Drug & supplement interaction

Cascara Sagrada + Sumatriptan

Sumatriptan brand name: Tosymra.

No Known Interaction
Medically reviewed by · Updated July 2026 · Pair last verified Sep 13, 2026
The bottom line No known interaction

We found no known interaction between Cascara Sagrada and Sumatriptan in our sources. Absence of a documented interaction is not the same as proven safety, and does not guarantee one does not exist. Do not start, stop, or change a medication or supplement based on this page; confirm with your pharmacist or doctor first.

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Interaction report

Cascara Sagrada and Sumatriptan

We checked these two against our interaction database. Here is what we found.

No Known Interaction Found

We did not find a documented interaction between Sumatriptan and Cascara Sagrada in our sources. This does not guarantee that the combination is completely free of risk — there is often limited research on supplements and herbal products, especially around drug interactions.

If you decide to take both, the practical routine is simple: add one new thing at a time and note the date you started it. If the combination is going to disagree with you, it usually shows in the first days to a couple of weeks — and a start date turns “I’ve been feeling off” into something a pharmacist can actually work with. Do not stop a prescribed medicine on your own.

Always talk with your pharmacist or doctor before making changes to your medications or supplements, particularly if you take several medications or have an ongoing health condition.

Cascara Sagrada safety at a glance

Cascara Sagrada overall Use caution It may help short-term constipation but carries real risks, especially with long-term use.
Pregnancy Avoid Stimulant laxatives like cascara are generally not recommended during pregnancy.
Breastfeeding Possibly Unsafe When used orally. Cascara sagrada is excreted into breast milk and might cause diarrhea. Read the full breastfeeding detail

Pregnancy & breastfeeding ratings are from Natural Medicines (Therapeutic Research Center) — the full detail is in the Special populations card below. Safety guidance is general; always confirm with your pharmacist or doctor for your situation.

Still wondering about combining Sumatriptan and Cascara Sagrada? Ask Dr. Brian Staiger, PharmD, BCPS directly ›
How we checked

Why No Interaction Is Listed for Sumatriptan

Interactions in our licensed database are recorded against drug classes, not just single drug names. Sumatriptan is filed under 4 classifications — including qt interval-prolonging drugs, serotonergic drugs, serotonergic drugs. Cascara Sagrada has documented interactions with 6 drug classes — the most serious being corticosteroids (moderate), digoxin (lanoxin) (moderate) and diuretic drugs (moderate) — and none of Sumatriptan’s classifications are among them.

Classification data comes from our licensed Natural Medicines dataset. A medication can belong to classes beyond those recorded there, so this describes how the check was run — it is not a safety guarantee.

Keep it in perspective

Cascara Sagrada Does Interact With Other Medications

Cascara Sagrada has 122 moderate, 623 minor known drug interactions in our database — Sumatriptan isn’t one of them. If you take anything else, check it against the full list below.

Moderate 122 Minor 623 No known interaction 2,085 (incl. Sumatriptan)
Taking anything else?

Check Another of Your Medications Against Cascara Sagrada

Covers the 2,830 medications we’ve checked against Cascara Sagrada. Pick one to open its full report.

What to actually watch for

What Cascara Sagrada Itself Has Been Linked To

This is not an interaction — nothing below involves Sumatriptan. It is the side-effect record for Cascara Sagrada on its own, from the licensed Natural Medicines monograph. If something new turns up after you add Cascara Sagrada, this list is the first place to look. 2 entries are worth acting on rather than waiting out — marked below.

  • Raised blood pressure Worth acting on Additional detail

    “There is some concern about potential liver problems with cascara sagrada. In some cases, cascara sagrada bark 750-1275 mg (containing approximately 21 mg cascaroside) daily in divided doses for three days resulted in cholestatic hepatitis, ascites, and portal hypertension. Symptoms resolved following discontinuation of cascara sagrada.”

