Citric acid/magnesium oxide/sodium picosulfate Disease Interactions

The use of laxatives is contraindicated in patients with inflammatory bowel disease. Patients with inflammatory bowel disease may experience colonic perforation with use of stimulant laxatives.

The use of laxatives is contraindicated in patients with intestinal obstruction disorders. Patients with intestinal obstruction disorders may need their underlying condition treated to correct the constipation. Some laxatives require reduction in the colon to their active form to be effective which may be a problem in patients with intestinal obstruction.

Magnesium is eliminated by the kidney. The serum concentration of magnesium is increased in patients with renal impairment. Magnesium toxicity includes CNS depression, muscular paralysis, respiratory depression, hypotension and prolonged cardiac conduction time. Disappearance of the patellar reflex is a useful clinical sign of magnesium intoxication. Therapy with magnesium should be administered cautiously and dosages should be modified in patients with compromised renal function. Clinical monitoring of serum magnesium levels is recommended.

Sodium picosulfate is a stimulant laxative contraindicated in patients with gastrointestinal complications, such as gastrointestinal obstruction or ileus, bowel perforation, toxic colitis or toxic megacolon, and gastric retention.

The use of sodium picosulfate is contraindicated in patients with severe renal impairment (creatinine clearance less than 30 mL/min) as accumulation of magnesium in plasma may occur. Use caution in patients with mild to moderate renal impairment or patients taking concomitant medications that may affect renal function as these patients may be at increased risk for renal injury. It is recommended to assess baseline and post-colonoscopy laboratory tests (electrolytes, creatinine, and BUN) in these patients.

The use of sodium picosulfate may cause serious arrhythmia. Use caution when prescribing this agent in patients at increased risk of arrhythmias (e.g., patients with a history of prolonged QT, uncontrolled arrhythmias, recent myocardial infarction, unstable angina, congestive heart failure, or cardiomyopathy). It is recommended to consider pre-dose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias.

The use of sodium picosulfate may cause generalized tonic-clonic seizures. Use caution when using this agent in patients with a history of seizures and in patients at risk of seizure, such as patients taking medications that lower the seizure threshold (e.g., tricyclic antidepressants), patients withdrawing from alcohol or benzodiazepines, or patients with known or suspected electrolyte abnormalities (e.g., hyponatremia, hypokalemia, hypocalcemia, and hypomagnesemia) and low serum osmolality.

Osmotic laxatives may produce colonic mucosal aphthous ulcerations. Sodium picosulfate should be used with caution in patients with severe active ulcerative colitis. Appropriate diagnostic studies should be performed to rule out gastrointestinal obstruction or perforation before administering this agent.