Dosing & Uses
Dosage Forms & Strengths
sodium picosulfate/magnesium oxide/anhydrous citric acid
powder for oral solution (Prepopik)
- 10mg/3.5g/12g per 16.1 g of powder (available as carton containing two 16.1 g packets of powder)
- Flavors: Orange, cranberry
solution, ready-to-drink (Clenpiq)
- (10mg/3.5g/12g)/160mL (available as carton containing two 160-mL bottles)
- Flavor: Cranberry
Bowel Preparation
Indicated for colon cleansing as a preparation for colonoscopy in adults
Two doses are required to complete the colonoscopy preparation by either a split dose regimen or a day before regimen
Prepopik: 1 dose is provided by 1 packet dissolved in 5-oz cold water in provided measuring cup
Clenpiq: 1 dose is provided by 1 bottle (160 mL) ready-to-drink solution
Instruct patients to only drink clear liquids all day the day before the colonoscopy, and the next day until 2 hours before the colonoscopy; stop drinking all fluids at least 2 hr before the colonoscopy
Do not eat solid food or dairy and do not drink anything colored red or purple
Do not drink alcohol
Also see Administration
Split dose
- Preferred dosing method
- First dose: Take during the evening before the colonoscopy (eg, 5:00 to 9:00 PM) followed by five 8-ounce drinks of clear liquids before bed; consume clear liquids within 5 hr
- Second dose: Take the next day ~5 hr before the colonoscopy followed by at least three 8-ounce drinks of clear liquids before the colonoscopy; consume clear liquids within 5 hr up until 2 hr before the time of the colonoscopy
Day before dose
- Alternate method
- First dose: Take in the afternoon or early evening (eg, 4:00 to 6:00 PM) before the colonoscopy followed by five 8-ounce drinks of clear liquids before the next dose; consume clear liquids within 5 hr
- Second dose: Take ~6 hr later in the late evening (eg, 10:00 PM to 12:00 AM), the night before the colonoscopy followed by three 8-ounce drinks of clear liquids before bed; consume clear liquids within 5 hr
sodium picosulfate/magnesium oxide/anhydrous citric acid
powder for oral solution (Prepopik)
- 10mg/3.5g/12g per 16.1 g of powder (available as carton containing two 16.1 g packets of powder)
- Flavors: Orange, cranberry
solution, ready-to-drink (Clenpiq)
- (10mg/3.5g/12g)/160mL (available as carton containing two 160-mL bottles)
- Flavor: Cranberry
Bowel Preparation
Indicated for cleansing of the colon as a preparation for colonoscopy in patients aged ≥9 years
<9 years: Safety and efficacy not established
≥9 years
- Two doses are required to complete the colonoscopy preparation by either a split dose regimen or a day before regimen
- Prepopik: 1 dose is provided by 1 packet dissolved in 5-oz cold water in provided measuring cup
- Clenpiq: 1 dose is provided by 1 bottle (160 mL) ready-to-drink solution
- Instruct patients to only drink clear liquids all day the day before the colonoscopy, and the next day until 2 hours before the colonoscopy; stop drinking all fluids at least 2 hr before the colonoscopy
- Do not eat solid food or dairy and do not drink anything colored red or purple
- Do not drink alcohol
-
Split dose
- Preferred dosing method
- First dose: Take during the evening before the colonoscopy (eg, 5:00 to 9:00 PM) followed by five 8-ounce drinks of clear liquids before bed; consume clear liquids within 5 hr
- Second dose: Take the next day ~5 hr before the colonoscopy followed by at least three 8-ounce drinks of clear liquids before the colonoscopy; consume clear liquids within 5 hr up until 2 hr before the time of the colonoscopy
-
Day before dose
- Alternate method
- First dose: Take in the afternoon or early evening (eg, 4:00 to 6:00 PM) before the colonoscopy followed by five 8-ounce drinks of clear liquids before the next dose; consume clear liquids within 5 hr
- Second dose: Take ~6 hr later in the late evening (eg, 10:00 PM to 12:00 AM), the night before the colonoscopy followed by three 8-ounce drinks of clear liquids before bed; consume clear liquids within 5 hr
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (1)
- baloxavir marboxil
sodium picosulfate/magnesium oxide/anhydrous citric acid will decrease the level or effect of baloxavir marboxil by cation binding in GI tract. Avoid or Use Alternate Drug. Baloxavir may bind to polyvalent cations resulting in decreased absorption. Studies in monkeys showed concurrent use with calcium, aluminum, or iron caused significantly decreased plasma levels. Human studies not conducted.