    Cascara Sagrada · Natural Medicines adverse-effect record, reported in hepatitis.

    2 sources cited
    1. 6895. Nadir A, Reddy D, Van Thiel DH. Cascara-sagrada induced intrahepatic cholestasis causing portal hypertension: case report and review of herbal hepatotoxicity. Am J Gastroenterol 2000;95:3634-7. PubMed
    2. 92306. Nakasone ES, Tokeshi J. A serendipitous find: a case of cholangiocarcinoma identified incidentally after acute liver injury due to cascara sagrada ingestion. Hawaii J Med Public Health 2015;74(6):200-2.
  • Liver problems Worth acting on Additional detail

    “Orally, cascara sagrada seem to be well tolerated when used appropriately, short-term.

    Most Common Adverse Effects:

    Orally: Mild abdominal discomfort and cramps.

    Serious Adverse Effects (Rare):

    Orally: Hepatotoxicity. Fresh or improperly aged cascara sagrada bark can cause severe vomiting.”

    Cascara Sagrada · Natural Medicines adverse-effect record, reported in nausea and vomiting.

  • Stomach upset / Vomiting Additional detail

    “Orally, cascara sagrada can commonly cause mild abdominal discomfort, colic, and cramps (4). In some cases, chronic use can cause pseudomelanosis coli. Pseudomelanosis coli (pigment spots in intestinal mucosa) is believed to be harmless, usually reverses with discontinuation, and is not directly associated with an increased risk of developing colorectal adenoma or carcinoma.

    Fresh or improperly aged cascara sagrada b…”

    Cascara Sagrada · Natural Medicines adverse-effect record, reported in colorectal adenoma.

    4 sources cited
    1. 4. Newall CA, Anderson LA, Philpson JD. Herbal Medicine: A Guide for Healthcare Professionals. London, UK: The Pharmaceutical Press, 1996.
    2. 6138. Nusko G, Schneider B, Schneider I, et al. Anthranoid laxative use is not a risk factor for colorectal neoplasia: results of a prospective case control study. Gut 2000;46:651-5. PubMed
    3. 2. Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Trans. S. Klein. Boston, MA: American Botanical Council, 1998.
    4. 92307. Cirillo C, Capasso R. Constipation and botanical medicines: an overview. Phytother Res 2015;29(10):1488-93. PubMed

Everything above comes from the Natural Medicines adverse-effect record for Cascara Sagrada — expand a row for the licensed statement it rests on. We read the ADVERSE REACTIONS section of Sumatriptan’s FDA label too, and the two lists don’t meaningfully overlap — which is why no Sumatriptan column appears here.

Special populations

Cascara Sagrada in Pregnancy & Breastfeeding

Lactation Possibly Unsafe

When used orally. Cascara sagrada is excreted into breast milk and might cause diarrhea.

DISCLAIMER: This tool is intended for informational purposes only, and should not be interpreted as specific medical advice. Patients should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.© 2026 Therapeutic Research Center

From our Q&A

Questions About Cascara Sagrada or Sumatriptan

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Cascara Sagrada or Sumatriptan, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Sumatriptan

This page covers Cascara Sagrada only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Sumatriptan page lists 50 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), American Hellebore (major), Arsenic (major), Cesium (major) and Ephedra (major).

By severity: 8 major · 31 moderate · 11 minor.

From our pharmacist’s overview on the Sumatriptan page

“The supplement risk that matters most with sumatriptan (Tosymra) is serotonin overload. This migraine drug works through serotonin receptors, and 20 of the 50 interacting ingredients on file, 5-HTP among them, can push serotonin activity higher still, raising the risk of serotonin syndrome (agitation, racing heart, fever).”

