Sodium Picosulfate, Magnesium, and Citric Acid

Sodium picosulfate, and magnesium, and citric acid is a combination medicine utilized to clear out the colon before a scheduled colonoscopy to enable the doctor to see the colon walls clearly.

Overview

Sodium picosulfate, and magnesium, and citric acid medicine is used to clear out the colon or the gastrointestinal (GI) tract so the doctor can clearly see the walls of the colon. It is given to the patient before a scheduled colonoscopy is conducted. Colonoscopy is an assessment of the patient’s colon to check the presence of cancer of the cancer and related problems.

Sodium picosulfate belongs to a group of medications referred to as stimulant laxatives. Magnesium oxide and citric acid are combined by mixing the powder with water to form a medicine called magnesium citrate. Magnesium citrate belongs to a group of medications referred to as osmotic laxatives. These medicines induce diarrhea in the patient, making the colon free from stool. The US drug brand name for sodium picosulfate, magnesium, and citric acid combination medicine is Prepopik.

Conditions Treated

  • Empty the colon or clean out the gastrointestinal (GI) tract before a scheduled colonoscopy

Type of Medicine

  • laxatives

Side Effects

The combined medicine may cause some side effects in some patients. Some of these side effects could be severe. If the patient experiences any of the following symptoms after taking Sodium picosulfate, and magnesium, and citric acid combination medicine, he or she should seek medical attention right away:

  • stomach ache or stomach cramps
  • nauseous
  • vomiting, especially if the patient vomits the fluids needed for treatment
  • feeling dizzy
  • fainting
  • reduced urination
  • black or bloody stool
  • seizures
  • rapid or irregular heartbeat
  • skin rashes
  • hives

This list of side effects is not complete. Sodium picosulfate, and magnesium, and citric acid may cause other problems. The patient should inform the doctor if there are any other symptoms noted.

The patient should report any severe side effects to the Food and Drug Administration's (FDA) through their MedWatch Adverse Event Reporting program online through their website (http://www.fda.gov/Safety/MedWatch) or calling them by phone at 1-800-332-1088.

Dosage

Sodium picosulfate, and magnesium, and citric acid medicine comes as a powder to be taken orally or by mouth. It is often taken in two doses to prepare for a colonoscopy. The taken split-dose regimen includes taking the first dose the night before the scheduled colonoscopy and the second dose should be taken in the morning of the procedure.

The medicine may also be taken the day before the colonoscopy. The first dose should be taken by the patient in the afternoon or evening before the scheduled colonoscopy, then the next dose taken 6 hours after the first dosage. The doctor will inform the patient the exact time to take the sodium picosulfate, and magnesium, and citric acid.

The patient should follow the directions on the prescription label. If the instruction is not clear, he or she should ask the doctor or pharmacist to explain it. Take the exact prescribed dosage of sodium picosulfate, and magnesium, and citric acid combination. Do not take more or less than what is needed. Or, take it longer or more frequent than what is necessary.

To prepare for the colonoscopy, the patient may not eat any solid food or drink milk the day before. The patient should only drink clear liquids at this time. Clear liquids include water, fruit juice with no pulp, clear soup or broth, coffee or tea with no milk, popsicles, soft drinks, and flavored gelatin. Avoid drinking any alcoholic beverage. Do not consume liquid that is colored red or purple as the dye may interfere with the procedure. If the patient needs clarification on what liquids to drink, he or she should ask the doctor or better still, drink only clear water during this time.

The patient needs to mix the sodium picosulfate, and magnesium, and citric acid medicine with cold water right before taking it. Swallowing the powder without mixing with water could lead to higher risks of experiencing unwanted or even life-threatening side effects.

To prepare each dose of medication, fill the dosing cup that comes with the medicine with cold water. Make sure that the water level reaches the lower line (5 ounces or 150 mL) marker on the cup. Pour the contents of one packet of sodium picosulfate, and magnesium, and citric acid into the water. Stir the mixture for 2-3 minutes so the powder will dissolve totally. The mixture may feel a bit warm when the powder dissolves. Drink the whole mixture immediately. The patient should only mix the sodium picosulfate, and magnesium, and citric acid powder with water when he or she is ready to take it. The medication should not be mixed with water hours before taking it.

