Longitudinal changes in senna-based laxative dosing in pediatric constipation: A single-center retrospective study

Area of Science:

• Pediatric Gastroenterology
• Pharmacology
• Clinical Therapeutics

Background:

• Chronic constipation is prevalent in children, often managed with senna-based laxatives.
• Concerns exist regarding long-term tolerance of senna in pediatric populations.
• Limited evidence addresses dose adjustments for sustained senna efficacy.

Purpose of the Study:

• To evaluate changes in senna dosing over time in pediatric patients.
• To determine if long-term senna use leads to tolerance.
• To assess the relationship between dose, weight, and follow-up duration.

Main Methods:

• Retrospective longitudinal study of pediatric patients on senna (2016-2023).
• Exclusion of patients with specific conditions like Hirschsprung disease or fecal incontinence.
• Analysis of total daily dose and weight-adjusted dose (mg/kg) using statistical models.

Main Results:

• Total daily senna dose increased significantly over time (45mg to 60mg).
• Weight-adjusted senna dose remained stable (1.89 vs. 1.88 mg/kg).
• Patient weight, not duration of follow-up, correlated with dose adjustments.

Conclusions:

• Weight-adjusted senna dosage is consistent during long-term pediatric use.
• Increased total daily dose reflects patient growth, not diminished therapeutic effect.
• Findings suggest senna does not exhibit tolerance and supports its use in pediatric bowel management.