Version May 2024
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: 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
Refer to adult dosing.
(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:
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 (Ref).
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 (Ref). 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 (Ref).
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 (Ref).
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 (Ref).
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 (Ref).
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 (Ref).
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 (Ref).
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.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
Frequency not defined: Gastrointestinal: Abdominal cramps, diarrhea, nausea, vomiting
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.
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).
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 Maximum Strength: 25 mg [contains corn starch, fd&c blue #1 (brill blue) aluminum lake, methylparaben, propylparaben, sodium benzoate]
FT Senna Laxatives: 8.6 mg
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]
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 [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)]
May be product dependent
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.
Once-daily doses should be preferentially taken at bedtime. Administer 2 hours before or after other medications.
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.
Constipation: Relieves occasional constipation (irregularity); generally causes bowel movement in 6 to 12 hours
Colonic cleansing before colonoscopy (adjunct)
Perdiem may be confused with Pyridium
Senexon may be confused with Cenestin
Senokot may be confused with Depakote
None known.
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: Laxatives (Stimulant) may enhance the adverse/toxic effect of Polyethylene Glycol-Electrolyte Solution. Specifically, the risk of colonic mucosal aphthous ulcerations may be increased. Management: Consider avoiding this combination due to a potential for increased risk of colonic mucosal aphthous ulcerations. Risk D: Consider therapy modification
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
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).
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).
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.
Onset of action: Oral: Within 6 to 24 hours
Metabolism: Hepatic
Excretion: Feces (via bile); urine
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