Associated Harms with Usage of Senna Leaves (Sana Makki) in Covid-19

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Abstract
Associated Harms with Usage of Senna Leaves (Sana Makki) in Covid-19
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Associated Harms with Usage of Senna Leaves (Sana Makki)
in Covid-19
Irshad Hussain1
1-Institute of Pharmacy, SMBB Medical University Larkana, Pakistan
Dear Editor,
A stimulant laxative; Senna is the ornamental plants of the family Fabaceae. There has been
ancient use of the drug for its laxative/purgative action. The plant is located in tropics. It contains
the constituents anthraquinones, dianthrones and anthrones. Sennosides A& B are derivatives of
anthraquinones at 2.5% minimal concentration. Leaves of the plants have been used for
laxative/purgative action by pediatricians, pediatric surgeons and pediatric gastroenterologists.1
Senna is described as a safe option to treat constipation. There have been some media reports of
the use of Senna in Pakistan for the prophylaxis or the treatment of Covid-19 infection. Governor
of the Sindh Province, Pakistan has shared his experience of the use of senna (Sanna Makki) by
himself when he was Covid-19 patient and has claimed before media the cure of disease
symptoms with the help of Sanna Makki and ginger water.2 A YouTube viral video of a person
introducing himself as a herbal researcher and UK resident having degree of doctorate, sharing
his personal experience of the use of leaves of Senna as a potent remedy to cure the Covid-19
and presenting himself for penalty if his claims are proved false provided that the drug is used as
prescribed by his method. The peoples have started using the leaves as suggested in the video
and there are heaps of recipes of Sana Makki leaves mentioned in different links of Facebook
mentioning the methods told by Dr Nazeer in video. Due to usage by community in Covid-19,
the price of sanna leaves has jumped from Rs 250 per kg to around Rs 2500 per Kg. Medical
professionals has described such news for of using Senna in Covid-19 as unproven, baseless and
misleading and warned the public not to use the herb to avoid unintended side effects that
outweigh some of its health benefits.3 Word “Senna” was combined with the word “Covid-19”
using the AND boolean and searching the results at Pubmed advanced database. There was
none retrieval of clinical evidence regarding the use and effectiveness of Senna in the Covid-19
infection. Only two articles were retrieved from the searched those were unrelated to the clinical
use of Senna. There has been no availability of any peer reviewed or published clinical
description regarding the use of senna in the Covid-19. Drug has been approved by FDA for its
use in constipation/laxative action and is included among the Over the counter (OTCs) Drugs
requiring no prescription.4 Gastrointestinal symptoms have been reported due to Covid-19 and
have been included in the symptoms of the disease.5 Use of laxatives in GIT symptoms can
definitely synergize the motility leading to diarrheal symptoms and dehydration affecting the
electrolyte balance of the patients. Loss of nutrients in diarrhea and vomiting can also reduce the
immunity of patients reducing the powerful natural defense of the body verses the Covid-19. It has been
recommendations of American herbal products associations (AHPA) regarding the labelling instructions
of the senna leave products to not use them if having diarrhea or abdominal pain and requiring the
consultation of health care provider for use in pregnant and nursing mothers as the constituents of
senna irritate the bowl linings for laxative action.4 There have been use of Senna infusions in chronic
constipation as similar use recommendations in the prophetic medicines. Medicinal plants have
common anti-inflammatory properties in providing symptomatic relief in common cold, fever and sore
throat. The myth of senna use in Covid-19 has started from such bases. However green tea, honey etc
can be safely used in such symptoms for the much better desirable antiviral and anti-inflammatory
properties than with Senna. Use of Senna in Covid-19 patients has been strongly discouraged due to its
enormous side effects like diarrhea, water loss, electrolyte imbalance and hypokalemia. Such side
effects can be harsh for those patients already in critical conditions. There have been many reported
interactions of senna with many drugs and it is not suited for heart, liver and kidney patients. Thereby
the use of Senna remains unpredictable and the risks can outweigh the benefits. Senna can also not be
used for long time due to possibility of its dependency on laxatives.6 WHO has encouraged the clinical
investigations to find safe and effective herbs in the treatment of Covid-19.7 Senna leaves may not be
used for the prophylaxis or treatment of Covid-19 without having any sufficient clinical data as
the drug is potent laxative and can raise the complications of Covid-19 patients instead of
Benefits by augmenting diarrhea and other Gastrointestinal problems.
