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Sodium Picosulfate/magnesium Oxide/citric Acid Generic Name & Formulations
Legal Class
Rx
General Description
Sodium picosulfate 10mg, magnesium oxide 3.5g, anhydrous citric acid 12g; per packet; powder for oral solution after reconstitution; orange-flavor.
Pharmacological Class
Stimulant + osmotic laxative.
How Supplied
Contact supplier
Manufacturer
Mechanism of Action
Sodium picosulfate is hydrolyzed by colonic bacteria to form an active metabolite: bis-(p-hydroxy-phenyl)-pyridyl-2-methane, BHPM, which acts directly on the colonic mucosa to stimulate colonic peristalsis. Magnesium oxide and citric acid react to create magnesium citrate in solution, which is an osmotic agent that causes water to be retained within the GI tract.
Sodium Picosulfate/magnesium Oxide/citric Acid Indications
Indications
Bowel cleansing before colonoscopy.
Sodium Picosulfate/magnesium Oxide/citric Acid Dosage and Administration
Adults and Children
<9yrs: not established. ≥9yrs: Split-Dose regimen (preferred): Take 1st dose evening before colonoscopy followed by drinking five 8oz cups of clear liquids within 5hrs and before bed. Take 2nd dose, the next day approx. 5hrs before colonoscopy followed by at least three 8oz cups of clear liquids, at least 2hrs before procedure. Day-Before regimen (alternative): Take 1st dose in the afternoon or early evening before colonoscopy followed by drinking five 8oz cups of clear liquids within 5hrs and before the next dose. Take 2nd dose approx. 6hrs later in the evening, the night before colonoscopy followed by three 8oz cups of clear liquids within 5hrs and before bed.
Administration
Reconstitute the powder right before each administration. Do not prepare the solution in advance. Fill the supplied dosing cup with cold water up to the lower (5oz) line on the cup and pour in the contents of one packet. Stir for 2 to 3 minutes. The reconstituted solution may become slightly warm as the powder dissolves.
Nursing Considerations
Reconstitute the powder right before each administration. Do not prepare the solution in advance. Fill the supplied dosing cup with cold water up to the lower (5oz) line on the cup and pour in the contents of one packet. Stir for 2 to 3 minutes. The reconstituted solution may become slightly warm as the powder dissolves. Additional fluids must be consumed after every dose in both dosing regimens. Observe patients with impaired gag reflex and those prone to regurgitation during administration.
Sodium Picosulfate/magnesium Oxide/citric Acid Contraindications
Contraindications
Severe renal impairment (CrCl <30mL/min). GI obstruction. Ileus. Bowel perforation. Toxic colitis or megacolon. Gastric retention.
Sodium Picosulfate/magnesium Oxide/citric Acid Boxed Warnings
Not Applicable
Sodium Picosulfate/magnesium Oxide/citric Acid Warnings/Precautions
Warnings/Precautions
Correct fluid/electrolyte abnormalities before use. CHF. History or risk of seizures. Alcohol or benzodiazepine withdrawal. Known or suspected hyponatremia. Mild-to-moderate renal impairment; consider baseline and post-colonoscopy lab tests. Increased risk of arrhythmias (eg, history of prolonged QT, uncontrolled arrhythmias, recent MI, unstable angina, CHF, cardiomyopathy); consider pre-dose and post-colonoscopy ECGs. Mucosal ulcerations may occur; consider when interpreting findings in inflammatory bowel disease. Rule out GI obstruction/perforation before administering. Severe active ulcerative colitis. Impaired gag reflex: risk of regurgitation or aspiration. Maintain adequate hydration. Children: monitor for hypoglycemia. Pregnancy. Nursing mothers.
Sodium Picosulfate/magnesium Oxide/citric Acid Pharmacokinetics
See Literature
Sodium Picosulfate/magnesium Oxide/citric Acid Interactions
Interactions
Caution with drugs that increase risk of fluid/electrolyte abnormalities or that may affect renal function (eg, diuretics, ACEIs, ARBs, NSAIDs). Administer oral meds at least 1hr before sodium picosulfate/magnesium oxide/citric acid. Separate dosing of tetracyclines, fluoroquinolones, iron, digoxin, chlorpromazine, or penicillamine by at least 2hrs before or >6hrs after. Antibiotics may reduce efficacy. Caution with drugs that lower seizure threshold (eg, tricyclics). Increased risk of colonic mucosal ulcerations or ischemic colitis with stimulant laxatives.
Sodium Picosulfate/magnesium Oxide/citric Acid Adverse Reactions
Adverse Reactions
Nausea, headache, vomiting; children: also abdominal pain.
Sodium Picosulfate/magnesium Oxide/citric Acid Clinical Trials
See Literature
Sodium Picosulfate/magnesium Oxide/citric Acid Note
Notes
Formerly known under the brand name Prepopik.
Sodium Picosulfate/magnesium Oxide/citric Acid Patient Counseling
See Literature
