Rhamnus purshiana

Other Names: cascara, rhamnus, bearberry, sacred bark

Composition: Cascara sagrada consists of the dried and aged (minimum 1 year according to the USP standards) bark of the plant. It contains anthranoids. The fresh bark should never be used as it contains free anthrone and can cause vomiting and spasms.

Description and History: Cascara sagrada bark (native to the Americas) is one of the most widely known and used laxatives available. Native Americans have used it for hundreds of years, and even today many over the counter products still contain cascara. The name comes from the early Spanish terms for sacred and bark. 

Cross-Reference List: Constipation & Diarrhea

Actions: The primary evidence-based use of cascara is as a laxative when other attempts to resolve constipation have been unsuccessful. It can also be used for pre-operative cleansing as it is a stimulant laxative, effective at contracting the muscles in the intestines which causes stool to move towards expulsion. Cascara often takes 6-8 hours for effects to be seen, and effects are often accompanied by cramping and fluid loss. Plenty of fluids should always be taken with any laxative. The plant is powerful and not to be used as a first step for constipation.

Dosing: Cascara is dosed as a single dose and used as needed. It is not dosed multiple times per day or even per week, and it should never be used continuously. The typical dose is 0.6-2 grams of the aged bark of the plant, but the smallest required dose should always be used. This dose is for an otherwise healthy 150-pound adult (age 13+); for elderly individuals and individuals with a lighter weight, smaller doses can be used–as little as 0.3g have been reported to be effective.

Contraindications: Should not be used during pregnancy or lactation or with children younger than age 4.

Interactions: Corticosteroids and thiazide diuretics should not be used with cascara. The loss of potassium possible with cascara use can lead to an increase in the effects of cardiac glycosides. Potassium deficiency is increased by the additional use of licorice root. 

Meet Dr Hawkins

Dr. Hawkins brings 20 years of expertise in the integrative health field to her role as Executive Director of the Franklin School of Integrative Health Sciences and the leader of our clinical research team.

She holds a Bachelor’s Degree in Environmental Health from Union Institute and University, a Master’s Degree in Health Education & Promotion from the University of Alabama, a post-graduate certificate in epidemiology from the London School of Hygiene and Tropical Medicine, a PhD in Health Research from Middle Tennessee State University, and is completing the post-doctoral Global Scholars Research Training Program at Harvard Medical School. She also holds certifications in numerous natural health fields including aromatherapy, aromatic medicine, herbalism, childbirth education, and labor support.