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Dietary supplement

Cascara Sagrada 450 mg Ingredients & Drug Interactions

by NOW

Cascara Sagrada 450 mg label
See full label image
Capsule 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 Sagrada 450 mg 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 Sagrada 450 mg is a dietary supplement by NOW 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 Cascara Sagrada. 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 Sagrada 450 mg by NOW

Ask about any prescription or over-the-counter medication and we check it for interactions with Cascara Sagrada 450 mg by NOW — and tell you which ingredient is responsible.

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HelloPharmacist Scorecard of Cascara Sagrada 450 mg by NOW

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 11, 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: cascara sagrada, a plant-derived stimulant laxative. The capsule also includes two inactive ingredients — hypromellose and stearic acid — as filler and binder.

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: promote bowel regularity.
  • We looked for evidence on: Constipation, Bowel preparation.
  • 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.

Cascara sagrada is rated possibly ineffective for bowel preparation. For constipation, there isn't enough reliable evidence to rate whether it works.

Because cascara is a stimulant laxative, it may produce bowel movements in the short term, but the safety data advises caution, especially if you're thinking about using it regularly.

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.

When used short-term and appropriately, cascara is generally well tolerated. The most common side effect is mild belly discomfort and cramps.

Long-term use carries real risks: it can lead to low potassium, kidney damage (showing up as protein or blood in urine), and weight loss (cachexia). Rare but serious risks include liver damage and severe vomiting if the bark is fresh or improperly aged.

Cascara is not recommended during pregnancy because stimulant laxatives carry known risks. While breastfeeding, it's best avoided because its active compounds may pass into breast milk.

If you're pregnant or nursing, talk with your pharmacist or doctor before considering this product.

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 cascara, check with your pharmacist if you use any water pills or diuretics, steroids, blood thinners like warfarin, digoxin (a heart medication), or other stimulant laxatives. These carry Moderate-severity interactions.

You should also ask about any other prescription medications you take, since cascara may affect how your liver breaks them down.

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 sagrada may help short-term constipation in people not taking other medications, but it's not a first choice — the risks, especially with regular use, outweigh the benefits for most people. If you take water pills, steroids, blood thinners, heart medications, or any other prescription drug, you need to check with your pharmacist before starting it.

Long-term use isn't safe.

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 May 23, 2024.

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 Sagrada 450 mg, straight from the product label.

Brand NOW
Barcode (UPC) 733739046239
Net contents 250 Veg Capsule(s)
Market status On market
Date entered into DSLD May 23, 2024
DSLD ID 313724
Product type Botanical
Supplement form Capsule
Dietary claims / uses All Other, Structure/Function
Intended target group(s) Vegan, Vegetarian, Adult (18 - 50 Years), Kosher, Halal, 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 Sagrada 450 mg by NOW, 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 Veg Capsule(s)
Maximum serving Sizes:
1 Veg Capsule(s)
Servings per container
250
UPC/BARCODE
733739046239
IngredientAmount% DV
Cascara Sagrada450 mg--

Other ingredients: Hypromellose, Stearic Acid

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.
Suggested/Recommended/Usage/Directions

Suggested Usage: Take 1 capsule at bedtime with a full glass of water.

Precautions

Do not exceed recommended dose. For short term use only; do not take continuously for more than 1 week.

Notice: This product contains cascara sagrada. Read and follow directions carefully. Do not use if you have or develop diarrhea, loose stools, or abdominal pain because cascara sagrada may worsen these conditions and be harmful to your health.

Consult your physician if you have frequent diarrhea or if you are pregnant, nursing, taking medication, or have a medical condition.

Caution: For adults only.

Keep out of reach of children.

Not manufactured with yeast, wheat, gluten, soy, corn, milk, egg, fish, shellfish or tree nut ingredients. Produced in a GMP facility that processes other ingredients containing these allergens.

