Sodium picosulfate with magnesium oxide and citric acid powder for oral
- Drugs List
- Therapeutic Indications
- Dosage
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Oral formulations containing sodium picosulfate, light magnesium oxide and citric acid.
Drugs List
Therapeutic Indications
Uses
Bowel evacuation - prior to investigative procedure
Bowel evacuation - prior to surgical procedure
Dosage
Adults
CitraFleet
One sachet reconstituted in water on the evening before the procedure, followed by 1.5 to 2 litres of clear liquids spread over several hours. The second reconstituted sachet should be taken in the morning on the day of the procedure, followed by at least six 250ml drinks of clear liquids spread over several hours, consumed until 2 hours before the procedure.
Or if the procedure is early in the morning:
One sachet reconstituted in water on the afternoon prior to the procedure, followed by 1.5 to 2 litres of clear liquids over several hours. The second reconstituted sachet should be taken in the evening prior to the procedure, followed by at least six 250ml drinks of clear liquids spread over several hours, consumed until 2 hours before the procedure.
Or if the procedure is in the afternoon or evening:
Both sachets reconstituted in water in the morning of the day of the procedure, followed by 1.5 to 2 litres of clear liquids over several hours, consumed until 2 hours before the procedure.
The time between taking the two sachets should be at least 5 hours.
Picolax
One sachet reconstituted in water as directed taken 10 to 18 hours before the procedure, followed by at least five 250ml drinks of clear liquids spread over several hours. The second reconstituted sachet should be taken 4 to 6 hours before the procedure, followed by at least three 250ml drinks of clear liquids spread over several hours, consumed until 2 hours before the procedure.
Children
Not all brands are licensed for use in children under 18 years of age.
Children aged 9 to 18 years
One sachet reconstituted in water as directed taken 10 to 18 hours before the procedure, followed by at least five 250ml drinks of clear liquids spread over several hours. The second reconstituted sachet should be taken 4 to 6 hours before the procedure, followed by at least three 250ml drinks of clear liquids spread over several hours, consumed until 2 hours before the procedure.
Children aged 4 to 9 years
One sachet reconstituted in water as directed taken 10 to 18 hours before the procedure, followed by at least five 250ml drinks of clear liquids spread over several hours. The second dose is half a reconstituted sachet (2 level measuring spoonfuls) taken 4 to 6 hours before the procedure, followed by at least three 250ml drinks of clear liquids spread over several hours, consumed until 2 hours before the procedure.
Children aged 2 to 4 years
Half a reconstituted sachet (2 level measuring spoonfuls) taken 10 to 18 hours before the procedure, followed by at least five 250ml drinks of clear liquids spread over several hours. The second dose is half a reconstituted sachet (2 level measuring spoonfuls) taken 4 to 6 hours before the procedure, followed by at least three 250ml drinks of clear liquids spread over several hours, consumed until 2 hours before the procedure.
Children aged 1 to 2 years
Quarter of a reconstituted sachet (1 level measuring spoonful) taken 10 to 18 hours before the procedure, followed by at least five 250ml drinks of clear liquids spread over several hours. The second dose is quarter of a reconstituted sachet (1 level measuring spoonful) taken 4 to 6 hours before the procedure, followed by at least three 250ml drinks of clear liquids spread over several hours, consumed until 2 hours before the procedure.
Patients with Renal Impairment
Risk of hypermagnesaemia in patients with severe renal impairment.
Contraindications
Ascites
Children under 1 year
Nausea
Vomiting
Acute inflammatory bowel disease
Acute surgical abdomen
Congestive cardiac failure
Delayed gastric emptying
Gastrointestinal obstruction
Gastrointestinal perforation
Gastrointestinal ulcer
Hypermagnesaemia
Paralytic ileus
Renal impairment - glomerular filtration rate below 30ml/minute/1.73m sq
Severe dehydration
Toxic colitis
Toxic megacolon
Precautions and Warnings
Children aged 1 to 18 years
Debilitation
Elderly
Predisposition to aspiration or regurgitation
Predisposition to hypokalaemia
Predisposition to hyponatraemia
Predisposition to rhabdomyolysis
Predisposition towards electrolyte imbalance
Restricted potassium intake
Cardiovascular disorder
Dehydration
Electrolyte imbalance
Galactosaemia
Glucose-galactose malabsorption syndrome
Hypotension
Hypovolaemia
Inflammatory bowel disease
Lactose intolerance
Moderate renal impairment
Pregnancy
Recent gastrointestinal surgery
Advise ability to drive/operate machinery may be affected by side effects
Correct hypovolaemia prior to administration
Not all available brands/formulations are licensed for use in children
Some formulations contain lactose
Ensure patient has adequate fluid intake
Measure electrolytes before & after use where risk of electrolyte imbalance
Measure renal function where risk of fluid or electrolyte imbalance
Monitor patient for hypotension or hypovolaemia during treatment
Consider the use of fluid and electrolyte replacement
Monitor periodically for signs of hypokalaemia
Monitor periodically for signs of hyponatraemia
Monitor renal function in elderly patients
Advise patient to expect frequent loose stools
Low residue diet recommended on the day before the procedure
Maximum treatment 24 hours
May affect the gastro-intestinal absorption of other drugs
Advise patient of appropriate fluid / dietary intake prior to procedure
Risk of electrolyte disorders or impaired renal function in the elderly or fragile patients.
