Cascara
Regulatory sources consulted
Approved indications
- Short-term treatment of occasional constipation in adults, adolescents and children over 12 years.
Contraindications
Absolute
- Intestinal obstruction or stenosis, atony, appendicitis, inflammatory bowel disease, unexplained abdominal pain, severe dehydration and children under 12 years.
Clinical warnings
- Major warning · Avoid prolonged treatment: it may cause dependence and electrolyte imbalance, especially in older people or those with renal impairment. — CIMA, ficha técnica Cáscara Sagrada Arkopharma
Drug interactions
- HighGlucósidos cardiacos, antiarrítmicos o fármacos que prolongan QT; diuréticos, corticosteroides o regaliz
Mechanism: El uso prolongado puede producir hipopotasemia y potenciar toxicidad o riesgo arrítmico.
Recommendation: Consultar antes de combinar; separar además de otros medicamentos orales.
CIMA FT 74097
Adverse events
Common (≥1%)
Dolor abdominal · espasmos · heces líquidas
Pregnancy and lactation
Breastfeeding is not recommended because data on metabolite excretion are insufficient.
Recent literature (PubMed)
Constipation is one of the most common and prevalent chronic gastrointestinal conditions across the globe that is treated or managed through various methods. Laxatives are used for the treatment or management of chronic/acute constipation. But due to the adverse effects associated with these laxatives, herbal foods should be considered as alternative therapies for constipation. In this review, the laxative potential of plant-based medicines used for constipation is discussed. Constipation may be caused by various factors such as lifestyle, particular food habits, pregnancy and even due to some medication. Chronic constipation is responsible for different health issues. Pharmacological and non-pharmacological paradigms are applied for the treatment or management of constipation. In the pharmacological way of treatment, medicinal plants have a key role because of their fibrous nature. Numerous plants such as Prunus persica (Rosaceae), Cyamopsis tetragonolobus (Leguminosae), Citrus sinensis (Rutaceae), Planta goovata (Plantaginaceae), Rheum emodi (Polygonaceae), Cassia auriculata (Caesalpinacea), Ricinus communis (Euphorbiaceae), Croton tiglium (Euphorbiaceae), Aloe barbadensis (Liliaceae), Mareya micrantha (Euphorbiaceae), Euphorbia thymifolia (Euphorbiaceae), Cascara sagrada (Rhamnaceae), Cassia angustifolia (Fabaceae) have laxative activity. Medicinal plants possess a significant laxative potential and support their folklore; therefore, further, well-designed clinical-based studies are required to prove and improve the efficacy of herbal medicine for constipation. The present review showed that herbs laxative effect in various in vivo/ in vitro models.
Background: Solid waste from coffee depulping process threatens the organism in environment as it produces organic pollutants. Evidence suggested that coffee by-product could valorize owing to its potential as antioxidant sources. The aim of this systematic review was to evaluate antioxidant activity of coffee by-products obtained from different coffee variants (arabica and robusta) and processing methods. Methods: The systematic review was conducted as of May 29, 2021 for records published within the last ten years (2011-2021) using seven databases: Embase, Medline, BMJ, Web of Science, Science Direct, Cochrane, and PubMed. Data on type of specimen, processing methods, and antioxidant activities were collected based on PRISMA guidelines. Results: Our data suggested that aqueous extract was found to be the most common processing method used to obtain the antioxidant from various coffee by-products, followed by methanol and ethanol extract. A variety of antioxidant properties ranging from strong to low activity was found depending on the variety, type of coffee by-products (cascara, pulp, husk, silverskin, and parchment), and processing technique. Fermentation employing proper bacteria was found effective in improving the yield of bioactive compounds resulting in higher antioxidant capacity. Applications in feedstuffs, foods, beverages, and topical formulation are among the potential utilization of coffee by-products. Conclusion: Coffee by-products contain bioactive compounds possessing antioxidant properties which could be used as additives in foods, beverages, and cosmetics. In particular, their benefits in skin care products require further investigation.
Coffee melanoidins are generated by the Maillard reaction during the thermal processes occurring in the journey of coffee from the plant to the cup (during drying and roasting). Melanoidins, the brown pigments formed as the end products of this reaction, have been reported in cascara, silverskin, spent coffee grounds, and coffee brew. The latter is one of the main natural sources of melanoidins of the daily diet worldwide. However, their presence in coffee by-products has been recently described. These complex macromolecules possess multiple health-promoting properties, such as antioxidant, anti-inflammatory, dietary fiber effect, and prebiotic capacity, which make them very interesting from a nutritional point of view. In addition, they have a great impact on the sensory profile of foods and their acceptance by the consumers. The present study is a descriptive, narrative, mini-review about the nature, structure, digestibility, properties (sensory, nutritional, and health-promoting), safety and regulatory status of melanoidins from the coffee brew and its by-products with a special emphasis on the latter.
This paper discusses concerns with specific approaches in identifying and eliminating gastrointestinal (GI) pathogens, as well as detoxifying toxic metals, that may be misleading and harmful to a patient's health. These are non-scientific methods that claim to improve GI microbial balance and mineral nutritional status that persist in the nutritional and natural medicine market, and unfortunately many are actively promoted through specific products and protocols marketed by nutritional supplement companies that should know better. The potential toxicity and mucosal damage of the long-term use of aggressive laxative herbs such as Cascara sagrada, rhubarb and/or Senna, as well as potential adverse events from ingredients containing fulvic acids and/or humic acids are discussed.
This multicenter, single-arm, phase II trial evaluated the safety and efficacy of cabazitaxel and carboplatin followed by abiraterone, plus androgen deprivation therapy (ADT), in patients with high-volume metastatic castration-sensitive prostate cancer (mCSPC). Eligible patients had high-volume mCSPC and ≤3 months of prior ADT. Patients received six 21-day cycles of cabazitaxel (20 mg/m2) and carboplatin (AUC 4) with continuous ADT, followed by maintenance abiraterone (1,000 mg daily) and prednisone (5 mg daily). The primary endpoint was the proportion of patients free of prostate-specific antigen (PSA) or radiographic progression at 12 months. Secondary endpoints included complete PSA response (≤0.2 ng/mL), objective response, progression-free survival (PFS), and safety. Overall survival (OS) was also reported. Sixty-one participants were enrolled at eight sites. The median age was 64 years, median baseline PSA was 6.6 ng/mL (0.07-745.7 ng/mL), 73.3% had Gleason grade group 5, 69.5% had 10 or more metastases, and 19.6% had a homologous recombination repair (HRR) mutation. PSA PFS at 12 months was 84.6% [95% confidence interval (CI), 72.5%-91.7%], and OS at 12 months was 94.8% (84.7%-98.3%). Complete PSA response was 66.7%, and complete objective response was 30.7%. Contrary to our hypothesis, relative to HRR wild-type patients, HRR-mutated patients (19.6%) had numerically fewer complete PSA responses (33.3% vs. 70.3%) and inferior PFS (HR, 2.43; 95% CI, 0.93-6.39). Common side effects of this quadruplet regimen included fatigue, nausea, and diarrhea. Cabazitaxel and carboplatin followed by abiraterone, together with ADT, were feasible, safe, and efficacious in patients with high-volume mCSPC and warrant further study in larger randomized trials.