If the patient is doing the split-dose regimen, he or she needs to take the first dose between 5:00-9:00 p.m. on the night before the scheduled colonoscopy. After taking this dose, the patient needs to drink five eight (8) ounces or equal to 240 mL clear liquid for the succeeding five (5) hours before the patient goes to bed. The second dose will be taken the next morning, around five (5) hours before the scheduled colonoscopy. After taking the second dosage, the patient needs to drink three eight (8) ounces of clear drinking liquid in five hours but the total three drinks need to be finished at least two (2) hours preceding the procedure.

For patients doing the regimen called day-before, the first dose needs to be taken at the soonest possible time, 4:00 pm and the latest, 6:00 in the evening. The patient should take it the evening before the scheduled colonoscopy. After taking the first dose, the patient needs to drink five 8 ounce drinks of clear liquid in the next 5 hours. The next dose will be taken six (6) hours later, between 10:00 pm-12:00 a.m. After taking the second dosage, the patient needs to drink three clear liquid drinks of eight (8) ounces each in the succeeding five (5) hours.

The patient should drink the required amounts of clear liquid during the procedure to replace the fluid that he or she loses once the colon is emptied. The dosing cup that comes with the sodium picosulfate, and magnesium, and citric acid medication may be used to measure eight (8) ounces of liquid by filling the cup up to the top marker. The patient may drink different clear liquids so it will be easier to drink the required amount.

The patient will have several bowel movements when the treatment with sodium picosulfate, and magnesium, and citric acid medicine begins. The patient should be near a toilet from the moment the first dosage of the medication is taken until the schedule of colonoscopy.

If the patient experiences severe bloating or stomach ache after taking the first dose of the medicine, he or she should wait until these symptoms go away before taking the second dose.

For children, the doctor should prescribe the required dosage.

Drug Interactions

The sodium picosulfate, and magnesium, and citric acid medicine may interact with other medications. However, the patient may need to use it even if an interaction might happen. This is why it is important to tell the doctor what existing medical conditions the patient has and what medications he or she is taking.

The doctor can change the dose, the length of time and frequency if needed. Using the following medications while using sodium picosulfate, and magnesium, and citric acid is not recommended. However, in some medical cases, it may be necessary. The patient should tell the doctor if he or she takes any of the following:

  • Digoxin
  • Elvitegravir
  • Eltrombopag
  • Gefitinib
  • Ketoconazole
  • Licorice
  • Ledipasvir
  • Levomethadyl
  • Mefenamic Acid
  • Mycophenolate Mofetil
  • Mycophenolic Acid
  • Pazopanib
  • Phenytoin
  • Raltegravir
  • Rilpivirine
  • Vismodegib

Using sodium picosulfate, and magnesium, and citric acid medicine with any of the following medicines may lead to an increased risk of side effects. However, taking both drugs may be necessary to treat the patient’s condition. If both medicines need to be prescribed together, the doctor may change the dose or the frequency and length of time for one or both of the medications. The patient should tell the doctor if he or she takes any of the following:

  • Amprenavir
  • Atevirdine
  • Chloroquine
  • Cefditoren Pivoxil
  • Chlortetracycline
  • Ciprofloxacin
  • Dasatinib
  • Delavirdine
  • Demeclocycline
  • Dicumarol
  • Dolutegravir
  • Doxycycline
  • Enoxacin
  • Felodipine
  • Fexofenadine
  • Gabapentin
  • Gabapentin Enacarbil
  • Gemifloxacin
  • Grepafloxacin
  • Isradipine
  • Levofloxacin
  • Levothyroxine
  • Lomefloxacin
  • Methacycline
  • Minocycline
  • Moxifloxacin
  • Nicardipine
  • Norfloxacin
  • Oxytetracycline
  • Pefloxacin
  • Potassium Phosphate
  • Potassium Phosphate, Dibasic
  • Potassium Phosphate, Monobasic
  • Quinidine
  • Rolitetracycline
  • Sodium Phosphate
  • Sodium Phosphate, Dibasic
  • Sodium Phosphate, Monobasic
  • Sodium Polystyrene Sulfonate
  • Sparfloxacin
  • Tacrolimus
  • Tetracycline
  • Ticlopidine
  • Tipranavir
  • Zalcitabine

