Sodium Picosulfate / Magnesium Oxide / Citric Acid

What it is and how it works

Sodium picosulfate is hydrolysed by colonic bacteria to an active diphenol that stimulates colonic peristalsis. Magnesium oxide reacts with citric acid in water to form magnesium citrate, an osmotic laxative that retains fluid in the bowel; together they produce rapid evacuation and cleansing.

Indications

Bowel cleansing before colonoscopy, radiological examination or colorectal surgery.

Dosage and administration (summary)

Adults: two sachets, each dissolved in about 150 mL of water — typically one taken the evening before and one on the morning of the procedure (or split according to the procedure time), each followed by plenty (about 1.5–2 L in total) of clear fluids.

Contraindications

Congestive heart failure; gastric retention, gastrointestinal ulceration, obstruction or perforation, ileus, toxic colitis or toxic megacolon; active inflammatory bowel disease; severe dehydration; rhabdomyolysis; hypermagnesaemia; severe renal impairment; acute abdominal conditions.

Warnings and precautions

Can cause dehydration and electrolyte disturbances (hyponatraemia, hypokalaemia, hypermagnesaemia), seizures from hyponatraemia, and renal impairment; caution in the elderly, frail and those taking diuretics, ACE inhibitors, NSAIDs or drugs affecting electrolytes. Adequate clear fluid intake is essential. Absorption of oral medicines taken within about 1 hour before to several hours after may be reduced, including oral contraceptives.

Pregnancy

Use in pregnancy only if clearly necessary.

Storage and supply

Store below 25 °C; prepare the solution immediately before use.

Source: reference summary prepared from the EU SmPC/EPAR, BNF and WHO Model Formulary. The approved product information in Iran governs.