Monitor Closely (135)
- acetohydroxamic acid
acetohydroxamic acid decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- amikacin
amikacin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- amoxicillin
amoxicillin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- ampicillin
ampicillin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- aspirin
aspirin, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances.
- aspirin rectal
aspirin rectal, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances.
- aspirin/citric acid/sodium bicarbonate
aspirin/citric acid/sodium bicarbonate, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances.
- azithromycin
azithromycin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- aztreonam
aztreonam decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- betamethasone
betamethasone, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances such as hypokalemia.
- capreomycin
capreomycin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- carbonyl iron
sodium picosulfate/magnesium oxide/anhydrous citric acid decreases levels of carbonyl iron by cation binding in GI tract. Use Caution/Monitor. Take at least 2 hours before and not less than 6 hours after administration of sodium picosulfate, magnesium oxide and anhydrous citric acid to avoid magnesium chelation.
- cefaclor
cefaclor decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- cefadroxil
cefadroxil decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- cefazolin
cefazolin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- cefdinir
cefdinir decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- cefditoren
cefditoren decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- cefepime
cefepime decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- cefixime
cefixime decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- cefotaxime
cefotaxime decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- cefotetan
cefotetan decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- cefoxitin
cefoxitin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- cefpirome
cefpirome decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- cefpodoxime
cefpodoxime decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- cefprozil
cefprozil decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- ceftaroline
ceftaroline decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- ceftazidime
ceftazidime decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- ceftibuten
ceftibuten decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- ceftriaxone
ceftriaxone decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- cefuroxime
cefuroxime decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- celecoxib
celecoxib, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances.
- cephalexin
cephalexin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- chloramphenicol
chloramphenicol decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- chlorpromazine
sodium picosulfate/magnesium oxide/anhydrous citric acid decreases levels of chlorpromazine by cation binding in GI tract. Use Caution/Monitor. Take at least 2 hours before and not less than 6 hours after administration of sodium picosulfate, magnesium oxide and anhydrous citric acid to avoid magnesium chelation .
- choline magnesium trisalicylate
choline magnesium trisalicylate, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances.
- ciprofloxacin
ciprofloxacin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
sodium picosulfate/magnesium oxide/anhydrous citric acid decreases levels of ciprofloxacin by cation binding in GI tract. Use Caution/Monitor. Take at least 2 hours before and not less than 6 hours after administration of sodium picosulfate, magnesium oxide and anhydrous citric acid to avoid magnesium chelation. - clarithromycin
clarithromycin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- clindamycin
clindamycin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- clofazimine
clofazimine decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- colistin
colistin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- corticotropin
corticotropin, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances such as hypokalemia.
- cortisone
cortisone, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances such as hypokalemia.
- cycloserine
cycloserine decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- dapsone
dapsone decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- daptomycin
daptomycin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- deflazacort
sodium picosulfate/magnesium oxide/anhydrous citric acid and deflazacort both decrease serum potassium. Use Caution/Monitor.
- demeclocycline
demeclocycline decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
sodium picosulfate/magnesium oxide/anhydrous citric acid decreases levels of demeclocycline by cation binding in GI tract. Use Caution/Monitor. Take at least 2 hours before and not less than 6 hours after administration of sodium picosulfate, magnesium oxide and anhydrous citric acid to avoid magnesium chelation. - dexamethasone
dexamethasone, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances such as hypokalemia.
- diclofenac
diclofenac, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances.