Drinking only water to replace the fluid losses may lead to electrolyte imbalance.
Caution is advised in patients already receiving drugs that may cause hypokalaemia (e.g diuretics or corticosteroids) or drugs where hypokalaemia is a particular risk (e.g. cardiac glycosides).
Caution is advised in patients already on NSAIDs or drugs known to induce SIADH (e.g tricyclic antidepressants, selective serotonin re-uptake inhibitors, antipsychotic drugs and carbamazepine) as these drugs may increase the risk of water retention and/or electrolyte imbalance.
Tetracycline and fluoroquinolone antibiotics, iron, digoxin, chlorpromazine and penicillamine should be taken at least 2 hours before and not less than 6 hours after administration of the bowel cleansing treatment in order to avoid chelation with magnesium.
Other oral drugs (e.g. anti-epileptics, contraceptives, anti-diabetics, antibiotics) should not be taken 1 hour before or after administration of bowel cleansing preparations because absorption may be impaired.
Bowel cleansing agents should not be considered as treatments for constipation.
Pregnancy and Lactation
Pregnancy
Use sodium picosulfate with magnesium oxide with caution during pregnancy.
Manufacturers advise caution if used during pregnancy. Studies in animals have shown reproductive toxicity at very high doses. No clinical data on exposed pregnancies are available.
Lactation
The medicine is considered safe for use during breastfeeding.
Manufacturers advise that the medicine may be used safely during breastfeeding. There is no experience with the use of sodium picosulfate with magnesium oxide in breastfeeding women. Neither sodium picosulfate nor magnesium oxide are expected to be excreted in breast milk.
Counselling
Advise patient that clear liquids may be consumed until 2 hours before the time of the procedure.
Advise patient that clear liquids should include a variety of fruit juice without pulp. soft drinks, clear soup, tea, coffee (without milk, soy or cream) and water. Do not drink only water.
Advise patient that a low residue diet is recommended on the day prior to the procedure. A clear liquid diet is recommended on the day of the procedure.
Advise patient that low residue foods include eggs, cereals, potatoes, pasta, meat, fish, bread, cream, cheese, sugar, gravy, clear jelly.
Advise patient that heat is generated during reconstitution and that the solution should be allowed to cool before drinking.
Advise patient that apart from the liquid intake together with the treatment regimen, a normal, thirst driven intake of clear liquids is recommended.
Advise patient to expect frequent loose stools.
Advise patient ability to drive/operate machinery may be affected by side effects.
Side Effects
Abdominal distension
Abdominal pain
Anaphylactoid reaction
Aphthoid ileal ulcers
Confusion
Convulsions
Dehydration
Diarrhoea
Dizziness
Dry mouth
Electrolyte disturbances
Epileptic seizures
Faecal incontinence
Fatigue
Flatulence
Headache
Hypersensitivity reactions
Hypokalaemia
Hyponatraemia
Nausea
Orthostatic hypotension
Proctalgia
Pruritus
Purpura
Rash
Sleep disturbances
Syncope
Thirst
Tonic-clonic seizures (generalised)
Urticaria
Vomiting
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: May 2021
Reference Sources
Summary of Product Characteristics: CitraFleet Powder for oral solution in sachet. Casen Recordati S.L. Revised July 2019.
Summary of Product Characteristics: Picolax. Ferring Pharmaceuticals Ltd. Revised February 2021.
NICE Evidence Services Available at: www.nice.org.uk Last accessed: 14 May 2021
Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
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