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Dietary supplement

Cascara Ingredients & Drug Interactions

by Herbal Terra

Cascara label
See full label image
Liquid Category: Botanical
Most serious interaction: Moderate
Clinical methodology reviewed by · Updated Sep 16, 2026 · Label data from the NIH DSLD
What is this page for?

First and foremost: checking Cascara against your medications. The heart of this page is the interaction checker and the full interaction report — how this product’s ingredients may interact with prescription and over-the-counter medicines you may be taking.

Around that, we add a pharmacist’s high-level view of the product as a whole — what’s inside, the evidence for its stated use, how transparent the label is, and what safety data exists — so you can see the full picture in one place. It’s educational information from our licensed clinical databases and the clinical staff at HelloPharmacist — not medical advice — and we don’t sell or endorse products. Our editorial policy

The interaction bottom line Most serious interaction: Moderate

Cascara is a dietary supplement by Herbal Terra with 1 active ingredient. Its ingredients are commonly taken for constipation, bowel cleansing before procedures, hemorrhoids.Based on those ingredients, 745 medications have a known interaction with it, the most serious rated moderate. The ingredients most likely to interact are wildcrafted Cascara (Rhamnus purshiana) dried bark liquid extract. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.

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Check Your Meds Against Cascara by Herbal Terra

Ask about any prescription or over-the-counter medication and we check it for interactions with Cascara by Herbal Terra — and tell you which ingredient is responsible.

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HelloPharmacist Scorecard of Cascara by Herbal Terra

Our pharmacy team’s full take, with four database checks built into the cards below — a summary of what is known, not a grade of the product itself.

From our pharmacy team — supplement deep dive

Generated from HelloPharmacist’s pharmacist-curated databases and editorial rules · Last generated Jul 12, 2026

What’s inside

Full disclosure
Ingredient Transparency · database check
Full

Every active ingredient lists its own amount on the label.

Why this rating?
  • The label discloses an exact amount for 1 of its 1 active ingredient.
  • No proprietary blends here — you can verify the dose of every single component.

This product contains one active ingredient: wildcrafted cascara sagrada (Rhamnus purshiana) dried bark in liquid extract form. Cascara has been used traditionally as a stimulant laxative to promote bowel movements.

The only other ingredient listed is menstruum, a carrier used to make the extract.

Does it work?

Leans against
Evidence for Intended Use · database check
By FDA rules, dietary supplements can’t claim to treat, cure, or prevent disease — so labels speak in careful marketing language. We discern each product’s intended use from its name, label claims, and label statements, then grade the clinical evidence for that use. How these ratings are computed
Leans against

The strongest graded evidence we hold for the stated purpose leans against a benefit.

Why this rating?
  • The label markets this product for: bowel health and regularity.
  • We looked for evidence on: Constipation, Bowel preparation, Bowel cleansing, Digestive support.
  • The closest evidence on file: Cascara Sagrada is rated "Possibly Ineffective" for Bowel preparation (Natural Medicines).
  • Also on file: Cascara Sagrada is rated "Insufficient Reliable Evidence To Rate" for Constipation.

The evidence for cascara is mixed. For bowel preparation — like before a medical procedure — it's rated possibly ineffective.

For constipation itself, there isn't enough reliable evidence in our data to say whether it works or doesn't.

The evidence, ingredient by ingredient Cascara Sagrada

How safe is it?

Well-documented data
Safety Information · database check
Well characterized

Adverse-effect, pregnancy, and general safety data are on file for most of these ingredients.

Why this rating?
  • We hold adverse-effect (side-effect) data for 1 of the 1 matched ingredient.
  • Pregnancy & breastfeeding safety ratings cover 1 of 1.
  • General safety write-ups exist for 1 of 1.
  • Remember: this measures how much safety information exists. Thin data is not the same as being safe.

