Sodium Picosulphate/ Magnesium Oxide/ Citric Acid

Registered South African indications:

• Bowel evacuation 

Contraindications

• Hypersensitivity to the active ingredients or any of the excipients in this combination product 
• Severe renal impairment
• Congestive cardiac failure
• Gastric retention
• Gastrointestinal ulceration
• Toxic colitis
• Toxic megacolon
• Ileus
• Nausea and vomiting
• Acute surgical abdominal conditions 
• Known or suspected gastrointestinal obstruction or perforation
• Severe dehydration
• Rhabdomyolysis
• Hypermagnesemia
• Active inflammatory bowel disease

Cautions

• Pregnancy 
• Mild to moderate renal impairment 
• Elderly
• Low body weight
• Children
• Debilitated patients 
• Patients at risk for hypokalaemia or hyponatraemia
• Recent gastrointestinal surgery
• Cardiovascular disease
• Prolonged use 
• Potassium-controlled diet 
• Galactose intolerance
• Lapp lactase deficiency
• Glucose-galactose malabsorption

Forms avail. in SA and covered in this monograph: pdr

Bowel evacuation 
- in preparation for gastrointestinal examination
- prior to surgery
- prior to intravenous pyelogram
- in severe constipation 

Sodium Picosulphate/ Magnesium Oxide/ Citric Acid
10mg/3.5g/12g (per sachet)

• Oral (pdr): Initial: 1 sachet, at 10-18hrs prior to examination; Then: 1 sachet, 4-6hrs prior to procedure

Dissolve the sachet in a glass of warm water

Continue drinking one glass of clear sugar-free fluids every hour until bedtime

No fluids for 6hrs prior to examination

Paed. forms avail. in SA and covered in this monograph: pdr

Bowel evacuation 
- in preparation for gastrointestinal examination
- prior to surgery
- prior to intravenous pyelogram
- in severe constipation 

Sodium Picosulphate/ Magnesium Oxide/ Citric Acid
10mg/3.5g/12g (per sachet)

Younger than 2 years

• Not established for use

Between 2-4 years

• Oral (pdr): Initial: 1/4 sachet, at 10-18hrs prior to examination; Then: 1/4 sachet, 4-6hrs prior to procedure 

Between 4-9 years 

• Oral (pdr): Initial: 1/2 sachet, at 10-18hrs prior to examination; Then: 1/2 sachet, 4-6hrs prior to procedure 

Older than 9 years

• See adult dosage

Dissolve the sachet in a glass of warm water

Continue drinking one glass of clear sugar-free fluids every hour until bedtime

No fluids for 6hrs prior to examination

Recommendations for this combination product as per highest risk category when comparing individual active ingredients 

Pregnancy

• FDA Pregnancy Category Not Rated (NR) (Sodium Picosulphate, Magnesium Oxide, Citric Acid)

Breastfeeding

• Compatible

Renal Impairment

• Mild to moderate: Caution; no dose adjustment recommended
• Severe: Contraindicated

Hepatic Impairment

• Caution; no information available

Elderly

• Caution; no dose adjustment recommended

Central Nervous System Disorders

• Confusional state
• Seizures
• Epilepsy 
• Headache

Gastrointestinal Disorders

• Nausea and vomiting
• Proctalgia
• Abdominal pain
• Aphthoid ileal ulcers
• Diarrhoea
• Faecal incontinence

Endocrine and Metabolic Disorders

• Hyponatraemia
• Hypokalaemia

Skin and Subcutaneous Tissue Disorders

• Rash
• Urticaria
• Purpura 

Immune, Blood and Lymphatic System Disorders

• Anaphylactic reaction
• Hypersensitivity

• Diuretics
• Corticosteroids
• Lithium
• Antiepileptics
• Oral contraceptives
• Oral anti-diabetics
• Oral antibiotics
• Tetracycline
• Fluoroquinolone
• Iron
• Digoxin
• Chlorpromazine
• Penicillamine
• Bulk-forming laxatives
• Potassium-depleting agents 
• Tricyclic antidepressants
• Selective serotonin reuptake inhibitors
• Antipsychotics
• Carbamazepine
• Non-steroidal anti-inflammatory drugs 

None routine. Specific cases may require

• Electrolytes
• Renal function
• ECG

Sodium picosulphate
Sodium picosulfate is hydrolyzed by colonic bacteria to form an active metabolite: bis-(p-hydroxy-phenyl)-pyridyl-2-methane, which acts directly on the colonic mucosa to stimulate colonic peristalsis. It works as a contact laxative.

Magnesium Oxide
Magnesium oxide is a magnesium supplement.

Citric Acid
Sodium citrate is metabolized to sodium bicarbonate and acts as a systemic alkalizer. 

COMBINATION PREPARATIONS

Sodium Picosulphate / Magnesium Oxide/ Citric Acid

Powder 10mg/3.5g/12g

• Picolax (Ferring)
• Picoprep (Beta Pharma)