Conflict of Interest: Author declares no conflict of interest.
Declaration: The Article have been uploaded on Research gate for awareness and will
be updated accordingly when published.
References:
1. Vilanova-Sanchez A, Gasior AC, Toocheck N, et al. Are Senna based laxatives safe when
used as long term treatment for constipation in children?. J Pediatr Surg. 2018;53(4):722‐
727. doi:10.1016/j.jpedsurg.2018.01.002.
2. https://www.dawn.com/news/1557883.
3. https://tribune.com.pk/story/2234073/1-tribune-fact-check-sana-makki-cure-covid-19/.
4. https://www.webmd.com/vitamins/ai/ingredientmono-652/senna.
5. Lijing Yang, and Lei Tu. Implications of gastrointestinal manifestations of COVID-19. Lancet
gastroenterology and Hepatology. 2020, 1-2.
https://www.thelancet.com/action/showPdf?pii=S2468-1253%2820%2930132-1.
6. https://www.youtube.com/watch?v=Nx1K1x4N9ok (A Report by BBC Urdu).
7. https://www.afro.who.int/news/who-supports-scientifically-proven-traditional-
medicine?gclid=Cj0KCQjwiYL3BRDVARIsAF9E4GdN9SZEFe2Ez8_qlFBvF63sireJnUu1QbJsgMX27Fe
QdZdk7GBbgRgaAtOvEALw_wcB
ResearchGate has not been able to resolve any citations for this publication.
  • Implications of gastrointestinal manifestations of COVID-19
    • Lijing Yang
    • Lei Tu
    Lijing Yang, and Lei Tu. Implications of gastrointestinal manifestations of COVID-19. Lancet gastroenterology and Hepatology. 2020, 1-2.
  • Article
    Background and aim: Senna is a stimulant laxative commonly used by pediatricians, pediatric gastroenterologists, and pediatric surgeons. Many clinicians avoid Senna for reasons such as tolerance or side effects but this has little scientific justification. We recently found several patients we were caring for developed perineal blistering during the course of Senna treatment. Because of this we chose to review the literature to identify side effects in children taking this medication as well as to analyze our Center's experience with Senna's secondary effects. Methods: We performed a literature review (MEDLINE, PUBMED) using the keywords of Senna, sen, sennosides and children, and pediatric and functional (idiopathic) constipation. We looked for articles with information regarding perineal blisters related to Senna as well as other secondary effects of Senna laxatives in children when used on a long-term basis. We also reviewed the charts of our patients who had previously taken Senna or are currently taking Senna, looking for adverse reactions. Results: Eight articles in the literature reported perineal blisters after administration of Senna laxatives in 28 patients. Of those occurrences, 18 patients (64%) had accidental administration of Senna and 10 (36%) had Senna prescribed as a long term treatment. All of the blistering episodes were related to high dose, night-time accidents, or intense diarrhea with a long period of stool to skin contact. At our institution, from 2014 to 2017, we prescribed Senna and have recorded data to 640 patients. During the study period, 17 patients (2.2%) developed blisters during their treatment. Patients who developed blisters had higher doses 60mg/day; 60 [12-100] vs. 17.5 [1.7-150] (p<0.001). All of the blistering episodes were related to night-time accidents, with a long period of stool to skin contact. 83 (13%) patients presented minor side effects such as abdominal cramping, vomiting or diarrhea which resolved once the type of laxatives were changed or enemas were started. The doses of Senna was not significantly different in these patients 15mg/day [4.4-150] vs. 17.5mg/day [1.5-150]. There were no other long-term side effects from Senna found in the pediatric literature for long-term treatment besides abdominal cramping or diarrhea during the first weeks of administration. We found no evidence of tolerance to Senna in our review. Conclusion: There is a paucity of information in the literature regarding side effects of sennosides as a long-term therapy, and to our knowledge, this is the first review of Senna side effects in children. Senna induced dermatitis is rare, but may occur when patients need a higher dose. All of the cases described had a long period of exposure of the skin to stool. Besides the perineal rash with blisters, we could find no other described major side effect with Senna administration in the pediatric population or evidence of the frequently mentioned concern of the development of tolerance to Senna. Pediatric caregivers should advise families of the rare side effect of skin blistering and educate them to change the diaper frequently in children who are not toilet- trained to reduce stool to skin exposure. We can conclude from this review that Senna is a safe treatment option for constipation in children. Level of evidence: IV.