Cascara is generally well tolerated when used short-term and appropriately, though mild abdominal discomfort and cramps can happen. The real concerns appear with long-term use: stimulant laxatives like this one carry risks including liver damage (though rare), protein in urine, blood in urine, and wasting of muscle and body mass.

Fresh or improperly aged cascara bark can also cause severe vomiting. The safety data advises against cascara during pregnancy and while breastfeeding, since active compounds may pass into breast milk.

Side effects, ingredient by ingredient Cascara Sagrada

Meds to double-check

Moderate interaction found
Known Interaction Concern · database check
Moderate identified

The most serious documented interaction for these ingredients is Moderate. Check your medications for a personalized result.

Why this rating?
  • 1 of the 1 matched ingredient can interact with medications — Cascara Sagrada.
  • The most serious interaction on file is rated Moderate.
  • Some involve high-stakes drug classes: anticoagulant / antiplatelet drugs; heart-rhythm medications.
  • For scale: 746 individual medications appear in the full list. A big number alone doesn't make a product dangerous — what matters is whether YOUR medication is on it, so run yours through the interaction checker on this page.

Before you take this, check with your pharmacist if you're on corticosteroids, water pills (diuretics), digoxin for your heart, warfarin or other blood thinners, other stimulant laxatives, or any medication metabolized by the liver enzyme CYP3A4. Altogether, these interactions span 746 individual medications.

Check your own medication Run your meds through the checker above

The bottom line

Scorecard at a glanceFully disclosed formula with graded evidence leaning against its stated purpose. Moderate medication interactions have been identified, and safety information is well characterized.

Cascara is best reserved for short-term constipation relief under the guidance of someone who knows your full medication list. If you take a water pill, corticosteroid, digoxin, warfarin, or other stimulant laxatives, or if you're pregnant or nursing, talk with your pharmacist or doctor before using it.

Long-term use carries real risks and isn't recommended.

Educational only — not medical advice; always confirm with your pharmacist. Our editorial policy · How we use AI

Assessment coverage: 1 of 1 active ingredient matched to our full ingredient reviews (monographs). Based on the product label dated Sep 25, 2020.

This Scorecard evaluates available label information, ingredient evidence, and known medication-safety considerations. It does not independently verify product identity, purity, potency, contamination, or manufacturing quality. How these ratings are computed

At a glance

General information

Key facts about Cascara, straight from the product label.

Brand Herbal Terra
Barcode (UPC) 7429523877822
Net contents 4 Fluid Ounce(s); 120 mL
Market status On market
Date entered into DSLD Sep 25, 2020
DSLD ID 234604
Product type Botanical
Supplement form Liquid
Dietary claims / uses All Other, Structure/Function
Intended target group(s) Adult (18 - 50 Years), Gluten Free
From the label
Everything in this section is reproduced from the manufacturer’s own product label — it’s the label speaking, not HelloPharmacist. We show it so you can see exactly what the maker states; we don’t verify or endorse those statements.

Supplement Facts

The label details for Cascara by Herbal Terra, sourced from the NIH Dietary Supplement Label Database.

Supplement Facts

Daily Value (DV) Target Group(s):
Adults and children 4 or more years of age
Minimum serving Sizes:
1 mL
Maximum serving Sizes:
1 mL
Servings per container
120
UPC/BARCODE
7429523877822
IngredientAmount% DV
wildcrafted Cascara (Rhamnus purshiana) dried bark liquid extract970 mg--

Other ingredients: Menstruum

Tap any ingredient to jump to its full detail below.

Label statements
These statements are the manufacturer’s wording, reproduced from the product label — the label is saying it, not HelloPharmacist. We don’t verify or endorse them.
Formulation

Origin of plant material: USA.

