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Sodium picosulfate, magnesium, and citric acid (Oral)

SIT-rik AS-id, mag-NEE-zee-um OX-ide, SOE-dee-um pye-koe-sul-fate

Medically reviewed on June 7, 2018

Commonly used brand name(s)

In the U.S.

  • Clenpiq
  • Prepopik

Available Dosage Forms:

  • Solution
  • Powder for Solution

Therapeutic Class: Laxative, Stimulant Combination

Uses For sodium picosulfate, magnesium, and citric acid

Citric acid, magnesium oxide, and sodium picosulfate combination is used to cleanse the colon (bowel) in preparation for a procedure called colonoscopy. Sodium picosulfate, magnesium, and citric acid is a laxative. It works by causing you to have diarrhea to clean your colon. Cleaning your colon will help your doctor see inside of it more clearly during colonoscopy.

Sodium picosulfate, magnesium, and citric acid is available only with your doctor's prescription.

Before Using sodium picosulfate, magnesium, and citric acid

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For sodium picosulfate, magnesium, and citric acid, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to sodium picosulfate, magnesium, and citric acid or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of citric acid, magnesium oxide, and sodium picosulfate combination in the pediatric population. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of citric acid, magnesium oxide, and sodium picosulfate combination in the elderly.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking sodium picosulfate, magnesium, and citric acid, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using sodium picosulfate, magnesium, and citric acid with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Acalabrutinib
  • Bictegravir
  • Digoxin
  • Dolutegravir
  • Eltrombopag
  • Elvitegravir
  • Gefitinib
  • Ketoconazole
  • Ledipasvir
  • Levomethadyl
  • Licorice
  • Mefenamic Acid
  • Mycophenolate Mofetil
  • Mycophenolic Acid
  • Pazopanib
  • Phenytoin
  • Raltegravir
  • Rilpivirine
  • Sodium Polystyrene Sulfonate
  • Vismodegib

Using sodium picosulfate, magnesium, and citric acid with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Amprenavir
  • Atevirdine
  • Cefditoren Pivoxil
  • Chloroquine
  • Chlortetracycline
  • Ciprofloxacin
  • Delafloxacin
  • Delavirdine
  • Demeclocycline
  • Dicumarol
  • Doxycycline
  • Enoxacin
  • Felodipine
  • Fexofenadine
  • Gabapentin
  • Gabapentin Enacarbil
  • Gemifloxacin
  • Grepafloxacin
  • Isradipine
  • Levofloxacin
  • Levothyroxine
  • Lomefloxacin
  • Methacycline
  • Minocycline
  • Moxifloxacin
  • Nicardipine
  • Norfloxacin
  • Oxytetracycline
  • Pefloxacin
  • Potassium Phosphate
  • Potassium Phosphate, Dibasic
  • Potassium Phosphate, Monobasic
  • Quinidine
  • Rolitetracycline
  • Sodium Phosphate
  • Sodium Phosphate, Dibasic
  • Sodium Phosphate, Monobasic
  • Sparfloxacin
  • Tacrolimus
  • Tetracycline
  • Ticlopidine
  • Tipranavir
  • Zalcitabine

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of sodium picosulfate, magnesium, and citric acid. Make sure you tell your doctor if you have any other medical problems, especially:

  • Angina (severe chest pain), unstable or
  • Electrolyte imbalance (eg, low calcium, magnesium, potassium, or sodium in the blood) or
  • Fluid imbalance or
  • Heart attack, recent or
  • Heart disease (eg, cardiomyopathy) or
  • Heart rhythm problems (eg, prolonged QT, uncontrolled arrhythmia), history of or
  • Withdrawal from alcohol or benzodiazepines (eg, alprazolam, clonazepam, diazepam, lorazepam, Xanax®)—May increase risk for seizures, arrhythmia, or kidney problems.
  • Congestive heart failure or
  • Dehydration or
  • Inflammatory bowel disease or
  • Kidney problems or
  • Seizures, history of or
  • Stomach or bowel blockage or perforation or
  • Trouble swallowing or
  • Ulcerative colitis, active and severe—Use with caution. May make these conditions worse.
  • Gastric retention (problems with emptying of food or fluid from the stomach) or
  • Kidney disease, severe or
  • Stomach or bowel problems (eg, blockage, ileus, perforation) or
  • Toxic colitis or megacolon (a very dilated intestine)—Should not be used in patients with these conditions.
  • Kidney disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

Proper Use of sodium picosulfate, magnesium, and citric acid

Take sodium picosulfate, magnesium, and citric acid exactly as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance of side effects.

Sodium picosulfate, magnesium, and citric acid comes with a Medication Guide and patient instructions. You must read, understand, and follow these instructions carefully. Ask your doctor if you have any questions.