- dicloxacillin
dicloxacillin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- diflunisal
diflunisal, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances.
- digoxin
sodium picosulfate/magnesium oxide/anhydrous citric acid decreases levels of digoxin by cation binding in GI tract. Use Caution/Monitor. Take at least 2 hours before and not less than 6 hours after administration of sodium picosulfate, magnesium oxide and anhydrous citric acid to avoid magnesium chelation .
- doxycycline
doxycycline decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
sodium picosulfate/magnesium oxide/anhydrous citric acid decreases levels of doxycycline by cation binding in GI tract. Use Caution/Monitor. Take at least 2 hours before and not less than 6 hours after administration of sodium picosulfate, magnesium oxide and anhydrous citric acid to avoid magnesium chelation. - ertapenem
ertapenem decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- erythromycin base
erythromycin base decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- erythromycin ethylsuccinate
erythromycin ethylsuccinate decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- erythromycin lactobionate
erythromycin lactobionate decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- erythromycin stearate
erythromycin stearate decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- ethambutol
ethambutol decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- ethionamide
ethionamide decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- etodolac
etodolac, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances.
- fenoprofen
fenoprofen, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances.
- ferric maltol
sodium picosulfate/magnesium oxide/anhydrous citric acid decreases levels of ferric maltol by cation binding in GI tract. Use Caution/Monitor. Take at least 2 hours before and not less than 6 hours after administration of sodium picosulfate, magnesium oxide and anhydrous citric acid to avoid magnesium chelation .
- ferrous fumarate
sodium picosulfate/magnesium oxide/anhydrous citric acid decreases levels of ferrous fumarate by cation binding in GI tract. Use Caution/Monitor. Take at least 2 hours before and not less than 6 hours after administration of sodium picosulfate, magnesium oxide and anhydrous citric acid to avoid magnesium chelation.
- ferrous sulfate
sodium picosulfate/magnesium oxide/anhydrous citric acid decreases levels of ferrous sulfate by cation binding in GI tract. Use Caution/Monitor. Take at least 2 hours before and not less than 6 hours after administration of sodium picosulfate, magnesium oxide and anhydrous citric acid to avoid magnesium chelation .
- fidaxomicin
fidaxomicin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- fludrocortisone
fludrocortisone, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances such as hypokalemia.
- flurbiprofen
flurbiprofen, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances.
- fosfomycin
fosfomycin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- gemifloxacin
gemifloxacin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
sodium picosulfate/magnesium oxide/anhydrous citric acid decreases levels of gemifloxacin by cation binding in GI tract. Use Caution/Monitor. Take at least 2 hours before and not less than 6 hours after administration of sodium picosulfate, magnesium oxide and anhydrous citric acid to avoid magnesium chelation. - gentamicin
gentamicin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- hydrocortisone
hydrocortisone, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances such as hypokalemia.
- ibuprofen
ibuprofen, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances.
- ibuprofen IV
ibuprofen IV, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances.
- imipenem/cilastatin
imipenem/cilastatin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- imipenem/cilastatin/relebactam
imipenem/cilastatin/relebactam decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- indomethacin
indomethacin, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances.
- isoniazid
isoniazid decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- ketoprofen
ketoprofen, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances.
- ketorolac
ketorolac, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances.
- ketorolac intranasal
ketorolac intranasal, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances.
- levofloxacin
levofloxacin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
sodium picosulfate/magnesium oxide/anhydrous citric acid decreases levels of levofloxacin by cation binding in GI tract. Use Caution/Monitor. Take at least 2 hours before and not less than 6 hours after administration of sodium picosulfate, magnesium oxide and anhydrous citric acid to avoid magnesium chelation. - lincomycin
lincomycin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- linezolid
linezolid decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- meclofenamate
meclofenamate, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances.
- mefenamic acid
mefenamic acid, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances.
- meloxicam
meloxicam, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances.
