Sodium Picosulfate + Magnesium Oxide + Citric Acid

• Bowel cleansing before diagnostic or surgical procedures: Indicated for complete bowel evacuation prior to colonoscopy, radiological examinations, or bowel surgery.
• Short-term treatment of constipation: Used to relieve occasional, infrequent constipation by stimulating bowel movements and softening stool.
• Off-label uses: Occasionally prescribed for pediatric bowel cleansing or constipation under strict medical supervision.

• Adults and elderly:
• Bowel preparation: Usually given as powder sachets dissolved in water (approximately 150 ml). The typical regimen involves taking one dose the evening before and/or the morning of the procedure, per physician’s instructions.
• Constipation: Dose varies; typically one sachet once daily, administered orally.
• Pediatrics: Use only if prescribed by a healthcare provider; dose adjusted according to age and weight.
• Route: Oral administration.
• Frequency: Usually single or divided doses for bowel prep; once daily for constipation relief.
• Duration: Short-term use recommended; generally one treatment course for bowel prep, limited days for constipation.
• Special populations: No routine dose adjustment needed for renal or hepatic impairment but caution advised in elderly or debilitated patients.

Sodium picosulfate is a prodrug activated by bacterial enzymes in the colon into an active metabolite that stimulates the enteric nerves, increasing peristalsis and promoting bowel evacuation. Magnesium oxide reacts with citric acid in the gastrointestinal tract to form magnesium citrate, which acts osmotically to retain water in the intestinal lumen, softening stool and facilitating defecation. The combined stimulant and osmotic effects result in enhanced and effective bowel cleansing and constipation relief.

• Absorption: Sodium picosulfate is minimally absorbed systemically and is activated locally in the colon. Magnesium and citrate ions are partially absorbed.
• Distribution: Sodium picosulfate’s active form remains localized to the colon; magnesium distributes widely in body tissues.
• Metabolism: Sodium picosulfate is metabolized by colonic bacteria; magnesium and citrate are metabolized and excreted primarily by the kidneys.
• Half-life: Systemic half-life of sodium picosulfate is negligible; magnesium’s elimination half-life varies with renal function (~41 hours).
• Elimination: Sodium picosulfate active metabolites are eliminated fecally; magnesium and citrate ions are excreted renally.

• Pregnancy: FDA Pregnancy Category C. Use only if potential benefits justify potential risk to the fetus.
• Lactation: Limited data available; caution advised when administered to breastfeeding women.

• Primary class: Laxative combination.
• Subclasses: Stimulant laxative (sodium picosulfate) and osmotic laxative (magnesium oxide + citric acid).

• Hypersensitivity to any component of the formulation.
• Intestinal obstruction, perforation, or ileus.
• Acute surgical abdomen or severe inflammatory bowel disease.
• Severe renal impairment (due to risk of magnesium accumulation).
• Severe dehydration or electrolyte imbalance.
• Toxic megacolon.

• Use cautiously in patients with abdominal pain of unknown origin.
• Monitor electrolytes in patients with risk factors for imbalance.
• Risk of hypermagnesemia in renal impairment.
• Avoid prolonged or excessive use to prevent dependency or worsened constipation.
• Adequate hydration must be maintained during treatment.
• Discontinue use if severe abdominal pain, rectal bleeding, or excessive diarrhea occurs.

• Common: Abdominal cramps, nausea, diarrhea, bloating.
• Less common: Electrolyte disturbances (e.g., hypokalemia, hypermagnesemia), headache, dizziness.
• Rare: Allergic reactions, dehydration.

• May potentiate other laxatives or diuretics, increasing electrolyte imbalance risk.
• Caution with medications sensitive to electrolyte fluctuations (e.g., digoxin, corticosteroids).
• No significant CYP450 interactions identified.
• Avoid concurrent use with magnesium-containing medications in renal impairment.

• Emphasis on combined stimulant and osmotic laxative use for enhanced bowel preparation efficacy.
• Recommendation for short-term use with adequate hydration to minimize electrolyte disturbances.
• Inclusion in updated bowel prep protocols for improved tolerability and colon cleansing.

• Store at 20°C to 25°C (68°F to 77°F).
• Protect from moisture and light.
• Keep container tightly closed.
• Keep out of reach of children.