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Alder Buckthorn Drug Interactions, Uses, Effectiveness, Safety & More

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Alder Buckthorn Drug Interactions: The Bottom Line

From the HelloPharmacist Editorial Team · Updated July 2026

Based on the available evidence, the overall risk of a clinically significant Alder Buckthorn drug interaction appears low for most people, since every listed concern is theoretical rather than proven. None of the interactions are rated major, and all of them are graded as possible, meaning they rest on limited or lab-based evidence rather than well-controlled human studies.

Interactions deserving the most attention

Nearly every concern traces back to one effect: alder buckthorn is a stimulant laxative, and heavy use can lower potassium or cause diarrhea. That matters most with warfarin, where diarrhea can raise INR and bleeding risk, with digoxin, where low potassium can increase the chance of toxicity, and with potassium-depleting diuretics, which could compound potassium loss. Corticosteroids and other stimulant laxatives raise the same electrolyte concern.

What the rest of the list means

A long list of interacting medications can look worrying, but here it mostly reflects one predicted mechanism applied across many drugs, not evidence of harm with each one. These effects have not been confirmed in human studies, and typical use is less likely to cause trouble than prolonged overuse.

Check your medications against Alder Buckthorn

Based on HelloPharmacist’s Alder Buckthorn interaction data and reviewed under our editorial standards.

Interaction report

Drugs that interact with Alder Buckthorn

122 medications have a known interaction with Alder Buckthorn, graded by severity. Select any drug for the full evidence-based detail.

2,830 drugs
Acetaminophen, Caffeine, PyrilamineMidol Max Strength Menstrual› Acetaminophen, Pamabrom, PyrilamineMidol Max Strength PMS, Pamprin, Pamprin ES› AcetazolamideAk-Zol, Diamox› Amiloride, HydrochlorothiazideAmil-Co, Amilzide, Moduret 25, Moduretic› Ammonium ChlorideAmmonium Chloride› ArmodafinilNuvigil› Atenolol, ChlortalidoneAtenixCo, Tenoret 50, Totaretic› Atenolol, ChlorthalidoneTenoretic› Azelastine Hydrochloride, Fluticasone PropionateDymista› Azilsartan, ChlorthalidoneEdarbyclor› Beclometasone DipropionateBecotide› BeclomethasoneBeclovent, Vanceril› Beclomethasone DipropionateQNASL, Qvar› Benazepril, HydrochlorothiazideLotensin HCT› BendroflumethiazideAprinox, Naturetin, Neo-NaClex› Bendroflumethiazide, NadololCorzide› Bendroflumethiazide, PotassiumCentyl K, Neo-NaClex-K› Bendroflumethiazide, Rauwolfia SerpentinaRauzide› BenzthiazideExna› BetamethasoneCelestone, Diprolene AF, Diprosone› Betamethasone DipropionateSernivo› Betamethasone Dipropionate, CalcipotrieneEnstilar, Wynzora› Betamethasone ValerateLuxiq› BisacodylDulcolax, Gentlax› Bisacodyl, DocusateDulcolax Laxative Tabs› Bisoprolol, HydrochlorothiazideZiac› BudesonideEntocort EC, Eohilia, Pulmicort, Tarpeyo, Uceris› BumetanideBurinex› Bumetanide, PotassiumBurinex K› Caffeine, Potassium Salicylate, SalicylamideTrim-Elim›
Read The List Like a Pharmacist

What Severity, Likelihood & Evidence Mean

Severity — How Serious It Can Be

  • Major. Clinically significant; generally best avoided, or used only under direct professional supervision.
  • Moderate. May need monitoring, a dose adjustment, or separating the times you take each one.
  • Minor. Generally not clinically significant, but still worth noting and mentioning to your pharmacist.
  • No known interaction. Checked against our sources with nothing documented — not the same as proven safety.

Likelihood — How Well It’s Documented

  • Likely. Well-controlled human studies have demonstrated the likely existence of this interaction
  • Probable. Interaction 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.
  • Possible. 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
  • Unlikely. Interaction has been demonstrated in animal or in lab research but has been shown not to occur in humans.