- meropenem
meropenem decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- meropenem/vaborbactam
meropenem/vaborbactam decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- methenamine
methenamine decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- methenamine/sodium salicylate/benzoic acid
methenamine/sodium salicylate/benzoic acid decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- methylprednisolone
methylprednisolone, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances such as hypokalemia.
- metronidazole
metronidazole decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- minocycline
minocycline decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
sodium picosulfate/magnesium oxide/anhydrous citric acid decreases levels of minocycline by cation binding in GI tract. Use Caution/Monitor. Take at least 2 hours before and not less than 6 hours after administration of sodium picosulfate, magnesium oxide and anhydrous citric acid to avoid magnesium chelation. - moxifloxacin
moxifloxacin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
sodium picosulfate/magnesium oxide/anhydrous citric acid decreases levels of moxifloxacin by cation binding in GI tract. Use Caution/Monitor. Take at least 2 hours before and not less than 6 hours after administration of sodium picosulfate, magnesium oxide and anhydrous citric acid to avoid magnesium chelation. - nabumetone
nabumetone, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances.
- nafcillin
nafcillin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- naproxen
naproxen, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances.
- neomycin PO
neomycin PO decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- nitrofurantoin
nitrofurantoin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- ofloxacin
ofloxacin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
sodium picosulfate/magnesium oxide/anhydrous citric acid decreases levels of ofloxacin by cation binding in GI tract. Use Caution/Monitor. Take at least 2 hours before and not less than 6 hours after administration of sodium picosulfate, magnesium oxide and anhydrous citric acid to avoid magnesium chelation. - omadacycline
sodium picosulfate/magnesium oxide/anhydrous citric acid will decrease the level or effect of omadacycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.
- oxacillin
oxacillin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- oxaprozin
oxaprozin, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances.
- penicillamine
sodium picosulfate/magnesium oxide/anhydrous citric acid decreases levels of penicillamine by cation binding in GI tract. Use Caution/Monitor. Take at least 2 hours before and not less than 6 hours after administration of sodium picosulfate, magnesium oxide and anhydrous citric acid to avoid magnesium chelation .
- penicillin G aqueous
penicillin G aqueous decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- penicillin G benzathine
penicillin G benzathine decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- penicillin G procaine
penicillin G procaine decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- penicillin VK
penicillin VK decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- pentamidine
pentamidine decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- piperacillin
piperacillin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- piroxicam
piroxicam, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances.
- polymyxin B
polymyxin B decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- polysaccharide iron
sodium picosulfate/magnesium oxide/anhydrous citric acid decreases levels of polysaccharide iron by cation binding in GI tract. Use Caution/Monitor. Take at least 2 hours before and not less than 6 hours after administration of sodium picosulfate, magnesium oxide and anhydrous citric acid to avoid magnesium chelation.
- prednisolone
prednisolone, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances such as hypokalemia.
- prednisone
prednisone, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances such as hypokalemia.
- quinupristin/dalfopristin
quinupristin/dalfopristin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- rifampin
rifampin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- rifapentine
rifapentine decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- salsalate
salsalate, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances.
- sarecycline
sodium picosulfate/magnesium oxide/anhydrous citric acid will decrease the level or effect of sarecycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.
- streptomycin
streptomycin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- sulfadiazine
sulfadiazine decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- sulfamethoxazole
sulfamethoxazole decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- sulfasalazine
sulfasalazine, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances.
- sulindac
sulindac, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances.
- telavancin
telavancin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- tetracycline
tetracycline decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
sodium picosulfate/magnesium oxide/anhydrous citric acid decreases levels of tetracycline by cation binding in GI tract. Use Caution/Monitor. Take at least 2 hours before and not less than 6 hours after administration of sodium picosulfate, magnesium oxide and anhydrous citric acid to avoid magnesium chelation. - ticarcillin
ticarcillin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- tigecycline
tigecycline decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
sodium picosulfate/magnesium oxide/anhydrous citric acid decreases levels of tigecycline by cation binding in GI tract. Use Caution/Monitor. Take at least 2 hours before and not less than 6 hours after administration of sodium picosulfate, magnesium oxide and anhydrous citric acid to avoid magnesium chelation. - tobramycin
tobramycin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- tolmetin
tolmetin, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances .
