毒理性
在推荐剂量下短时间内使用番泻叶与少数副作用有关，其中大多数副作用都是轻微且短暂的，与其泻药作用有关。然而，长期和高剂量使用番泻叶已有不良事件报道，包括多起临床上明显的肝损伤病例。肝损伤的出现时间通常在使用3到5个月后，血清酶升高的模式是肝细胞型。肝损伤通常是轻到中度的严重程度，并在停药后迅速缓解。至少在一个实例中，再次接触导致了肝损伤的快速复发。已发表的病例中未出现免疫过敏特征和自身免疫标记。
此外，一种常见的相关植物，通常被称为咖啡番泻叶或豆寇，已被联系到许多急性、严重毒性事件，包括脑病、肌病和肝功能障碍。在印度北部的Uttar Pradesh，每年通常在9月到11月之间，会发生原因不明的“肝-肌-脑病”爆发。调查最终确定摄入西番泻叶是可能的原因，通常发生在吃这种常见开花杂草的叶或豆荚的儿童中。虽然西番泻叶也被用来泡茶，但摄入的量是最小的。在儿童中，偶尔在成人中，病情表现急剧，伴有恶心、呕吐、震颤、异常和暴力行为、做鬼脸和自残，随后是昏迷，此时血清转氨酶和胆红素水平通常会升高。在严重的情况下，肝损伤是进行性的，血清氨和INR水平升高，患者出现昏迷、惊厥和状态性癫痫，对治疗无反应。尸检显示肝细胞坏死和胆汁淤积。摄入西番泻叶的动物也会出现类似的症状和损伤模式。这种综合征是否与罕见情况下归因于典型番泻叶（作为泻药使用的狭叶番泻或尖叶番泻）的肝损伤有相似的病理机制尚不清楚。
可能性评分：D（可能是临床上明显肝损伤的罕见原因）。
Use of senna in the recommended doses for a limited period of time has been associated with few side effects, most of which are mild and transient and related to its laxative action. With longer term and higher dose use of senna, however, adverse events have been described including several cases of clinically apparent liver injury. The time to onset of liver injury was usually after 3 to 5 months of use, and the pattern of serum enzyme elevations was hepatocellular. The liver injury was usually mild-to-moderate in severity and resolved rapidly with discontinuation. In at least one instance, reexposure led to rapid recurrence of liver injury. Immunoallergic features and autoimmune markers were not present in the published cases.
In addition, a related plant commonly known as coffee senna or Cassia orientalis has been linked to many instances of acute, severe toxicity with encephalopathy, myopathy and hepatic dysfunction. Outbreaks of “hepato-myo-encephopathy” of unknown cause among children occurred yearly in Uttar Pradesh, India typically between September and November. Investigation eventually identified Cassia occidentalis ingestion as the probable cause, typically occurring in children who eat the leaves or pods of the common flowering weed. While Cassia occidentalis has also been used to prepare tea, the amount ingested was minimal. In children, and rarely in adults, the presentation was precipitous with nausea, vomiting, tremor, abnormal and violent behavior, grimacing and self-mutilation followed by stupor and coma at which time serum aminotransferase and bilirubin levels were typically elevated. In severe instances, the liver injury was progressive, serum ammonia and INR levels rose and patients developed coma, convulsions and status epilepticus that was unresponsive to therapy. Autopsies revealed hepatic necrosis and cholestasis. A similar pattern of symptoms and injury occurs in animals that consume Cassia occidentalis. Whether this syndrome has a similar pathogenesis to the rare instance of hepatic injury attributed to typical senna (Cassia acutifolia or angustifolio) that is used as a laxative is unknown.
Likelihood score: D (possible rare cause of clinically apparent liver injury).
来源:LiverTox