Reviewed by 2 · Jul 18, 2026

Open the Sumatriptan interaction page

One more smart check

Taking Cascara Sagrada as Part of a Dietary Supplement Product? Check It for Interactions

We hold 849 real supplement products containing Cascara Sagrada, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Cascara Sagrada. Even though Cascara Sagrada itself has no known interaction with Sumatriptan, another ingredient on your label might. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Cascara Sagrada and Sumatriptan Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Cascara Sagrada
Top 25%

#241 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Sumatriptan
Top 5%

#37 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Where does our data come from?
  • Source: the Natural Medicines (TRC Healthcare) clinical database — the evidence-graded professional reference for herb & supplement interactions.
  • Citation library: 103,510 references behind our interaction content, 65,311 of them resolved to verified PubMed/DOI sources. See every Cascara Sagrada reference on this page ↓
  • Freshness: we automatically re-check this combination every week — this pair was last verified September 13, 2026. The Cascara Sagrada and Sumatriptan records this page draws on were last updated July 11, 2026.
  • What “no known interaction” means: no documented interaction in the sources above — not a guarantee of safety. Supplements are studied far less than prescription drugs, so we say exactly what the evidence supports, and nothing more.
Data structure & sourcing designed and verified by .
Supplement

About Cascara Sagrada

What is Cascara Sagrada?

Cascara Sagrada
  • Constipation
  • Bowel cleansing before procedures
  • Hemorrhoids
  • Traditional liver and gallbladder remedy

Cascara sagrada is a stimulant laxative made from the aged bark of a Pacific Northwest tree, used mainly for short-term relief of constipation. Because it can cause cramping, dehydration, and electrolyte problems—and was removed from over-the-counter laxative products in the U.S. due to safety concerns—it should only be used briefly, if at all, and with guidance from a pharmacist or doctor.

Frangula purshiana · Rhamnaceae · Dried, aged bark · Capsules, tablets, dried bark, liquid extract, tea

An interaction check asks whether these two react with each other — it does not ask whether Cascara Sagrada is a good idea for someone in your situation. Here is what our Cascara Sagrada record says about it on its own.

Cascara Sagrada: dosing

There is no single official standardized dose for cascara sagrada supplements, and products vary in strength. The safest approach is to follow the directions on the product label and use the lowest amount that works.As a general rule, stimulant laxatives like cascara are meant for short-term use only—typically no more than about one week unless a doctor advises otherwise. Aged (cured) bark should always be used, never fresh bark.

From our Cascara Sagrada monograph — the full record covers uses, side effects and every documented interaction.

Read the full Cascara Sagrada monograph & all interactions
Medication

About Sumatriptan

What Is Sumatriptan Used For?

Brand name: Tosymra

Sumatriptan is used to stop a migraine headache once it starts — with or without aura (the visual or sensory warning signs some people get before a migraine). It is available as tablets, nasal sprays, nasal capsules, and subcutaneous (under-the-skin) injections for this purpose.

Sumatriptan subcutaneous injections (brands: Imitrex injection, Sumatriptan Injection, Sumatriptan Succinate Injection) are also approved to treat acute cluster headaches in adults. Sumatriptan is not used to prevent migraines or cluster headaches — it only treats attacks once they begin.

Most-Reported Side Effects for Sumatriptan

From FAERS, the FDA’s public side-effect reporting system (46,096 reports, all brands). Reports are voluntary and are not proof the drug caused the effect.

Headache 3,911 reports
Nausea 3,510 reports
Migraine 3,445 reports
Fatigue 2,617 reports
Dizziness 2,121 reports
See full Sumatriptan drug information
Keep checking

Other Drugs & Cascara Sagrada

Browse every other medication we’ve checked against Cascara Sagrada — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major
122Moderate
623Minor
2,084No known interaction
122 Moderate 623 Minor 2,084 No interaction
Moderate

122 interactions

Showing 60 of 122 moderate interactions — see all 122 on the Cascara Sagrada page.

Minor

623 interactions

Showing 60 of 623 minor interactions — see all 623 on the Cascara Sagrada page.