- triamcinolone acetonide injectable suspension
triamcinolone acetonide injectable suspension, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances such as hypokalemia.
- trimethoprim
trimethoprim decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- vancomycin
vancomycin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
Minor (0)
Adverse Effects
>10%
Decreased eGFR (10-13.1%)
Increased magnesium (8.7-11.6%)
1-10%
Increased serum creatinine (1.9-4.5%)
Vomiting (3-4%)
Decreased potassium (4.7-7.3%)
Decreased sodium (1-3.7%)
Decreased chloride (1-3.7%)
Nausea (2.6-3%)
Headache (1.6-2.7%)
Postmarketing Reports
Allergic reactions including rash, urticaria, and purpura
Electrolyte abnormalities including hypokalemia, hyponatremia, and hypermagnesemia
Gastrointestinal reactions including abdominal pain, diarrhea, fecal incontinence, and proctalgia; also isolated reports of aphthoid ileal ulcers and ischemic colitis (causal relationship not established)
Neurologic effects including generalized tonic-clonic seizures associated with and without hyponatremia in epileptic patients, syncope
Warnings
Contraindications
Hypersensitivity
Severe renal impairment (ie, CrCl <30 mL/minute)
GI obstruction or ileus
Bowel perforation
Toxic colitis or toxic megacolon
Gastric retention
Cautions
Orthostatic changes occurred in ~20% of patients in clinical trials on the day of colonoscopy and were documented out to 7 days post colonoscopy
Uncorrected magnesium concentration reached a maximum of ~1.9 mEq/L, which occurred at 10 hr post initial packet administration; this represents an ~20% increase from baseline
Renal impairment or coadministration with medications that may affect renal function (eg, diuretics, ACE inhibitors, ARBs, NSAIDs) may increase risk for renal injury; adequate hydration before during and after the use is particularly important in these patients; consider performing baseline and post-colonoscopy laboratory tests (electrolytes, creatinine, and BUN)
Increased magnesium plasma levels may occur with severe renal impairment (ie, CrCl <30 mL/min) (see Contraindications)
Caution with severe active ulcerative colitis; osmotic laxatives may produce colonic mucosal aphthous ulcerations and there have been reports of more serious cases of ischemic colitis requiring hospitalization; concurrent use of additional stimulant laxatives with this drug may increase risk; consider potential for mucosal ulcerations when interpreting colonoscopy findings in patients with known or suspected inflammatory bowel disease
There have been rare reports of serious arrhythmias associated with the use of ionic osmotic laxative products for bowel preparation; use caution when prescribing therapy for patients at increased risk of arrhythmias (eg, patients with a history of prolonged QT, uncontrolled arrhythmias, recent myocardial infarction, unstable angina, congestive heart failure, or cardiomyopathy); consider pre-dose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias
Caution with impaired gag reflex or patients prone to aspiration; these patients should be observed during administration
Syncope
- Syncope has been reported in the postmarketing setting; some cases were serious events that included falls with associated head injuries or fractures requiring hospitalization; in some cases, electrolyte abnormalities were also present (eg, hyponatremia and hypokalemia); cases have been reported after one or two doses and many of these cases occurred within 12 hours of dosing
- Patients should be aware of risk of syncope during treatment and adequately hydrate before, during, and after administration; advise patients to consume a variety of clear liquids (eg, balanced electrolyte solution), not only water after each dose and to get up gradually from a lying or sitting position
Serious fluid and electrolyte abnormalities
- Adequate hydration essential before, during, and after the use
- Caution with congestive heart failure when replacing fluids
- If significant vomiting or signs of dehydration including signs of orthostatic hypotension develop after use, consider performing post-colonoscopy lab tests (electrolytes, creatinine, and BUN) and treat accordingly
- Fluid and electrolyte disturbances can lead to serious adverse events including cardiac arrhythmias or seizures and renal impairment
Seizures
- There have been reports of generalized tonic-clonic seizures with use of bowel preparation products in patients with no prior history of seizures and/or loss of consciousness; the seizure cases were associated with electrolyte abnormalities (eg, hyponatremia, hypokalemia, hypocalcemia, and hypomagnesemia) and low serum osmolality; the neurologic abnormalities resolved with correction of fluid and electrolyte abnormalities