Formula

Cascara Sagrada Bark (Rhamnus purshiana), which means "sacred bark", has a long history of use by traditional herbalists to promote bowel regularity.

Triangle K (Kosher)

Crescent H (Halal)

FDA Disclaimer Statement

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

Formulation

Natural color variation may occur in this product.

Herbal Regularity Promotes Bowel Function

Non GMO

Vegetarian/Vegan

Not manufactured with yeast, wheat, gluten, soy, corn, milk, egg, fish, shellfish or tree nut ingredients.

Seals/Symbols

Non GMO Project Verified nongmoproject.org

Triangle K (Kosher)

Crescent H (Halal) GMP Quality Assured

FDA Statement of Identity

A Dietary Supplement

General Statements

Botanicals/Herbs Family owned since 1968.

Storage

Store in a cool, dry place after opening.

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

See for yourself

Cascara Sagrada 450 mg by NOW label

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

Cascara Sagrada 450 mg 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 Sagrada 450 mg by NOW

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

Serving size1 Veg Capsule(s) Dosage formCapsule Servings per container250 Amounts shown are per serving.

Cascara Sagrada

Interacts with
745 drugs
450 mg per serving Form: Rhamnus purshiana

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...

Cascara Sagrada monograph & interactions

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

Interaction report

Cascara Sagrada 450 mg by NOW Drug Interactions

Want to check YOUR meds against Cascara Sagrada 450 mg?

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

Cascara Sagrada 745

Individual Drug Interactions

The ingredients in Cascara Sagrada 450 mg interact with 745 drugs. Click any drug to see the details.

1 of the 1 ingredient in Cascara Sagrada 450 mg interact with drugs. Each result below shows which ingredient is responsible. Cascara Sagrada

Each ingredient & the kinds of drugs it affects

For each ingredient in Cascara Sagrada 450 mg 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.

Cascara Sagrada6 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
Cascara Sagrada full monograph & interactions
The maker

Brand information

Manufacturer and brand details for Cascara Sagrada 450 mg, from the product label.

NOW

See all NOW products
Name
NOW FOODS
Street Address
395 S. Glen Ellyn Rd.
City
Bloomingdale
State
IL
ZipCode
60108
Web Address
nowfoods.com
Pharmacist Counseling Corner

Cascara Sagrada 450 mg by NOW: Common Questions

Does Cascara Sagrada 450 mg by NOW interact with any medications?
Yes. Based on its ingredients, Cascara Sagrada 450 mg 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 Sagrada 450 mg 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 take cascara sagrada long-term for ongoing constipation?
No — long-term use carries real risks, including low potassium, kidney damage, and weight loss. Cascara is meant for short-term relief only. If constipation is chronic, talk with your doctor or pharmacist about safer options.
What's the most common side effect?
Mild belly discomfort and cramps. Most people tolerate it well when used short-term. Serious side effects — like liver damage or severe vomiting — are rare and usually happen if the bark wasn't properly aged.
Can I take it while I'm pregnant or breastfeeding?
No. Stimulant laxatives like cascara aren't recommended during pregnancy, and the active compounds pass into breast milk, so it's best avoided while nursing. Talk with your doctor or pharmacist for safer alternatives.
Does cascara actually work for constipation?
There isn't enough reliable evidence to say whether it works for constipation. It's rated possibly ineffective for bowel prep. It may cause bowel movements in the short term, but safer and better-studied options exist.
Why does my pharmacist want to check my medications before I start this?
Cascara interacts with many common medications — including water pills, steroids, blood thinners, and heart drugs — and can cause low potassium or boost the effects of blood thinners dangerously. It's important to make sure it's safe with what you're already taking.

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

Not sure if Cascara Sagrada 450 mg is safe with your meds?

Our pharmacists answer your medication & supplement questions — free.

Ask a pharmacist

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 Sagrada 450 mg label
Go deeper

The Full Monographs Behind Cascara Sagrada 450 mg’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 Sagrada 450 mg'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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