Where This Data Comes From

  • Interaction records are evidence-graded and sourced from the Natural Medicines database (TRC Healthcare), the same reference used by pharmacists and hospitals.
  • Each drug listed above links to the full report for that exact Alder Buckthorn combination — clinical detail, likelihood, evidence level, and citations.
  • Content is reviewed by licensed HelloPharmacist pharmacists — see our data sources and editorial standards.
The big picture

The kinds of drugs Alder Buckthorn affects

Every type of medication (drug category) Alder Buckthorn is known to interact with. Open any category for the detail — or search your exact drug in the checker above.

All 5 drug categories Alder Buckthorn interacts with
CorticosteroidsDigoxin (lanoxin)Diuretic DrugsStimulant LaxativesWarfarin (coumadin)
Corticosteroids

Alder buckthorn has stimulant laxative effects. Theoretically, concomitant use of corticosteroids with alder buckthorn can increase the risk of potassium depletion.

Likelihood Possible Evidence D
Digoxin (Lanoxin)

Alder buckthorn has stimulant laxative effects. Theoretically, potassium depletion associated with alder buckthorn might increase the risk of digoxin toxicity.

Likelihood Possible Evidence D
Diuretic Drugs

Alder buckthorn has stimulant laxative effects. Theoretically, overuse of alder buckthorn might compound diuretic-induced potassium loss. There is some concern that people taking alder buckthorn along with potassium depleting diuretics might have an increased risk for hypokalemia.
Some diuretics that can deplete potassium include chlorothiazide (Diuril), chlorthalidone (Thalitone), furosemide (Lasix), and hydrochlorothiazide (HCTZ, HydroDIURIL, Microzide), and others.

Likelihood Possible Evidence D
Stimulant Laxatives

Alder buckthorn has stimulant laxative effects. Concomitant use with stimulant laxative medications might compound fluid and electrolyte loss.

Likelihood Possible Evidence D
Warfarin (Coumadin)

Alder buckthorn has stimulant laxative effects. In some people alder buckthorn can cause diarrhea. Diarrhea can increase the effects of warfarin, increase international normalized ratio (INR), and increase the risk of bleeding. Advise patients who take warfarin not to take excessive amounts of alder buckthorn.

Likelihood Possible Evidence D
Monograph

Alder Buckthorn: Uses, Safety & Side Effects

The bottom line

Alder buckthorn bark is a stimulant laxative traditionally used for short-term relief of constipation. It can work, but it carries real risks with prolonged use, including bowel damage, and should only be used briefly, if at all, after checking with a pharmacist or doctor.

Alder Buckthorn
Scientific name
Frangula alnus
Family
Rhamnaceae
Part used
Dried, aged bark
Common forms
Tea, dried bark, liquid extracts, capsules, tablets
People commonly use it for
  • Constipation
  • Bowel cleansing before procedures
  • Occasional irregularity

Popular and traditional uses — not proof it works. See “Uses & effectiveness” below for the evidence.

Safety at a glance
OverallUse caution

May relieve constipation short-term but can harm the bowel with regular or long-term use.

PregnancyBest avoided

Stimulant laxatives like alder buckthorn are generally not recommended during pregnancy.

BreastfeedingLikely Unsafe

When used orally ; avoid using.

Read the full breastfeeding detail

Pregnancy & breastfeeding ratings are from Natural Medicines (Therapeutic Research Center). Safety guidance is general; always confirm with your pharmacist or doctor for your situation.

Jump to a section

Overview

Alder buckthorn is a shrub or small tree that grows wild across much of Europe, parts of Asia, and North America, where it is often considered an invasive plant. The part used in herbal products is the bark, which must be dried and aged (or specially treated) before use because fresh bark can cause severe nausea and vomiting.

For centuries, the bark has been used as a natural laxative to help relieve constipation. Today it is found in some herbal teas, dried bark blends, and over-the-counter laxative products, sometimes combined with other herbs. It belongs to the same plant family as cascara and common buckthorn, which are also used as laxatives.

How it works

Alder buckthorn bark contains compounds called anthraquinone glycosides (also known as anthraglycosides). After you swallow them, bacteria in your gut break them down into active forms that act on the lining of the large intestine.