Other Interactions

The patient may need to avoid certain foods or drinks during the treatment such as certain liquid drinks. Alcohol is not recommended when using sodium picosulfate, and magnesium, and citric acid. Tobacco may interact with certain medicines. The patient should discuss with the doctor if he or she should ingest food, drinks or alcohol.

Warning

Before the patient takes the sodium picosulfate, magnesium, and citric acid:

  • He or she should tell the doctor or pharmacist if they have allergies to sodium picosulfate, or magnesium, or citric acid, or its ingredients.
  • Do not take any other laxatives while taking sodium picosulfate, and magnesium oxide, and citric acid.
  • If the patient takes other medications by mouth, he or she should take them at least 1 hour before taking sodium picosulfate, and magnesium, and citric acid. If the patient takes any of the following medicines, he or she should take them 2 hours before taking sodium picosulfate, magnesium, and citric acid medicine or 6 hours after completing the treatment: digoxin, chlorpromazine, antibiotics especially fluoroquinolone, gemifloxacin, levofloxacin, moxifloxacin, norfloxacin, and ofloxacin, iron supplements, tetracycline and penicillamine.
  • The patient should inform the doctor if she is pregnant, plans to become pregnant, or is breastfeeding. The medicine is in Category B of the FDA's pregnancy drug classification. This means it is safe for use during pregnancy. It is not known if it passes through the milk while breastfeeding.

Other Medical Problems

The existence of other medical conditions may affect the use of this medicine. The patient should tell their doctor if he or she has any other medical conditions, such as:

  • Angina
  • Electrolyte imbalance
  • Fluid imbalance
  • Heart attack,
  • Heart disease
  • Heart rhythm problems
  • Withdrawal from alcohol or benzodiazepines – this may lead to increase risk for arrhythmia, seizures, or kidney illnesses.
  • Congestive heart failure
  • Dehydration
  • Inflammatory bowel disease
  • Kidney problems
  • Seizures
  • Trouble swallowing
  • Ulcerative colitis - this medicine may worsen the condition
  • Gastric retention
  • Intestinal problems
  • Toxic megacolon - the medicine is not be given to patients with this medical problem
  • Kidney disease - this may heighten the effect of the medicine due to slower disposal of the medicine from the body.

Storage

Sodium picosulfate, and magnesium , and citric acid combination medicine has to be stored at room temperature. Keep it in a dry place, away from moisture and direct sunlight. Do not store in a bathroom.

Keep out of the reach of children and pets to prevent drug poisoning and ask the pharmacist how to dispose of expired or unused drugs correctly.

Summary

Sodium picosulfate, and magnesium, and citric acid combination medicine is an effective medicine used to clean out the colon or gastrointestinal tract of a patient before a scheduled colonoscopy. It works by emptying the contents of the colon so the doctor can see the walls clearly. This allows the doctor to diagnose the patient’s medical condition correctly, such as cancer of the colon and other colon-related problems.

The patient should inform the doctor if he or she is allergic to the medicine or any of its ingredients. If the patient has other medical conditions, he or she should inform the doctor before taking sodium picosulfate, and magnesium, and citric acid. If the patient is taking other medications, he or she should let the doctor know to prevent unwanted side effects.

The patient should take the medicine as directed. He or she should not take more or less than what is required. Taking more may cause overdosage. Taking less may render the medication ineffective. Also, the patient should not take it more frequently or for a longer period of time than what is required.

Drinking clear liquid is an important requirement during the treatment. The patient loses fluid while taking the medicine. Drinking clear liquid will replenish it and prevent dehydration.

If the patient is in doubt, always ask the doctor or pharmacist for clarification to prevent unnecessary side effects.

Resources
Last Reviewed:
December 23, 2017
Last Updated:
December 22, 2017
Content Source: