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Dietary supplement

Cascara Sagrada Ingredients & Drug Interactions

by Pure Herbs

Cascara Sagrada label
See full label image
Liquid Category: Botanical
Most serious interaction: Moderate
Clinical methodology reviewed by · Updated Sep 9, 2026 · Label data from the NIH DSLD
What is this page for?

First and foremost: checking Cascara Sagrada 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 is a dietary supplement by Pure Herbs 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 Bark 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 Sagrada by Pure Herbs

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

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HelloPharmacist Scorecard of Cascara Sagrada by Pure Herbs

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: cascara sagrada bark extract, a plant compound with stimulant laxative properties. Stimulant laxatives work by triggering bowel muscle contractions to move stool through your intestines.

There are no other inactive ingredients listed.

Does it work?

Insufficient evidence
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
Insufficient

There isn't enough reliable clinical evidence to rate this product's ingredients for its stated purpose.

Why this rating?
  • The label markets this product for: support for occasional constipation.
  • We looked for evidence on: Constipation, bowel regularity, digestive comfort.
  • The closest evidence on file: Cascara Sagrada is rated "Insufficient Reliable Evidence To Rate" for Constipation (Natural Medicines).

The evidence on cascara sagrada for constipation is insufficient — we don't have reliable data to rate whether it actually works for that purpose. For bowel preparation (such as before a procedure), it's rated possibly ineffective.

Because the data we hold doesn't establish clear benefit and the long-term risks are real, it's worth discussing with your pharmacist whether a different approach might suit you better.

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 sagrada is generally well tolerated. Mild belly discomfort and cramping are the most common side effects.

Long-term use carries serious risks: it can harm your liver (rarely), cause blood in your urine, deplete muscle tissue, and consistently lower your potassium. Fresh or improperly aged bark can cause severe vomiting.

The safety data advises against cascara during pregnancy because stimulant laxatives are not recommended in that setting. While nursing, it's rated possibly unsafe — active compounds can pass into breast milk, so it's best avoided.

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 start, double-check with your pharmacist if you take blood thinners like warfarin (Coumadin), water pills (diuretics), steroids (corticosteroids), digoxin (Lanoxin), or any other stimulant laxatives. These represent Moderate-severity interactions.

You should also mention any drugs your liver breaks down via CYP3A4, which cascara may weaken.

Check your own medication Run your meds through the checker above

The bottom line

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

Cascara sagrada may help short-term constipation, but the evidence is weak and long-term use carries real risks — especially low potassium and liver harm. If you take blood thinners, water pills, steroids, or digoxin, talk to your pharmacist before using this product.

Pregnant people and those nursing should avoid it. For constipation, there are often safer options worth discussing first.

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 Dec 13, 2022.

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, straight from the product label.

Brand Pure Herbs
Net contents 4 Fluid Ounce(s); 120 mL
Market status On market
Date entered into DSLD Dec 13, 2022
DSLD ID 279749
Product type Botanical
Supplement form Liquid
Dietary claims / uses All Other, Structure/Function
Intended target group(s) Adult (18 - 50 Years)
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 by Pure Herbs, 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:
2 mL
Maximum serving Sizes:
2 mL
Servings per container
60
IngredientAmount% DV
Cascara sagrada Bark Extract1892 mg--

Other ingredients: None

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

Directions: For adults, mix 2 mL (abt. 1/2 tsp) of extract in 2 fl. oz (60 mL) water one time daily preferably with a meal.

Shake well before use

Formulation

Beneficial for occasional constipation.

FDA Disclaimer Statement

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

Precautions

Notice: This product contains Cascara Sagrada. Read and follow directions carefully. Do not use if you have or develop diarrhea, loose stool, 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.

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

Keep out of reach of children

Brand IP Statement(s)

Pure Herbs, Ltd. Natural Herbal Extracts

FDA Statement of Identity

Dietary Supplement

General Statements

"No expense has been spared to provide the finest nature has to offer."

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

See for yourself

Cascara Sagrada by Pure Herbs label

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

Cascara Sagrada 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 by Pure Herbs

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

Serving size2 mL Dosage formLiquid Servings per container60 Amounts shown are per serving.

Cascara sagrada Bark Extract

Interacts with
745 drugs
1892 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...

Cascara sagrada Bark Extract monograph & interactions

Other (inactive) ingredients: None. These complete the product’s ingredient list but are not active constituents.

Interaction report

Cascara Sagrada by Pure Herbs Drug Interactions

Want to check YOUR meds against Cascara Sagrada?

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 Bark Extract 745

Individual Drug Interactions

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

1 of the 1 ingredient in Cascara Sagrada interact with drugs. Each result below shows which ingredient is responsible. Cascara sagrada Bark Extract

Each ingredient & the kinds of drugs it affects

For each ingredient in Cascara Sagrada 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 sagrada Bark 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
Cascara sagrada Bark Extract full monograph & interactions
The maker

Brand information

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

Pure Herbs

See all Pure Herbs products
Name
Pure Herbs, Ltd.
City
Sterling Heights
State
MI
Phone Number
(800) 860-4372
Web Address
www.pureherbs.com
Pharmacist Counseling Corner

Cascara Sagrada by Pure Herbs: Common Questions

Does Cascara Sagrada by Pure Herbs interact with any medications?
Yes. Based on its ingredients, Cascara Sagrada 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 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.
Does cascara sagrada actually work for constipation?
The evidence isn't there to say for sure. We have insufficient reliable data to rate it for constipation, and for bowel prep it's rated possibly ineffective. Given the interaction risks, it's worth asking your pharmacist about safer alternatives first.
Is it safe to use long-term?
No. Long-term use is associated with serious risks including low potassium, blood in your urine, liver damage, and muscle wasting. It's meant for short-term use only.
Can I take this if I'm pregnant or breastfeeding?
No. Stimulant laxatives like cascara are not recommended during pregnancy. While nursing, it's rated possibly unsafe because active compounds can pass into breast milk. Talk to your doctor or pharmacist for safe alternatives.
What are the most common side effects?
Mild belly discomfort and cramping when used short-term and as directed. Fresh or improperly aged bark can cause severe vomiting, which is rare but serious.
If I take a water pill or steroid, can I use this?
Not without checking with your pharmacist first. Both diuretics and steroids can lower your potassium, and cascara does the same — combining them raises the risk of dangerously low potassium.
Does this interact with blood thinners?
Yes. If you take warfarin (Coumadin), cascara can trigger diarrhea, which boosts the drug's effects, raises your INR, and increases bleeding risk. Your pharmacist needs to know before you start.

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 Sagrada label
Go deeper

The Full Monographs Behind Cascara Sagrada’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'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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