These active compounds stimulate the muscles of the colon to contract and also increase the amount of water and electrolytes that stay in the bowel. The result is a softer stool and a bowel movement, usually several hours after taking it. Much of this understanding comes from laboratory research and the known behavior of similar anthraquinone laxatives.

Effectiveness

Does Alder Buckthorn work?

Evidence overview · 1 use evaluated
1 Possibly effective
How to read these evidence grades

Natural Medicines’ 7-point scale. We show each rating’s label word-for-word.

1EffectiveStrong, consistent evidence it works.
2Likely EffectiveGood evidence, though not yet conclusive.
3Possibly EffectiveSome evidence suggests a benefit.
4Possibly IneffectiveSome evidence it may not help.
5Likely IneffectiveFairly strong evidence it doesn’t help.
6IneffectiveStrong evidence it doesn’t work.
7Insufficient Reliable Evidence to RateToo little research to say either way.
Possibly Effective Constipation
Rating & evidence shown verbatim from Natural Medicines

Alder buckthorn contains laxative anthraquinones, which are known to relieve constipation. Alder buckthorn has laxative effects comparable to cascara.

Sources Ref 3 Ref 4 Ref 7 Ref 12

Source & disclaimer. Effectiveness ratings and evidence summaries are provided by Natural Medicines (Therapeutic Research Center) and shown as licensed. Where Natural Medicines hasn’t rated a use, HelloPharmacist’s pharmacists may add their own reviewed rating and evidence (each such entry is labeled). This is educational information, not medical advice — talk with your pharmacist or doctor before starting, stopping, or changing a supplement.

Safety & precautions

Alder buckthorn should be used only for a short time, typically no more than about a week, and ideally only occasionally. Regular or long-term use can damage the lining of the colon, cause a harmless but telling dark pigmentation of the bowel lining (pseudomelanosis coli), and may lead to a "lazy bowel" that struggles to work without laxatives. Some health authorities have also raised concern about a possible link between long-term anthraquinone laxative use and colorectal cancer, though this is not firmly proven.

The U.S. FDA removed alder buckthorn's "Generally Recognized As Safe" status for over-the-counter laxatives because of insufficient safety data, especially regarding long-term use. Never use fresh or unaged bark, which can cause violent vomiting and cramping.

People who should avoid it include anyone with intestinal blockage, undiagnosed belly pain, inflammatory bowel disease (such as Crohn's or ulcerative colitis), appendicitis symptoms, or severe dehydration. Children should not use it without a doctor's advice. Pregnant and breastfeeding women should avoid alder buckthorn, since stimulant laxatives may not be safe and the active compounds can pass into breast milk.

Side effects

Common side effects include stomach cramps, abdominal discomfort, and diarrhea. Taking too much can cause watery diarrhea, which may lead to dehydration and loss of important minerals such as potassium.

With repeated or long-term use, more serious problems can develop, including loss of normal bowel function (dependence on laxatives), electrolyte imbalances, and damage to the bowel lining. Low potassium can affect the heart and muscles, which is one reason long-term use is discouraged. Stop use and seek medical care if you have severe cramping, rectal bleeding, or a bowel movement does not occur as expected.

Alder Buckthorn: Reported Adverse Effects

Documented safety reports on Alder Buckthorn from the evidence-graded Natural Medicines (TRC Healthcare) database, shown word-for-word from the licensed record.

Orally, alder buckthorn seems to be well tolerated when properly aged bark is used appropriately for no more than 8 to 10 days. Adverse effects include cramp-like discomfort. Chronic use, especially for 9 months or longer, is associated with damage to gastrointestinal epithelial cells and pigmentation of the colonic mucosa, known as pseudomelanosis coli. There is some data linking this condition to an increased risk of colorectal cancer, although there is also contradictory evidence which does not show a link. Alder buckthorn has also been associated with potassium depletion, albuminuria, and hematuria when used orally.