Manufactured in the USA in an FDA registered facility

Alcohol free

Dried herb/menstruum ratio: 1:3 Expertly extracted Laboratory tested 330 mg/1 mL Premium product Alcohol-free liquid herbal extract

Non GMO

No artificial ingredients, GMO, gluten, color additives, fillers, preservatives or binders. Natural Gluten Free

Suggested/Recommended/Usage/Directions

Direction Shake well before use. Adults take up to 30 drops (1 mL, one full squeeze of the dropper bulb) in 3-4 fl. oz of juice or water up to 4 times a day. We recommend to seek expert medical advice before taking this or any other herbal supplements.

FDA Disclaimer Statement

Notice This product has not been evaluated by the FDA and is not intended to diagnose, treat, cure, or prevent any disease.

Precautions

Caution May have contraindications.

Do not use if you are allergic to any ingredients.

Consult a physician before using during pregnancy, if nursing, or if you are on any medications.

Keep out of the reach of children.

Storage

Store in a cool, dry, dark place.

Formula

Rhamnus purshiana

FDA Statement of Identity

Herbal Supplement

Seals/Symbols

Made in USA Made in an FDA registered facility Natural Gluten Free

Is this label outdated? Report a formula or label change and our pharmacy team will review it.

See for yourself

Cascara by Herbal Terra label

The label scan from the NIH Dietary Supplement Label Database. Tap to enlarge.

Cascara label

Label images are published by the NIH Dietary Supplement Label Database for the version of this product on file. Always read your actual product label.

View the full label (PDF)
What’s inside

The Ingredients in Cascara by Herbal Terra

This is the 1 active ingredient this product is made of. Select it to open its full monograph.

Serving size1 mL Dosage formLiquid Servings per container120 Amounts shown are per serving.

Wildcrafted Cascara (Rhamnus purshiana) dried bark liquid extract

Interacts with
745 drugs
970 mg per serving

Cascara sagrada is a stimulant laxative made from the aged bark of a Pacific Northwest tree, used mainly for short-term relief of constipation. Becaus...

Wildcrafted Cascara (Rhamnus purshiana) dried bark liquid extract monograph & interactions

Other (inactive) ingredients: Menstruum. These complete the product’s ingredient list but are not active constituents.

Interaction report

Cascara by Herbal Terra Drug Interactions

Want to check YOUR meds against Cascara?

Ask about interactions with your drugs in plain English — “Can I take it with lisinopril?” — and we find you the answer in seconds, ingredient by ingredient.

 Go to the checker
745Drugs
122 Moderate 623 Minor

Ingredients driving the most interactions

wildcrafted Cascara (Rhamnus purshiana) dried bark liquid extract 745

Individual Drug Interactions

The ingredients in Cascara interact with 745 drugs. Click any drug to see the details.

1 of the 1 ingredient in Cascara interact with drugs. Each result below shows which ingredient is responsible. wildcrafted Cascara (Rhamnus purshiana) dried bark liquid extract

Each ingredient & the kinds of drugs it affects

For each ingredient in Cascara with known interactions, here are the types of medications it can affect. Open any type for the detail — or search your exact drug in the checker above.

wildcrafted Cascara (Rhamnus purshiana) dried bark liquid extract6 drug types · 745 drugs

Corticosteroids

Theoretically, cascara sagrada might increase the risk of hypokalemia when taken with corticosteroids.
Cascara sagrada has stimulant laxative effects, and long-term use has been associated with hypokalemia.

Likelihood Possible Evidence D
Digoxin (Lanoxin)

Theoretically, cascara sagrada might cause hypokalemia, potentially increasing the risk of digoxin toxicity.
Cascara sagrada has stimulant laxative effects, and long-term use has been associated with hypokalemia.

Likelihood Possible Evidence D
Diuretic Drugs

Theoretically, cascara sagrada might increase the risk of hypokalemia when taken with diuretic drugs.
Cascara sagrada has stimulant laxative effects, and long-term use has been associated with hypokalemia.

