Sodium picosulfate, magnesium oxide, and anhydrous citric acid is used in adults and children 9 years of age and older to empty the colon (large intestine, bowel) before a colonoscopy (examination of the inside of the colon to check for colon cancer and other abnormalities) so that the doctor will have a clear view of the walls of the colon. Sodium picosulfate is in a class of medications called stimulant laxatives. Magnesium oxide and anhydrous citric acid combine to form a medication called magnesium citrate. Magnesium citrate is in a class of medications called osmotic laxatives. These medications work by causing watery diarrhea so that the stool can be emptied from the colon.
Sodium picosulfate, magnesium oxide, and anhydrous citric acid combination comes as a powder (Prepopik® ) to mix with water and as a solution (liquid) (Clenpiq ® ) to take by mouth. It is generally taken as two doses in preparation for a colonoscopy. The first dose is usually taken the night before the colonoscopy and the second dose taken the morning of the procedure. The medication may also be taken as two doses on the day before the colonoscopy, with the first dose taken the late afternoon or early evening before the colonoscopy and the second dose taken 6 hours later. Your doctor will tell you exactly when you should take your medication. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take sodium picosulfate, magnesium oxide, and anhydrous citric acid combination exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
To prepare for your colonoscopy, you may not eat any solid food or drink milk beginning the day before the procedure. You should only have clear liquids during this time. Examples of clear liquids are water, light colored fruit juice without pulp, clear broth, coffee or tea without milk, flavored gelatin, popsicles and soft drinks. Do not drink alcoholic beverages or any liquid that is red or purple. Ask your doctor if you have any questions about which liquids you may drink before your colonoscopy.
If you are taking the powder (Prepopik® ), you will need to mix the medication powder with cold water right before you take it. If you swallow the powder without mixing it with water, there is a greater chance that you will experience unpleasant or dangerous side effects. To prepare each dose of your medication, fill the dosing cup that was provided with the medication with cold water up to the lower line (5 ounces, 150 mL) that is marked on the cup. Pour in the contents of one packet of sodium picosulfate, magnesium oxide, and anhydrous citric acid powder and stir for 2 to 3 minutes to dissolve the powder. The mixture may become slightly warm as the powder dissolves. Drink the entire mixture right away. Mix the medication with water only when you are ready to take it; do not prepare the mixture in advance.
If you are taking the solution (Clenpiq® ), drink the entire contents of one bottle of sodium picosulfate, magnesium oxide, and anhydrous citric acid solution directly from the bottle for each dose you are to take. Sodium picosulfate, magnesium oxide, and anhydrous citric acid solution comes ready to drink and should not be mixed with a liquid before use.
If you are taking the medication the night before and the morning of your colonoscopy, you will take your first dose between 5:00 to 9:00 p.m. on the night before your colonoscopy. After you take this dose, you will need to drink five 8-ounce (240 mL) drinks of clear liquid within the next 5 hours before you go to bed. You will take your second dose the next morning, about 5 hours before your colonoscopy is scheduled. After you take the second dose, you will need to drink three 8-ounce drinks of clear liquid within the next 5 hours, but you should finish all the drinks at least 2 hours before your colonoscopy.
If you are taking both doses of the medication the day before your colonoscopy, you will take your first dose between 4:00-6:00 p.m. on the evening before your colonoscopy. After you take this dose, you will need to drink five 8-ounce drinks of clear liquid within 5 hours. You will take your next dose 6 hours later, between 10:00 p.m. to 12:00 a.m. After you take the second dose, you will need to drink three 8-ounce drinks of clear liquid within 5 hours.
It is very important that you drink the required amounts of clear liquid during your treatment to replace the fluid that you will lose as your colon is emptied. You can use the dosing cup provided with your medication to measure your 8-ounce portions of liquid by filling the cup to the top line. You may find it easier to drink the full amount of liquid if you choose a variety of different clear liquid drinks.
You will have many bowel movements during your treatment with sodium picosulfate, magnesium oxide, and anhydrous citric acid combination. Be sure to stay close to a toilet from the time you take your first dose of the medication until the time of your colonoscopy appointment. Ask your doctor about other things you can do to stay comfortable during this time.
If you experience severe bloating or stomach pain after you take the first dose of this medication, wait until these symptoms go away before you take the second dose.
Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with sodium picosulfate, magnesium oxide, and anhydrous citric acid. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website ( Web Site) or the manufacturer's website to obtain the Medication Guide.
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.
Before taking sodium picosulfate, magnesium oxide, and anhydrous citric acid,
Your doctor will tell you what you may eat and drink before, during, and after your treatment with sodium picosulfate, magnesium oxide, and anhydrous citric acid. Follow these directions carefully.
Call your doctor if you forget or are unable to take this medication exactly as directed.
Sodium picosulfate, magnesium oxide, and anhydrous citric acid may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately or get emergency medical treatment:
Sodium picosulfate, magnesium oxide, and anhydrous citric acid may cause other side effects. Call your doctor if you have any unusual problems while you are taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online ( Web Site ) or by phone (1-800-332-1088).
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website ( Web Site) for more information if you do not have access to a take-back program.
It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. Web Site
In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at Web Site. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.
Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your body's response to sodium picosulfate, magnesium oxide, and anhydrous citric acid.
Do not let anyone else take your medication.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
AHFS® Consumer Medication Information. © Copyright, The American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland. All Rights Reserved. Duplication for commercial use must be authorized by ASHP.
Selected Revisions: November 15, 2019.