  1. McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.
  2. Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Trans. S. Klein. Boston, MA: American Botanical Council, 1998.
  3. Siegers, C. P., Hertzberg-Lottin, E., Otte, M., and Schneider, B. Anthranoid laxative abuse--a risk for colorectal cancer? Gut 1993;34(8):1099-1101.
  4. van Gorkom, B. A., de Vries, E. G., Karrenbeld, A., and Kleibeuker, J. H. Review article: anthranoid laxatives and their potential carcinogenic effects. Aliment.Pharmacol Ther 1999;13(4):443-452.
  5. Willems, M., van Buuren, H. R., and de, Krijger R. Anthranoid self-medication causing rapid development of melanosis coli. Neth.J Med 2003;61(1):22-24.
  6. 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.
Reports by condition
Albuminuria Genitourinary

Orally, adverse effects to alder buckthorn include albuminuria and hematuria.

  1. Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Trans. S. Klein. Boston, MA: American Botanical Council, 1998.
Cancer Oncologic
Nausea and vomiting Gastrointestinal

Orally, adverse effects include cramp-like discomfort. Chronic use, especially for 9 months or longer, is associated with damage to gastrointestinal epithelial cells and pigmentation of the colonic mucosa, known as pseudomelanosis coli. The fresh bark contains free anthrone, which can cause severe vomiting. This constituent is destroyed by aging the bark naturally for one year or artificially with heat and aeration.

  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. Siegers, C. P., Hertzberg-Lottin, E., Otte, M., and Schneider, B. Anthranoid laxative abuse--a risk for colorectal cancer? Gut 1993;34(8):1099-1101.
  3. van Gorkom, B. A., de Vries, E. G., Karrenbeld, A., and Kleibeuker, J. H. Review article: anthranoid laxatives and their potential carcinogenic effects. Aliment.Pharmacol Ther 1999;13(4):443-452.
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.

Adverse-effects data: Natural Medicines, Therapeutic Research Center

Dosing

There is no single official "correct" dose for alder buckthorn, and the strength of products can vary a lot. The general rule for stimulant laxatives is to use the lowest amount that produces a comfortable, soft bowel movement, and to use it for the shortest time possible.

Because dosing depends on the specific product and how it is prepared, the safest approach is to follow the directions on the product label and to check with a pharmacist or doctor before using it. Do not exceed the labeled amount or use it for more than about a week without medical advice.

Pregnancy & Breastfeeding

Alder Buckthorn & Breastfeeding

Likely Unsafe

When used orally ; avoid using.

  1. McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.
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

Pregnancy & lactation ratings: Natural Medicines, Therapeutic Research Center

References & further reading

The 10 references that drive our Alder Buckthorn 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. Tyler VE. Herbs of Choice. Binghamton, NY: Pharmaceutical Products Press, 1994.
  3. Newall CA, Anderson LA, Philpson JD. Herbal Medicine: A Guide for Healthcare Professionals. London, UK: The Pharmaceutical Press, 1996.
  4. Schulz V, Hansel R, Tyler VE. Rational Phytotherapy: A Physician's Guide to Herbal Medicine. Terry C. Telger, transl. 3rd ed. Berlin, GER: Springer, 1998.
  5. McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.
  6. Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications, 1998.
  7. 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
  8. Siegers, C. P., Hertzberg-Lottin, E., Otte, M., and Schneider, B. Anthranoid laxative abuse--a risk for colorectal cancer? Gut 1993;34(8):1099-1101. PubMed
  9. van Gorkom, B. A., de Vries, E. G., Karrenbeld, A., and Kleibeuker, J. H. Review article: anthranoid laxatives and their potential carcinogenic effects. Aliment.Pharmacol Ther 1999;13(4):443-452. PubMed
  10. Willems, M., van Buuren, H. R., and de, Krijger R. Anthranoid self-medication causing rapid development of melanosis coli. Neth.J Med 2003;61(1):22-24.
Keep reading

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.

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

Brand directory

Brands that make products with Alder Buckthorn

7 brands in our database make a supplement containing Alder Buckthorn.

Product directory

Supplement products with Alder Buckthorn

19 products in our database contain Alder Buckthorn. Open any to see its full ingredient list and every drug interaction we check.