You may take sodium picosulfate, magnesium, and citric acid in two dosing regimens: Split-Dose dosing regimen and Day-Before dosing regimen. Your doctor will tell you how to take sodium picosulfate, magnesium, and citric acid depending on your colonoscopy schedule, distance traveled, and other personal circumstances.

To use Clenpiq™:

  • Sodium picosulfate, magnesium, and citric acid is available in a ready-to-drink bottle and is equal to one dose. You will need two doses of sodium picosulfate, magnesium, and citric acid. Drink all of sodium picosulfate, magnesium, and citric acid straight from the bottle.
  • Drink the additional prescribed amount of clear fluids (eg, water, apple juice, clear broth, white cranberry juice, white grape juice, or ginger ale) before and after every dose of sodium picosulfate, magnesium, and citric acid, and until at least 2 hours before your colonoscopy.
  • Do not eat solid foods or drink dairy or anything colored red or purple while you are taking sodium picosulfate, magnesium, and citric acid.

To use Prepopik™:

  • One dose of sodium picosulfate, magnesium, and citric acid consists of two packets of powder, each packet is mixed with cold water and taken at separate dosing times. Drink the liquid right away after mixing. Do not prepare the solution in advance.
  • Do not take the powder directly without mixing it with cold water. Doing so, may increase risk of side effects.
  • Use the supplied medicine cup when preparing the solution.
  • Drink the additional prescribed amount of clear fluids (eg, water, apple juice, white cranberry juice, white grape juice, or ginger ale) after every dose of sodium picosulfate, magnesium, and citric acid to prevent dehydration.
  • Do not eat solid foods or drink milk while taking sodium picosulfate, magnesium, and citric acid.
  • Drink clear liquids until your colonoscopy.

Avoid taking other laxatives while you are taking sodium picosulfate, magnesium, and citric acid.

Avoid taking any medicines by mouth within 1 hour before taking citric acid, magnesium oxide, and sodium picosulfate combination. Oral medicines may not be absorbed completely.

If you are taking chlorpromazine (Thorazine®), digoxin (Lanoxin®), penicillamine (Cuprimine®, Depen®), iron supplements, and certain antibiotics (eg, ciprofloxacin, doxycycline, minocycline, tetracycline, Avelox®, Levaquin®, Vigamox®), take these medicines at least 2 hours before and 6 hours after taking citric acid, magnesium oxide, and sodium picosulfate combination.

Dosing

The dose of sodium picosulfate, magnesium, and citric acid will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of sodium picosulfate, magnesium, and citric acid. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (powder for solution, solution):
    • For cleansing of the colon:
      • Adults—Your doctor will prescribe your dosing regimen to be taken the day or night before your colonoscopy.
        • Split-dose dosing regimen: Take your first packet the night before colonoscopy, and the second dose the next day, in the morning or at least 5 hours before your colonoscopy.
        • Day-Before dosing regimen: Take your first packet in the afternoon or early evening, and the second dose at least 6 hours after the first dose, the night before colonoscopy.
      • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of sodium picosulfate, magnesium, and citric acid, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Do not refrigerate or freeze Clenpiq™.

Precautions While Using sodium picosulfate, magnesium, and citric acid

It is important that your doctor check your progress closely for any problems or unwanted effects that may be caused by sodium picosulfate, magnesium, and citric acid. Blood and urine tests may be needed to check for unwanted effects.

Contact your doctor right away if you have decreased urination, dizziness, headache, or vomiting. These could be symptoms of a loss of too much body fluid (dehydration).

If you have severe bloating, distension, or abdominal or stomach pain after taking the first dose, stop taking sodium picosulfate, magnesium, and citric acid or delay taking the second dose until your symptoms improve.

Sodium picosulfate, magnesium, and citric acid may cause fluid and electrolyte imbalances, which may lead to serious unwanted effects, including heart rhythm problems, seizures, or kidney problems. Your doctor should correct these imbalances before you start taking sodium picosulfate, magnesium, and citric acid. Also drink plenty of clear liquids prescribed by your doctor.

Do not drink alcohol together with Clenpiq™.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Sodium picosulfate, magnesium, and citric acid Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Incidence not known

  • Bleeding of the rectum
  • bloody stools
  • confusion
  • decreased urine output
  • diarrhea
  • dizziness or fainting
  • dry mouth
  • fast, slow, or irregular heartbeat
  • fever
  • headache
  • hives, itching, skin rash
  • increased thirst
  • jerking or shaking of the muscles
  • joint pain, stiffness, or swelling
  • loss of bowel control
  • loss of consciousness
  • muscle pain or cramps
  • nausea
  • numbness or tingling in the hands, feet, or lips
  • pinpoint red or purple spots on the skin
  • seizures
  • stomach pain and tenderness
  • swelling of the eyelids, face, lips, ankles, hands, or feet
  • tightness in the chest
  • troubled breathing or swallowing
  • unusual tiredness or weakness
  • vomiting

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Incidence not known

  • Pain in the rectum

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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