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Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-.

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Drugs and Lactation Database (LactMed) [Internet].

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Last Revision: December 3, 2018.

Estimated reading time: 2 minutes

Drug Levels and Effects

Summary of Use during Lactation

The bark, stems and leaves of European buckthorn (Rhamnus catharticus), alder buckthorn (Rhamnus frangula) and California buckthorn (Rhamnus purshiana) contain anthraquinones that have potent cathartic properties. (Do not confuse these products with sea buckthorn [Hippophae rhamnoides]). Maternal intake of the cathartic buckthorn products might cause loose stools in breastfed infants and their use should be avoided.[1][2][3][4]

Dietary supplements do not require extensive pre-marketing approval from the U.S. Food and Drug Administration. Manufacturers are responsible to ensure the safety, but do not need to prove the safety and effectiveness of dietary supplements before they are marketed. Dietary supplements may contain multiple ingredients, and differences are often found between labeled and actual ingredients or their amounts. A manufacturer may contract with an independent organization to verify the quality of a product or its ingredients, but that does not certify the safety or effectiveness of a product. Because of the above issues, clinical testing results on one product may not be applicable to other products. More detailed information about dietary supplements is available elsewhere on the LactMed Web site.

Drug Levels

No published information was found as of the revision date on European buckthorn or alder buckthorn. However, the chemical constituents of these products is similar to that of cascara sagrada (California buckthorn).

Maternal Levels. After administration of 65 mg of cascara sagrada as cascara fluidextract, cascara was qualitatively detected in the breastmilk of 5 of 10 women collected over 20 hours.[5] The sensitivity of the assay was about 1100 mg/L of cascara.

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

In 2 uncontrolled studies, a total of 10 of 22 breastfed infants appeared to have loose stools after administration of 65 mg of cascara as cascara fluidextract to their mothers.[5]

No cases of diarrhea were observed among the breastfed infants of 142 mothers who received 400 mg of cascara extract on day 3 postpartum.[6]

Effects on Lactation and Breastmilk

Relevant published information was not found as of the revision date.

Alternate Drugs to Consider

Bisacodyl, Magnesium Hydroxide, Senna


Lewis JH, Weingold AB and the Committee of FDA-Related Matters, American College of Gastroenterology. The use of gastrointestinal drugs during pregnancy and lactation. Am J Gastroenterol. 1985;80:912-23. [PubMed: 2864852]
Nice F, Coghlan RJ, Birmingham BT. Which herbals are safe to take while breastfeeding? Here's a guide to popular herbs and their potential risk to nurslings. US Pharm. 2000;25.
Hardy ML. Women's health series: herbs of special interest to women. J Am Pharm Assoc (Wash). 2000;40:234-42. [PubMed: 10730024]
Kopec K. Herbal medications and breastfeeding. J Hum Lact. 1999;15:157-61. [PubMed: 10578793]
Tyson RM, Shrader EA, Perlman HH. Drugs transmitted through breast milk. Part I: Laxatives. J Pediatr. 1937;11:824-32.
Duncan AS. Standardized senna as a laxative in the puerperium. A clinical assessment. Br Med J. 1957;1:439-41. [PMC free article: PMC1974525] [PubMed: 13396280]

Substance Identification

Substance Name


Scientific Name

Rhamnus catharticus Rhamnus frangula Rhamnus purshiana

Drug Class

  • Breast Feeding
  • Cathartics
  • Complementary Therapies
  • Gastrointestinal Agents
  • Phytotherapy
  • Plants, Medicinal

Disclaimer: Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.


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