Appetite Improvement Complex by TerraVita Liquid 1 Fluid Ounce(s) · 30 mL View ingredients & interactions Appetite Improvement Complex Chocolate Flavor by TerraVita Liquid 1 Fluid Ounce(s) · 30 mL View ingredients & interactions Appetite Improvement Complex Mint Flavor by TerraVita Liquid 1 Fluid Ounce(s) · 30 mL View ingredients & interactions Appetite Improvement Complex Strawberry Flavor by TerraVita Liquid 1 Fluid Ounce(s) · 30 mL View ingredients & interactions Appetite Improvement Complex Vanilla Flavor by TerraVita Liquid 1 Fluid Ounce(s) · 30 mL View ingredients & interactions Buckthorn Alcohol Free by Hawaii Pharm Liquid 4 Fluid Ounce(s) · 120 mL View ingredients & interactions DetoxOne by NutraOne Capsule 60 Capsule(s) View ingredients & interactions Expectorant Formula by TerraVita Liquid 1 Fluid Ounce(s) · 30 mL View ingredients & interactions Expectorant Formula Chocolate Flavor by TerraVita Liquid 1 Fluid Ounce(s) · 30 mL View ingredients & interactions Expectorant Formula Mint Flavor by TerraVita Liquid 1 Fluid Ounce(s) · 30 mL View ingredients & interactions Expectorant Formula Strawberry Flavor by TerraVita Liquid 1 Fluid Ounce(s) · 30 mL View ingredients & interactions Expectorant Formula Vanilla Flavor by TerraVita Liquid 1 Fluid Ounce(s) · 30 mL View ingredients & interactions FT by Loomis Enzymes Capsule 90 Capsule(s) View ingredients & interactions Herb-Lax by Shaklee Tablet Or Pill 240 Tablet(s) View ingredients & interactions Infinite Cleanse by Infinite Age Capsule 90 Capsule(s) View ingredients & interactions Lower Bowel Stimulator by Nature's Sunshine Tablet Or Pill 100 Vegitab(s) View ingredients & interactions Tiao He Cleanse by Nature's Sunshine Capsule 30 Packet(s) · 180 Capsule(s) View ingredients & interactions Ultra BDG by Loomis Enzymes Capsule 180 Capsule(s) View ingredients & interactions Ultra BDG by Loomis Enzymes Capsule 180 Capsule(s) View ingredients & interactions
Pharmacist Counseling Corner

Alder Buckthorn: Common Questions

What is Alder Buckthorn used for, and does it work?
People use Alder Buckthorn for many reasons, but the evidence varies by use. According to the Natural Medicines database, there is at least some clinical evidence supporting Alder Buckthorn for Constipation. For most other uses it has been studied for, the evidence is currently insufficient to rate. See the graded list on this page, and always confirm with your pharmacist or doctor.
Does Alder Buckthorn interact with prescription medications?
Yes. We list 122 medications with a known interaction with Alder Buckthorn. Use the checker above to see how Alder Buckthorn interacts with a specific drug.
How are Alder Buckthorn interactions rated?
Each interaction is graded major, moderate, or minor based on how clinically significant it is and the strength of the evidence behind it. Major interactions are the most serious and are best avoided, or used only under close professional supervision.
Is it safe to take Alder Buckthorn with my medications?
It depends on the specific medication. Some combinations are fine, while others call for monitoring, timing changes, or should be avoided. Check your exact drug above and confirm with your pharmacist or doctor before starting, stopping, or changing anything.
Where does this Alder Buckthorn interaction information come from?
Our interaction data is built on the Natural Medicines database — an evidence-graded reference for vitamins, herbs, and supplements — and is reviewed by licensed HelloPharmacist pharmacists, who may add clinical context.
What is Alder Buckthorn used for?
It is mainly used as a short-term natural laxative to relieve occasional constipation. There is little reliable evidence supporting any other use.
Is Alder Buckthorn safe to use long-term?
No. Regular or long-term use can damage the bowel lining, cause dependence on laxatives, and lead to mineral imbalances, so it should only be used briefly and occasionally.
Can I use Alder Buckthorn while pregnant or breastfeeding?
It is best avoided during pregnancy and breastfeeding. Stimulant laxatives are generally not recommended in pregnancy, and the active compounds may pass into breast milk.
Why does the bark need to be aged before use?
Fresh Alder Buckthorn bark contains compounds that can cause severe nausea, vomiting, and cramping. Proper drying and aging reduces these effects, which is why only treated bark should be used.

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

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