg senna leaf extract) twice daily.

Dosing: Older Adult

Refer to adult dosing.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Leaves, Oral:

Generic: (454 g [DSC])

Liquid, Oral:

Generic: 8.8 mg/5 mL (237 mL)

Syrup, Oral:

OneLAX Senna: 8.8 mg/5 mL (237 mL) [alcohol free, gluten free, paraben free, sugar free; contains saccharin sodium, sodium benzoate]

Senna-GRX: 8.8 mg/5 mL (15 mL [DSC], 236 mL [DSC]) [contains parabens, propylene glycol]

Sennazon: 8.8 mg/5 mL (237 mL) [alcohol free; contains methylparaben, propylene glycol, propylparaben; chocolate flavor]

Generic: 8.8 mg/5 mL (5 mL, 15 mL, 236 mL [DSC], 237 mL); 176 mg/5 mL (15 mL, 237 mL)

Tablet, Oral:

Ex-Lax: 15 mg [DSC] [sodium free]

Ex-Lax Maximum Strength: 25 mg [contains corn starch, fd&c blue #1 (brill blue) aluminum lake, methylparaben, propylparaben, sodium benzoate]

Geri-kot: 8.6 mg

GoodSense Laxative Pills: 25 mg [contains corn starch, fd&c blue #1 (brilliant blue)]

GoodSense Senna Laxative: 8.6 mg

Perdiem Overnight Relief: 15 mg [contains corn starch, methylparaben, propylparaben, sodium benzoate]

Senexon: 8.6 mg [DSC]

Senna Laxative: 8.6 mg

Senna Smooth: 15 mg [contains sodium benzoate]

Senna-Lax: 8.6 mg

Senna-Tabs: 8.6 mg

Senna-Time: 8.6 mg

Senno: 8.6 mg [DSC]

Senokot: 8.6 mg

Senokot Extra Strength: 17.2 mg

Generic: 8.6 mg

Tablet Chewable, Oral:

Ex-Lax: 15 mg [DSC] [contains soybean lecithin, whey]

Ex-Lax: 15 mg [contains soybean lecithin, whey; chocolate flavor]

Senokot Laxative Gummies: 8.7 mg [contains coconut oil (copra/cocos nucifera oil)]

Senokot Laxative Gummies: 8.7 mg [dairy free, egg free, fish derivative free, gluten free, peanut free, shellfish free, soy free; contains coconut oil (copra/cocos nucifera oil)]

Generic Equivalent Available: US

May be product dependent

Administration: Adult

Once-daily doses should be preferentially taken at bedtime. Administer 2 hours before or after other medications.

Administration: Pediatric

Oral: Administer at bedtime (preferable) with water; syrup can be taken with juice or milk or mixed with ice cream to mask taste. Administer 2 hours before or after other medications.

Use: Labeled Indications

Constipation: Relieves occasional constipation (irregularity); generally causes bowel movement in 6 to 12 hours

Use: Off-Label: Adult

Colonic cleansing before colonoscopy (adjunct)

Medication Safety Issues
Sound-alike/look-alike issues:

Perdiem may be confused with Pyridium

Senexon may be confused with Cenestin

Senokot may be confused with Depakote

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

Frequency not defined: Gastrointestinal: Abdominal cramps, diarrhea, nausea, vomiting

Warnings/Precautions

Dosage form specific issues:

• Benzyl alcohol and derivatives: Some dosage forms may contain sodium benzoate/benzoic acid; benzoic acid (benzoate) is a metabolite of benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol derivative with caution in neonates. See manufacturer’s labeling.

Other warnings/precautions:

• Appropriate use: Failure to have a bowel movement or occurrence of rectal bleeding after use should be reported to health care provider.

• Self-medication (OTC use): Not recommended for use in patients experiencing stomach pain, nausea, vomiting, or a sudden change in bowel movements which lasts >2 weeks. Not recommended for OTC use in children <2 years of age. Do not use for more than 1 week.

