Senna and Other Laxative Teas: Risks of Regular Use

Read this first. Senna is a stimulant laxative, and a tea made from it is a laxative. Sources we read say it is for short-term use only, that frequent or continued use may cause dependence, and that it can cause loss of water and salts. [1][2] Senna is contraindicated in pregnancy, breastfeeding and for children under 12 in the EU monograph. [2] If you have belly pain, vomiting, rectal bleeding or a sudden change in bowels, talk to a clinician before using it. [1] In the US, Poison Help is 1-800-222-1222 for an overdose, and 911 is for collapse, seizure or trouble breathing. [1]

What senna tea is

Senna tea is an infusion of dried senna leaf. Some products use the fruit (pods) instead; the liver case report below involved fruits. The EU herbal monograph covers Senna alexandrina Mill., also called Cassia senna L. and Cassia angustifolia Vahl, using the leaf (the plant is in the family Fabaceae). [2][3] The EMA says senna leaf medicines are usually available as herbal tea and as solid or liquid forms. [4] A tea bag sold for "regularity", "cleansing" or "slimming" may contain senna alone or in a blend. For the plant itself, see the senna herb guide.

Traditional use and regulatory view

The sources we read describe senna's use as a laxative in medical terms; they do not name a specific people, region or period of traditional tea use, so we describe no particular tradition. In the EU, senna leaf is a well-established use herbal medicine: the HMPC concluded it can be used short term for occasional constipation, based on bibliographic evidence covering at least 10 years in the EU. [4] That is a regulatory category for standardized medicines, not a statement that any tea bag is equivalent.

What the sources say about regular use

Risks documented in the sources

• Dependence. MedlinePlus says frequent or continued use of senna may make you dependent on laxatives and cause your bowels to lose their normal activity. [1]
• Fluid and electrolyte loss. The EU monograph lists water and electrolyte imbalance with long-term use, and says overdose or abuse causes griping pain and severe diarrhea with losses of fluid and electrolytes, with potassium to be monitored, especially in the elderly. [2]
• Common side effects. MedlinePlus lists stomach discomfort, nausea, cramps, faintness and brown urine; rectal bleeding is a serious sign to report. [1] The EU monograph also lists itching and rash from hypersensitivity. [2]
• Liver. A case report describes acute liver failure and kidney impairment in a 52-year-old woman who drank, for more than 3 years, a liter a day of tea made from a bag of dry senna fruits; it was judged possibly related to senna, and the authors call severe liver injury unusual. [7] It is a single case with an unusually large exposure, and it involved fruits, not leaf.
• Hidden senna in blends. A survey found sennosides in 21 commercial "health tea" products, and another report found senna leaf in every one of 10 samples of health tea listing malva leaves. [8][9] The abstracts do not say whether senna was named on the labels. Check the ingredient list for senna, Cassia names and sennosides. [1][2]

Medicines, pregnancy, children and other conditions

• Medicines. The EU monograph says people taking cardiac glycosides, heart rhythm medicines, QT-prolonging medicines, diuretics, corticosteroids or licorice root need to consult a doctor before using senna, because low potassium can follow. [2] See licorice in blends and how interactions work. MedlinePlus says some senna products may affect how other medicines work and names mineral oil as a possible interaction. [1]
• Pregnancy and breastfeeding. Contraindicated in the EU monograph (genotoxicity concerns for several anthranoids in experimental data; active metabolites in breast milk). [2] MedlinePlus asks you to tell your doctor if pregnant or breastfeeding. [1] See pregnancy and breastfeeding.
• Children. Contraindicated under 12 in the EU monograph. [2]
• Older adults. MedlinePlus says people 65 or older should not usually take senna for a long time because it is not as safe as other medicines for the same condition. [1] See older adults.
• Kidney and bowel conditions. The monograph says people with kidney disorders should be aware of possible electrolyte imbalance, and lists blockage, inflammatory bowel disease, appendicitis, unexplained belly pain and severe dehydration as contraindications. [2]
• Surgery. Not described in the sources we read, other than MedlinePlus noting senna is also used to empty the bowels before procedures under medical direction. [1]

What a reader can do

Ask a clinician or pharmacist about constipation that needs a laxative every day: the EU monograph says if laxatives are needed every day, the cause should be investigated. [2] Amounts and schedules belong to the prescriber, pharmacist or the product label for a licensed medicine. This page gives no dosing advice. For other bowel options, see herbs for constipation, constipation and the detox and slimming tea claim check.