Likelihood Possible Evidence D
Stimulant Laxatives

Theoretically, cascara sagrada might have additive adverse effects when taken with stimulant laxatives.
Cascara sagrada has stimulant laxative effects and might compound fluid and electrolyte losses when taken with stimulant laxatives.

Likelihood Possible Evidence D
Warfarin (Coumadin)

Theoretically, cascara sagrada might increase the risk of bleeding when taken with warfarin.
Cascara sagrada has stimulant laxative effects. In some people, cascara sagrada can cause diarrhea. Diarrhea can increase the effects of warfarin, increase international normalized ratio (INR), and increase the risk of bleeding.

Likelihood Possible Evidence D
Cytochrome P450 3A4 (Cyp3A4) Substrates

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.

Likelihood Possible Evidence D
wildcrafted Cascara (Rhamnus purshiana) dried bark liquid extract full monograph & interactions
The maker

Brand information

Manufacturer and brand details for Cascara, from the product label.

Herbal Terra

See all Herbal Terra products
Name
Herbal Terra
Pharmacist Counseling Corner

Cascara by Herbal Terra: Common Questions

Does Cascara by Herbal Terra interact with any medications?
Yes. Based on its ingredients, Cascara has a known interaction with 745 medications. Use the checker to see how it interacts with a specific drug.
How can one product interact with so many drugs?
Cascara contains a single active ingredient, and that one ingredient can interact with many different medications on its own. We check it against each medication and show the mechanism responsible.
Where does this information come from?
The product label data comes from the NIH Dietary Supplement Label Database (DSLD); the interaction data is built on the Natural Medicines database and reviewed by HelloPharmacist pharmacists.
Can I use cascara if I'm pregnant or breastfeeding?
No — the safety data advises against it during pregnancy, and while nursing, active compounds may pass into breast milk. Talk with your doctor or pharmacist about safer options for constipation during these times.
What are the side effects of cascara?
Short-term use usually causes mild abdominal discomfort and cramps. Long-term use carries more serious risks, including liver damage (rare but possible), protein or blood in urine, and wasting of muscle mass. Fresh or improperly aged cascara can trigger severe vomiting.
Does cascara actually work for constipation?
There isn't enough reliable evidence in our data to say whether it works for constipation. For bowel preparation before a medical procedure, it's rated possibly ineffective.
Why is cascara risky with water pills or heart medications?
Cascara can lower your potassium level, especially with long-term use. Water pills also lower potassium, so together the risk climbs. Low potassium is particularly dangerous if you take digoxin for your heart — it can trigger life-threatening heart rhythm problems.
What's menstruum in this product?
Menstruum is a liquid carrier used to make the cascara extract. It's an inactive ingredient and not the active part of the product.
Is this safe for long-term use?
No — the safety data cautions that cascara may help short-term constipation but carries real risks with long-term use. If you need ongoing relief, talk with your pharmacist about safer options.

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

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Label information is sourced from the NIH Dietary Supplement Label Database and reflects the product version on file; always read your actual product label. This page is for education only and is not a substitute for professional medical advice. Confirm with your pharmacist or doctor before combining supplements and medications.

Cascara label
Go deeper

The Full Monographs Behind Cascara’s Ingredients

Every ingredient we hold a full HelloPharmacist monograph for — uses, evidence, safety, and the complete interaction list.

Herb & supplement monograph

Cascara Sagrada

Interacts with 745 drugs

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, an...

Read the full Cascara Sagrada monograph →
Sources

Sources & How We Checked

Cascara's label data comes from the NIH Dietary Supplement Label Database; the ingredient interaction data is from the Natural Medicines database, reviewed by our pharmacists.

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

The 9 references behind this product’s interaction data

Every citation that drives the interaction findings for this product’s ingredients, from the evidence-graded Natural Medicines (TRC Healthcare) database. Open an ingredient to browse its citations — links open the study on PubMed or the publisher’s site.

Cascara Sagrada 9 references
  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

See these in context on the Cascara Sagrada monograph →

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

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