Warnings: Additional Pediatric Considerations

Use with caution in younger children (particularly those not toilet trained); senna may cause perianal skin breakdown and blistering if the stool is left in contact with the skin for a prolonged time and/or if high doses are administered (Cogley 2017; Vilanova-Sanchez 2018).

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Dichlorphenamide: Laxatives may enhance the hypokalemic effect of Dichlorphenamide. Risk C: Monitor therapy

Digoxin: Senna may enhance the adverse/toxic effect of Digoxin. Risk C: Monitor therapy

Polyethylene Glycol-Electrolyte Solution: Senna may enhance the adverse/toxic effect of Polyethylene Glycol-Electrolyte Solution. Risk C: Monitor therapy

Sodium Sulfate: Laxatives (Stimulant) may enhance the adverse/toxic effect of Sodium Sulfate. Specifically, the risk of mucosal ulceration or ischemic colitis may be increased. Risk X: Avoid combination

Pregnancy Considerations

Use of senna should be limited during pregnancy due to an increased risk of adverse events, such as electrolyte abnormalities. When dietary changes and lifestyle modifications are insufficient, agents other than senna are recommended for the treatment of constipation in pregnant women (Body 2016; Gomes 2018).

Breastfeeding Considerations

Rhein, an active metabolite of senna, is present in breast milk.

Breast milk was sampled following maternal administration of sennosides A+B (equivalent to ~sennosides 15 mg [rhein 9.8 mg]) and plantago to 20 women. Dosing occurred in the evening of postpartum days 2, 3, and 4. Breast milk was sampled prior to and for 26 hours after the last dose. The highest concentrations of rhein were found 10 hours after the dose, which was the first sample following drug administration. Rhein was still measurable in breast milk 26 hours after the dose in half of the women. Authors of the study calculated the daily amount of rhein present in breast milk to be 0.007% of the maternal dose (Faber 1988).

Although there have been reports of diarrhea or loose stools in breastfeeding infants, bowel patterns were not changed in most cases (Baldwin 1963; Duncan 1957; Greenhalf 1973; Shelton 1980; Werthmann 1973). The WHO considers use of senna for maternal constipation to be compatible with breastfeeding; however, it should only be used when dietary changes are inadequate (WHO 2002).

Mechanism of Action

The anthraquinone group of stimulant laxatives includes the plant-derived agents such as senna. Stimulant laxatives typically induce defecation by stimulating peristaltic activity on the intestine by direct action on intestinal mucosa or nerve plexus, therefore increasing motility.

Pharmacokinetics

Onset of action: Oral: Within 6 to 24 hours

Metabolism: Hepatic

Excretion: Feces (via bile); urine

Pricing: US

Chewable (Ex-Lax Oral)

15 mg (per each): $0.18

Chewable (Senokot Laxative Gummies Oral)

8.7 mg (per each): $0.24

Syrup (OneLAX Senna Oral)

8.8 mg/5 mL (per mL): $0.04

Syrup (Senna Oral)

176 mg/5 mL (per mL): $0.05 - $0.07

Tablets (Ex-Lax Maximum Strength Oral)

25 mg (per each): $0.23

Tablets (Perdiem Overnight Relief Oral)

15 mg (per each): $0.15

Tablets (Senna Smooth Oral)

15 mg (per each): $0.22

Tablets (Senokot Extra Strength Oral)

17.2 mg (per each): $0.50

Tablets (Senokot Oral)

