Cascara used to be approved by the federal Food and Drug Administration (FDA) as an over-the-counter (OTC) drug for constipation. However, over the years, concerns were raised about cascara’s safety and effectiveness. The FDA gave manufacturers the chance to submit safety and effectiveness information to answer these concerns. But the companies decided the cost of conducting safety and effectiveness studies would likely be more than the profit they could expect from sales of cascara. So they didn’t comply with the request. As a result, the FDA notified manufacturers to remove or reformulate all OTC laxative products containing cascara from the U.S. market by November 5, 2002. Today, you can buy cascara as a “dietary supplement,” but not as a drug. “Dietary supplements” don’t have to meet the standards that the FDA applies to OTC or prescription drugs.
Cascara is used as a laxative for constipation, as well as a treatment for gallstones, liver ailments, and cancer. Some people use it as a “bitter tonic.”
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Pregnancy and breast-feeding: Not enough is known about the use of cascara during pregnancy. Stay on the safe side and avoid use if you are pregnant. Cascara is POSSIBLY UNSAFE when taken by mouth while breast-feeding. Cascara can cross into breast milk and might cause diarrhea in a nursing infant.
Children: Cascara is POSSIBLY UNSAFE in children when taken by mouth. Don’t give cascara to children. They are more likely than adults to become dehydrated and also harmed by the loss of electrolytes, especially potassium.
Gastrointestinal (GI) disorders such as intestinal obstruction, Crohn’s disease, ulcerative colitis, appendicitis, stomach ulcers, or unexplained stomach pain: People with any of these conditions should not use cascara.
BY MOUTH: As a laxative for constipation: 20-30 mg per day of the active ingredient (hydroxyanthracene derivatives). A typical dose is 1 cup of tea, which is made by steeping 2 grams of finely chopped bark in 150 mL of boiling water for 5-10 minutes, and then straining. The cascara liquid extract is taken in a dose of 2-5 mL three times daily. The appropriate amount of cascara is the smallest dose that is needed to maintain soft stools.