Cascara Sagrada

Botanical name(s):

Rhamnus purshiana. Family: Rhamnaceae

Other name(s):

bitter bark, sacred bark

General description

Cascara sagrada was first used by the American Indians. It means "sacred bark." It comes from the bark of a tree found in the northwestern U.S.

The bark contains anthraquinone glycosides. This acts as a cathartic or laxative. Cascara may help relieve constipation. In 2002, the FDA marked laxatives that contain cascara sagrada as category II agents. This means they are not generally recognized as safe and effective for over-the-counter use. Manufacturers had not done the studies to show the safety of cascara sagrada. 

Medically valid uses

Cascara is used to treat constipation. The usual dose is 300 mg taken 1 time a day. It is not advised to take cascara at a higher dose or for longer than 6 days.

When taken by mouth, it has these effects:

  • Acts as a laxative or purgative to loosen and increase bowel movements

  • Empties the colon

Unsubstantiated claims

There may be benefits that have not yet been proven through research.

Cascara may help treat parasitic infestations. This is a condition in which one organism (the parasite) either harms its host or in some way lives at the expense of the host.

Dosing format

Cascara sagrada comes as oral tablets, capsules, and syrup. Follow the instructions on the package for the correct dose. Cascara is also prepared as a tea or aromatic fluid extract. The aromatic fluid extract dosage is 1 ml.

Side effects, toxicity, and interactions

Side effects include stomach cramping and diarrhea.

You should not use cascara sagrada when you have stomach pain, nausea, or vomiting. This is true for all laxatives. Do not use cascara if you have chronic intestinal problems. These include Crohn's disease, ulcerative colitis, sprue, appendicitis, stomach ulcers, any unexplained stomach pain, or irritable bowel syndrome.

Women who are pregnant or breastfeeding should not use cascara sagrada. The nursing infant may experience diarrhea. This could be caused by cascara sagrada crossing over to the breastmilk.

Don't take a higher than recommended dose. There are reports of liver toxicity when taken long-term in higher than recommended doses or for more than 6 days in a row.

Cascara sagrada is not safe for children. They are likely to suffer serious side effects. This includes decreased potassium levels and dehydration.

Online Medical Reviewer: Bianca Garilli MD
Online Medical Reviewer: Chris Southard RN
Online Medical Reviewer: Stacey Wojcik MBA BSN RN
Date Last Reviewed: 8/1/2023