Mechanism of Action & Pharmacology:

• Anthraquinone glycosides have a mild laxative action and are absorbed in the jejunum and hydrolyzed during absorption. They are then re-secreted back into the bowel where they irritate, and hence, stimulate the intestines to undergo peristalsis.
• Tannins provide an astringent action on the GIT acting as a gentle intestinal tonic and are antioxidants.
• Tincture extracts have shown antimicrobial activity against Staphylococcus aureus and have demonstrated potential cytotoxic & anti-cancerous effects as a potent antioxidant and exerting cell-death via apoptosis.

Pharmacy:

• Decoction
• Tincture
• Capsules
• Topically in ointments & creams

Safety & Toxicity Concerns:

• Fresh root is emetic & purgative. Fresh leaf in high doses may cause acute oxalate toxicity.
• High doses may cause an aggravation of inflammatory skin disorders, nausea, vomiting, diarrhea, and can aggravate irritable bowel and spastic colon.
• Excessive use exacerbates atonicity of the colon and can lead to dependence on laxatives for a bowel movement to occur.
• Hypokalemia may occur with long-term use.
• All anthraquinone-rich herb CIs apply (e.g. Pregnancy, prolonged use, acute inflammatory bowel disease, etc.). However,it is generally gentler and less extreme in its effects when compared to other laxative herbs.
• Use caution in gout and predisposition to kidney stones due to oxalates.

Interactions:

• Due to decrease in transit time, may potentially interfere with absorption of practically any medication.
• Avoid concomitant use with potassium-depleting agents (e.g. thiazide diuretics, corticosteroids) as may cause hypokalemia.
• May affect activity of cardiac glycosides & antiarrhythmic agents if potassium deficiency resulting from long-term laxative abuse is present.