- Use caution when prescribing therapy for patients with a history of seizures and in patients at risk of seizure, such as patients taking medications that lower seizure threshold (eg, tricyclic antidepressants), patients withdrawing from alcohol or benzodiazepines, patients with known or suspected hyponatremia
Drug interaction overview
- Oral medications taken within 1 hour of each dosing may be flushed from GI tract and not properly absorbed
- Administer drugs prone to chelation with magnesium (eg, tetracycline, iron, digoxin) at least 2 hr before or at least 6 hr after administration
- Prior or concomitant antibiotics may reduce efficacy by decreasing colonic bacteria-mediated conversion of sodium picosulfate to the active metabolite (BHPM)
Pregnancy & Lactation
Pregnancy
No data are available regarding use in pregnant women
In animal reproduction studies, no adverse developmental effects were observed in pregnant rats when administered at doses 1.2 times the recommended human dose based on body surface area during organogenesis
Lactation
There are no data on presence of magnesium oxide or anhydrous citric acid in either human or animal milk, effects on breastfed infant, or on milk production; published data on lactating women indicate that active metabolite of sodium picosulfate, bis-(p-hydroxyphenyl)-pyridyl-2-methane (BHPM) remained below limit of detection (1 ng/mL) in breast milk after both single and multiple doses of 10 mg/day; there are no data on effects of sodium picosulfate on breastfed infant or on milk production; the developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for Prepopik and any potential adverse effects on breastfed infant or underlying maternal condition
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
The stimulant laxative activity of sodium picosulfate together with the osmotic laxative activity of magnesium citrate produces a purgative effect which, when ingested with additional fluids, produces watery diarrhea
Sodium picosulfate: Hydrolyzed by colonic bacteria to form an active metabolite, bis-(p-hydroxy-phenyl)-pyridyl-2-methane (BHPM); BHPM acts directly on the colonic mucosa to stimulate colonic peristalsis
Magnesium oxide and anhydrous citric acid: These 2 ingredients react to create magnesium citrate in solution, an osmotic agent that causes water to be retained within the GI tract
Absorption
Peak Plasma Time: 7 hr (sodium picosulfate, 2 packets)
Peak Plasma Concentration: 3.2 ng/mL (sodium picosulfate after 2 doses); active metabolite BHPM below level of quantification
Metabolism
Sodium picosulfate, a prodrug, is converted to its active metabolite, bis-(p-hydroxy-phenyl)-pyridyl-2-methane (BHPM), by colonic bacteria
Magnesium oxide and citric acid react in water to create magnesium citrate
Elimination
Half-life: 7.4 hr (sodium picosulfate)
Administration
Oral Preparation
Prepopik powder for solution
- Do not prepare solution in advance
- Reconstitute powder with cold water immediately before each dose
- Fill the supplied dosing cup with cold water up to the lower (5-ounce) line on the cup and pour in the contents of 1 packet of Prepopik powder
- Stir solution for 2-3 minutes; reconstituted solution may become slightly warm as the powder dissolves
Oral Administration
Take with additional clear liquids after each dose according to either split-dose or day-before dose directions (see Adult Dosing)
Do not take oral medications within 1 hr of start of each dose
If taking tetracycline or fluoroquinolone antibiotics, iron, digoxin, chlorpromazine, or penicillamine, take these medications at least 2 hr before and not less than 6 hr after administering prep
Do not take with other laxatives
Storage
Prepopik
- Store at 25°C (77°F); excursions permitted at 15-30°C (59-86°F)
Clenpiq
- Store at 25°C (77°F); excursions permitted at 15-30°C (59-86°F)
- Do not refrigerate or freeze
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Clenpiq oral - | 10 mg-3.5 gram- 12 gram/160 mL solution |  | |
| Clenpiq oral - | 10 mg-3.5 gram- 12 gram/160 mL solution |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
sodium picosulfate-magnesium oxide-citric acid oral
SODIUM PICOSULFATE/MAGNESIUM OXIDE/CITRIC ACID - ORAL
COMMON BRAND NAME(S): Clenpiq, Prepopik
USES: Sodium picosulfate/magnesium oxide/citric acid solution is used to clean out the intestines before surgery or certain procedures (such as colonoscopy, X-rays). It is a laxative that works by drawing large amounts of water into your intestines and stimulating the colon. This causes watery bowel movements (diarrhea). Clearing stool from the intestines helps your doctor to better examine the inside of your colon.