8.6 mg (per each): $0.24

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Brand Names: International
  • Adjust-A (JP);
  • Bekunis (AT, CH, CY, ES, HK, IL, KW, LU, MX, PL, PT, SG);
  • Bekunis Instant (DE);
  • Cholax (CL);
  • Ciruelax Comp (MX);
  • Colonorm (AT);
  • Darmol (AT, CH, HU);
  • Efectilax (CL);
  • Ex-Lax (GB);
  • Falquilax (IT);
  • Fuca (BE);
  • Fuca Excellent (NL);
  • Jungborn (IL);
  • Lacass (BR);
  • Lagenbach (MX);
  • Laxal (JO, KW);
  • Laxante Olan (ES);
  • Laxen (PH);
  • Laxton (HK);
  • Linella (SE);
  • List Senny (CZ);
  • Midro (BE, CH);
  • Midro Tee (DE);
  • Naturlax (CL);
  • Neholis (ES);
  • Purgaton (EG);
  • Pursennid (AE, FI, SE);
  • Pursennide (FR);
  • Ramend (DE);
  • Regulax (HR, HU, LT, PL, RU, SK, UA);
  • Senade (LV);
  • Senadex (LT);
  • Senadexin (RU, UA);
  • Senadin (UA);
  • Senalax (PH);
  • Senareti (BR);
  • Senna (CY);
  • Sennalax Fort (EG);
  • Sennefol (PL);
  • Sennocol (NL);
  • Sennoket (JO);
  • Sennove Lusky (CZ);
  • Senokot (AU, GB, HK, IE, KW, MY, PH, SG, TH, TR, TW, ZA);
  • Soflax (ZA);
  • Thea Bona (DK);
  • X-Prep (AT, GR, MX);
  • Xenna (PL);
  • Yodel-S (JP)


For country code abbreviations (show table)
  1. Acs N, Bánhidy F, Puhó EH, Czeizel AE. Senna treatment in pregnant women and congenital abnormalities in their offspring--a population-based case-control study. Reprod Toxicol. 2009;28:100-104. [PubMed 19491001]
  2. Ahlfors CE. Benzyl alcohol, kernicterus, and unbound bilirubin. J Pediatr. 2001;139(2):317-319. [PubMed 11487763]
  3. Anderson PO, Sauberan JB. Modeling drug passage into human milk. Clin Pharmacol Ther. 2016;100(1):42-52. [PubMed 27060684]
  4. Baldwin WF. Clinical study of senna administration to nursing mothers: assessment of effects on infant bowel habits. Can Med Assoc J. 1963;89:566-568. [PubMed 14045350]
  5. Blackmer AB, Farrington EA. Constipation in the pediatric patient: an overview and pharmacologic considerations. J Pediatr Health Care. 2010;24(6):385-99. doi:10.1016/j.pedhc.2010.09.003 [PubMed 20971414]
  6. Body C, Christie JA. Gastrointestinal diseases in pregnancy: nausea, vomiting, hyperemesis gravidarum, gastroesophageal reflux disease, constipation, and diarrhea. Gastroenterol Clin North Am. 2016;45(2):267‐283. doi:10.1016/j.gtc.2016.02.005 [PubMed 27261898]
  7. Centers for Disease Control (CDC). Neonatal deaths associated with use of benzyl alcohol—United States. MMWR Morb Mortal Wkly Rep. 1982;31(22):290-291. http://www.cdc.gov/mmwr/preview/mmwrhtml/00001109.htm [PubMed 6810084]
  8. Cogley K, Echevarria A, Correa C, De la Torre-Mondragón L. Contact burn with blister formation in children treated with sennosides. Pediatr Dermatol. 2017;34(2):e85-e88. doi:10.1111/pde.13068 [PubMed 28111797]
  9. Duncan AS. Standardized senna as a laxative in the puerperium; a clinical assessment. Br Med J. 1957;1(5016):439-441. [PubMed 13396280]
  10. Ex-Lax Maximum Strength tablets (sennosides) [prescribing information]. Parsippany, NJ: Novartis; February 2013.
  11. Ex-Lax Maximum Strength tablets (sennosides) [prescribing information]. Parsippany, NJ: Novartis; received May 2022.
  12. Ex-Lax Regular Strength chewable tablet (senna) [prescribing information]. Parsippany; NJ: Novartis Consumer Health, Inc; September 2014.
  13. Ex-Lax Regular Strength tablets (sennosides) [prescribing information]. Parsippany, NJ: Novartis; received May 2022.
  14. Fletcher's Laxative (senna) [prescribing information]. Orchard Park, NY: The Mentholatum Company; received 2018.
  15. Genexa Kids (senna) [prescribing information]. Atlanta, GA: Genexa Inc; August 2021.
  16. Genexa Laxative (senna) [prescribing information]. Los Angeles, GA: Genexa Inc; October 2020.
  17. "Inactive" ingredients in pharmaceutical products: update (subject review). American Academy of Pediatrics (AAP) Committee on Drugs. Pediatrics. 1997;99(2):268-278. [PubMed 9024461]
  18. Gomes CF, Sousa M, Lourenço I, Martins D, Torres J. Gastrointestinal diseases during pregnancy: what does the gastroenterologist need to know? Ann Gastroenterol. 2018;31(4):385‐394. doi:10.20524/aog.2018.0264 [PubMed 29991883]
  19. Greenhalf JO, Leonard HS. Laxatives in the treatment of constipation in pregnant and breast-feeding mothers. Practitioner. 1973;210(256):259-263. [PubMed 4570522]
  20. Hookey LC, Depew WT, Vanner SJ. Combined low-volume polyethylene glycol solution plus stimulant laxatives versus standard-volume polyethylene glycol solution: A prospective, randomized study of colon cleansing before colonoscopy. Can J Gastroenterol, 2006;20(2):101-105. [PubMed 16482236]
  21. Iida Y, Miura S, Asada Y, et al. Bowel preparation for the total colonoscopy by 2,000 mL of balanced lavage solution (Golytely) and sennoside. Gastroenterol Jpn, 1992;27:728-733. [PubMed 1468604]
  22. Ito S. Drug therapy for breast-feeding women. N Engl J Med. 2000;343(2):118-126. [PubMed 10891521]
  23. Johnson DA, Barkun AN, Cohen LB, et al. Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the US multi-society task force on colorectal cancer. Am J Gastroenterol, 2014;109(10):1528-1545. [PubMed 25223578]
  24. Perdiem (sennosides) [prescribing information]. Warren, NJ: GSK Consumer Healthcare; received May 2020.
  25. Senexon syrup (sennosides) [prescribing information]. Livonia, MI: Rugby; February 2013.
  26. Senna Liquid (sennosides) [prescribing information]. Livonia, MI: Rugby Laboratories; October 2019.
  27. Senna Syrup (sennosides) [prescribing information]. Southlake, TX: Method Pharmaceuticals, LLC; January 2021.
  28. Senna Syrup (senna leaf extract) [prescribing information]. Greenville, SC: Pharmaceutical Associates, Inc; June 2017.
  29. Senokot tablet (senna) [prescribing information]. Stamford, CT: Purdue Products L.P.; February 2013.
  30. Senokot tablets (senna concentrate) [prescribing information]. Stamford, CT: Purdue; 2011
  31. Senokot tablets (senna concentrate) [prescribing information]. Stamford, CT: Purdue; 2020.
  32. Senokot XTRA tablets (senna concentrate) [prescribing information]. Stamford, CT: Purdue; 2016.
  33. Senokot XTRA tablets (senna concentrate) [prescribing information]. Stamford, CT: Purdue; December 2021.
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  35. Tabbers MM, DiLorenzo C, Berger MY, et al; European Society for Pediatric Gastroenterology, Hepatology, and Nutrition; North American Society for Pediatric Gastroenterology. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr. 2014;58(2):258-274. doi:10.1097/MPG.0000000000000266 [PubMed 24345831]
  36. Vilanova-Sanchez A, Gasior AC, Toocheck N, et al. Are Senna based laxatives safe when used as long term treatment for constipation in children? J Pediatr Surg. 2018;53(4):722-727. doi:10.1016/j.jpedsurg.2018.01.002 [PubMed 29429768]
  37. Werthmann MW Jr, Krees SV. Quantitative excretion of Senokot in human breast milk. Med Ann Dist Columbia. 1973;42(1):4-5. [PubMed 4511106]
  38. World Health Organization (WHO). Breastfeeding and maternal medication, recommendations for drugs in the eleventh WHO model list of essential drugs. 2002. Available at http://www.who.int/maternal_child_adolescent/documents/55732/en/
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