No interaction 2,084 drugs checked — show the list

We also checked Cascara Sagrada against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 2,084 medications checked with no known interaction — see the full Cascara Sagrada list.

See the full Cascara Sagrada interactions page
See every supplement checked against Sumatriptan, ranked by severity
Evidence & sources

Cascara Sagrada References

The 9 references that drive our Cascara Sagrada monograph and interaction data, from the evidence-graded Natural Medicines (TRC Healthcare) database. Citations with a link open the study on PubMed or the publisher’s site.

  1. Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Trans. S. Klein. Boston, MA: American Botanical Council, 1998.
  2. Newall CA, Anderson LA, Philpson JD. Herbal Medicine: A Guide for Healthcare Professionals. London, UK: The Pharmaceutical Press, 1996.
  3. Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications, 1998.
  4. Covington TR, et al. Handbook of Nonprescription Drugs. 11th ed. Washington, DC: American Pharmaceutical Association, 1996.
  5. Nusko G, Schneider B, Schneider I, et al. Anthranoid laxative use is not a risk factor for colorectal neoplasia: results of a prospective case control study. Gut 2000;46:651-5. PubMed
  6. Nadir A, Reddy D, Van Thiel DH. Cascara-sagrada induced intrahepatic cholestasis causing portal hypertension: case report and review of herbal hepatotoxicity. Am J Gastroenterol 2000;95:3634-7. PubMed
  7. Nakasone ES, Tokeshi J. A serendipitous find: a case of cholangiocarcinoma identified incidentally after acute liver injury due to cascara sagrada ingestion. Hawaii J Med Public Health 2015;74(6):200-2.
  8. Cirillo C, Capasso R. Constipation and botanical medicines: an overview. Phytother Res 2015;29(10):1488-93. PubMed
  9. Mazzari ALDA, Lacerda MG, Milton FA, et al. In vitro effects of European and Latin-American medicinal plants in CYP3A4 gene expression, glutathione levels, and P-glycoprotein activity. Front Pharmacol 2022;13:826395. PubMed

Medication overviews come from MedlinePlus (NIH); supplement label data from the NIH Dietary Supplement Label Database. Content is written and reviewed by licensed HelloPharmacist pharmacists — see our data sources and editorial standards.

Pharmacist Counseling Corner

Taking Cascara Sagrada and Sumatriptan Together: Common Questions

Is it safe to take Cascara Sagrada with Sumatriptan?
We do not list a known interaction between Cascara Sagrada and Sumatriptan. That does not guarantee the combination is risk-free, so confirm with your pharmacist or doctor — especially if you take other medications or have a health condition.
How was the Cascara Sagrada and Sumatriptan combination checked?
Interactions in our licensed database are recorded against drug classes. Sumatriptan is filed under 4 classifications, and Cascara Sagrada has documented interactions with 6 drug classes — none of Sumatriptan's classifications are among them. A medication can belong to classes beyond those recorded in our dataset, so this describes how the check was run rather than guaranteeing safety.
Does Cascara Sagrada interact with any other medications?
Yes. Cascara Sagrada has 745 documented drug interactions in our database — Sumatriptan is simply not one of them. If you take anything else, it is worth checking each one; they are all listed on this page.
Does Sumatriptan interact with any supplements?
Yes. Sumatriptan has documented interactions with 50 supplements in our database — Cascara Sagrada is not one of them. The Sumatriptan interaction page linked on this page lists every one, ranked by severity.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Where next

Keep Exploring

Cascara Sagrada monograph Uses, safety profile, and every drug interaction in one place Sumatriptan drug information The full plain-English guide to this medication Sumatriptan supplement interactions Every supplement checked against Sumatriptan, ranked by severity Supplement interaction checker Check any supplement or product against your medications Browse medications A–Z Every drug we’ve checked against herbs & supplements References The 9 citations behind this page Ask a pharmacist Free, personal answer from our licensed team

Still Have a Question About Sumatriptan and Cascara Sagrada?

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.