Cascara Sagrada and Breastfeeding

Summary of use during lactation

Maternal cascara intake might cause loose stools in some breastfed infants and should be avoided.[1] Other cathartics are preferred.

Drug levels in milk and infant serum

After administration of 65 mg of cascara sagrada as cascara fluidextract, cascara was qualitatively detected in the breastmilk of 5 of 10 women collected over 20 hours.[2] The sensitivity of the assay was about 1100 mg/L of cascara. Infant Levels. Relevant published information was not found as of the revision date.

Effects in breastfed infants

In 2 uncontrolled studies, a total of 10 of 22 breastfed neonates appeared to have loose stools after administration of 65 mg of cascara as cascara fluidextract to their mothers.[2] In an observational case series, no cases of diarrhea were observed among the breastfed infants of 142 mothers who received 400 mg of cascara extract on day 3 postpartum.[3] This result might have been because of the small amount of colostrum received by the infants of this age.

Effects on lactation and breastmilk

Relevant published information was not found as of the revision date.

Alternative drugs to consider

Bisacodyl, Magnesium Hydroxide, Senna

References

1. LewisJH WeingoldAB Committee of FDA-Related Matters American College of Gastroenterology The use of gastrointestinal drugs during pregnancy and lactation. Am J Gastroenterol 1985 80 912 23 2864852 PubMed
2. TysonRM ShraderEA PerlmanHH Drugs transmitted through breast milk. Part I: Laxatives. J Pediatr 1937 11 824 32 10.1016/S0022-3476(37)80040-2
3. DuncanAS Standardized senna as a laxative in the puerperium. A clinical assessment. Br Med J 1957 1 439 41 13396280 PubMed