Drug & supplement interaction

Cascara Sagrada + Tenapanor Hydrochloride

Tenapanor Hydrochloride brand name: Ibsrela.

Minor Interaction
Medically reviewed by · Updated September 2026
The bottom line Minor

Cascara Sagrada has a minor interaction with Tenapanor Hydrochloride. Theoretically, cascara sagrada might decrease the effects of CYP3A4 substrates.

Read the full interaction report
SeverityMinor
LikelihoodPossible
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Cascara Sagrada and Tenapanor Hydrochloride

Here is the interaction we found between these two, with the evidence behind it.

Minor

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

Why this applies to Tenapanor Hydrochloride

Tenapanor Hydrochloride falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES — the group Cascara Sagrada interacts with.

Theoretically, cascara sagrada might decrease the effects of CYP3A4 substrates.
In vitro research suggests that cascara sagrada can induce CYP3A4 enzymes, albeit to a much lower degree than rifampin, a known CYP3A4 inducer.
Severity Minor Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the interesting wrinkle with these two: tenapanor (Ibsrela) and cascara sagrada do the same job. Both are used to help with bowel movements, tenapanor for IBS with constipation, and cascara as a stimulant laxative. Stacking them could leave you with more cramping, urgent diarrhea, and dehydration than you bargained for.

On the enzyme side, the lab note says cascara might nudge up an enzyme called CYP3A4. But tenapanor barely gets absorbed into your bloodstream, it works right inside the gut, so this enzyme angle isn't really meaningful here. The evidence is only from test-tube studies, so I wouldn't lose sleep over it. The bigger practical concern is the doubled-up laxative effect. Check with your pharmacist or doctor before combining them.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. 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

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

Cascara Sagrada Also Interacts With Other Medications

Cascara Sagrada has 122 moderate, 622 minor known drug interactions in our database — the Tenapanor Hydrochloride one above is one of them. If you take anything else, check it against the full list below.

Moderate 122 Minor 622 No known interaction 2,086 (incl. Tenapanor Hydrochloride)
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.

Everything else you take

See Every Supplement That Interacts With Tenapanor Hydrochloride

This page covers Cascara Sagrada only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Tenapanor Hydrochloride page lists 138 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Grapefruit (major), St. John's Wort (major), Acacia Rigidula (moderate) and Adrafinil (moderate).

By severity: 3 major · 94 moderate · 41 minor.

From our pharmacist’s overview on the Tenapanor Hydrochloride page

“Tenapanor hydrochloride (Ibsrela) works in the gut to relieve irritable bowel syndrome with constipation, and its supplement interaction list deserves genuine care rather than a quick skim. Three of the 138 ingredients on file rate major: grapefruit, St.”

Reviewed by 2 · Jul 18, 2026

Open the Tenapanor Hydrochloride 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. Your product may carry other ingredients that interact with Tenapanor Hydrochloride too, on top of Cascara Sagrada — and those would not show on this page. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Cascara Sagrada and Tenapanor Hydrochloride 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%

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

29 days ago today
Medication Tenapanor Hydrochloride
Top 25%

#485 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.

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.

Read the full Cascara Sagrada monograph & all interactions
Medication

About Tenapanor

What Is Tenapanor Used For?

Brand name: Ibsrela

Tenapanor is approved for two distinct conditions, each under a separate brand. Ibsrela is used to treat irritable bowel syndrome with constipation (IBS-C) in adults. XPHOZAH is used to reduce high phosphorus levels (hyperphosphatemia) in adults with chronic kidney disease (CKD) who are on dialysis — specifically as an add-on when phosphate binders haven't worked well enough or aren't tolerated.

See full Tenapanor 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
622Minor
2,085No known interaction
122 Moderate 622 Minor 2,085 No interaction
Moderate

122 interactions

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

Minor

622 interactions

Showing 60 of 622 minor interactions — see all 622 on the Cascara Sagrada page.

No interaction 2,085 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 2,085 medications checked with no known interaction — see the full Cascara Sagrada list.

See the full Cascara Sagrada interactions page
See every supplement checked against Tenapanor Hydrochloride, ranked by severity
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Keep exploring
Cascara Sagrada monograph › Uses, safety, and every drug interaction in one place Tenapanor Hydrochloride supplement interactions › Every supplement checked against Tenapanor Hydrochloride, ranked by severity Tenapanor drug information › The full plain-English guide to this medication Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking Cascara Sagrada and Tenapanor Hydrochloride Together: Common Questions

Can you take Cascara Sagrada with Tenapanor Hydrochloride?
There is only a minor interaction, which is usually not serious. Read the full details on this page and confirm with your pharmacist before combining them.
How serious is the Cascara Sagrada and Tenapanor Hydrochloride interaction?
We rate it Minor. This interaction is generally not clinically significant, but it remains worth noting and discussing with your pharmacist.

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

Still Have a Question About Tenapanor Hydrochloride 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.