Cascara sagrada

Tier 3 — weak evidence · Constipation · Stimulant laxative

A stimulant laxative bark similar to senna that was formerly an FDA-approved OTC laxative. FDA reclassified it as not generally recognized as safe in 2002 due to insufficient evidence and concern about chronic use. Like senna, it causes dependency and electrolyte depletion with long-term use. Short-term use for acute constipation is generally safe. Prefer fibre supplements or osmotic laxatives.

Dose: 300 mg dried bark before bed for acute constipation only; FDA removed GRAS status in 2002