HOW TO USE: Read the Medication Guide and, if available, the Instructions for Use provided by your pharmacist before you start using this product and each time you get a refill. Be sure to read and follow all instructions for use from your doctor or the manufacturer before taking this product. If you have any questions, ask your doctor or pharmacist.Follow any special diet instructions provided by your doctor. Usually, you may only have clear liquids on the day before your procedure. Do not drink milk, other dairy products, red/dark-colored liquids, or alcohol. To prevent becoming dehydrated, drink as much clear liquid as you can before, during, and after drinking this medication. Try to drink not only water, but also other types of clear liquids as directed by your doctor. Follow your doctor's directions carefully.Take this product in 2 separate doses as directed by your doctor. Carefully follow your doctor's directions for when to take each dose. The dosage is based on your age and medical condition.This product comes as either a powder in packets that must be mixed with water before taking or as a liquid in bottles that is ready to drink. Carefully follow the instructions for your product. If you are using the powder packets, just before using, mix each dose with 5 ounces/150 milliliters of cold water as directed. Stir well until the powder dissolves completely (2 to 3 minutes), then drink all of it.If you have bloating or stomach/abdominal pain after taking this product, it may help if you stop drinking clear liquids for a little while or allow a longer time between each dose.Watery bowel movements usually begin 2 to 4 hours after you drink the medication. This is normal and shows that the medicine is working. You should have access to a toilet until the effects of this medication have worn off.Do not take any other medications by mouth within 1 hour before you start to drink this product because your body may not absorb the other medications. Some medications (such as digoxin, iron, tetracycline antibiotics, quinolone antibiotics such as ciprofloxacin/levofloxacin, chlorpromazine, penicillamine) should not be taken within 2 hours before or 6 hours after taking this product. Ask your doctor or pharmacist when to take your other medications.
SIDE EFFECTS: Frequent, very watery bowel movements at any time should occur after you drink this product. Nausea, vomiting, bloating, headache, or stomach/abdominal cramps may also occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.If your doctor has directed you to use this medication, remember that your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.This medication can cause your body to lose too much fluid and salts (dehydration). Tell your doctor right away if you have any of these serious side effects: confusion, severe dizziness, fainting, fast/irregular heartbeat, seizure.Tell your doctor right away if you have any serious side effects, including: stomach/abdominal pain that is severe or doesn't go away, signs of kidney problems (such as change in the amount of urine), bloody stools, rectal bleeding.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before taking this medication, tell your doctor or pharmacist if you have any allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: heart problems (such as irregular heartbeat, heart attack), kidney problems, salt/mineral imbalance (such as low level of sodium in the blood), seizure, stomach/intestinal problems (such as gastric retention, blockage, ulcers, ulcerative colitis), trouble swallowing.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this product passes into breast milk. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: See also How to Use section.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Do not use other laxatives while taking this product.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
NOTES: Do not share this medication with others.Lab tests (such as sodium/potassium blood levels, blood sugar level) may be done before or after taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.
MISSED DOSE: If you are unable to drink all of this product and clear liquids as directed, call your doctor right away. Your procedure may need to be rescheduled.
STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised January 2023. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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