Citric Acid Magnesium Oxide Sodium Picosulfate

Citric Acid, Magnesium Oxide, and Sodium Picosulfate are prescription medications used for bowel cleansing before a colonoscopy. 

• Citric Acid, Magnesium Oxide, and Sodium Picosulfate are available under various brand names: Clenpiq, Prepopik 

Common side effects of Citric Acid, Magnesium Oxide, and Sodium Picosulfate include:

• Stomach pain.
• Nausea, vomiting; or
• Headache.

Serious side effects of Citric Acid, Magnesium Oxide, and Sodium Picosulfate include:

• Hives. 
• Difficult breathing. 
• Swelling of the face, lips, tongue, or throat.
• A light-headed feeling, 
• Confusion,
• Irregular heartbeats,
• A seizure,
• Little or no urination,
• Severe nausea or vomiting,
• Painful bloating, severe stomach cramps,
• Rectal bleeding, or
• Trouble swallowing or trouble drinking liquids.

Rare side effects of Citric Acid, Magnesium Oxide, and Sodium Picosulfate include:

• None

Seek medical care or call 911 at once if you have the following serious side effects:

• Severe headache, confusion, slurred speech, arm or leg weakness, trouble walking, loss of coordination, feeling unsteady, very stiff muscles, high fever, profuse sweating, or tremors;
• Serious eye symptoms such as sudden vision loss, blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
• Serious heart symptoms such as fast, irregular, or pounding heartbeats; fluttering in the chest; shortness of breath; sudden dizziness, lightheartedness, or passing out.

This is not a complete list of side effects and other serious side effects or health problems that may occur because of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

Adult and pediatric dosage

Powder for oral solution (Prepopik)

• 10 mg/3.5 g/12 g per 16.1 g of powder (available as a carton containing two 16.1 g packets of powder)

Solution, ready-to-drink (Clenpiq)

• (10 mg/3.5 g/12 g)/160 ml (available as a carton containing two 160-ml bottles)
• Flavor: Cranberry

Bowel cleansing

Adult dosage

Clenpiq:

• Split-dose regimen: 160 ml (1 bottle) the evening before the colonoscopy (5 PM to 9 PM), followed by a second 160 ml dose approximately 5 hours before the colonoscopy.

Prepopik:

• Split-dose regimen (preferred): 150 ml (5 oz) the evening before the colonoscopy (5 PM to 9 PM), followed by a second 150 ml (5 oz) dose approximately 5 hours before the colonoscopy.
• Day-before regimen (alternative): 150 ml (5 oz) in the early evening before the colonoscopy (4 PM to 6 PM), followed by a second 150 ml (5 oz) dose 6 hours later (10 PM to 12 AM) the night before the colonoscopy.

Pediatric dosage

• Children above 9 years and Adolescents:  
• Clenpiq: Split-dose regimen: First dose: 160 ml (1 bottle) administered the evening before the colonoscopy (. G, 5 PM to 9 PM). 
• Second dose: 160 ml dose (1 bottle) administered the next morning approximately 5 hours before the colonoscopy.

Prepopik: 

• Split-dose regimen (preferred): First dose: 1 packet administered the evening before the colonoscopy (. G, 5 PM to 9 PM). Second dose: 1 packet administered the next morning approximately 5 hours before the colonoscopy.
• Day-before regimen: First dose: 1 packet administered the early evening before the colonoscopy (. G, 4 PM to 6 PM). 
• Second dose: 1 packet administered 6 hours later (. G, 10 PM to 12 AM) the night before the colonoscopy.

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Citric Acid, Magnesium Oxide, and Sodium Picosulfate have severe interactions with no other drugs.
• Citric Acid, Magnesium Oxide, and Sodium Picosulfate have serious interactions with the following drug:
  • Baloxavir marboxil
• Citric Acid, Magnesium Oxide, and Sodium Picosulfate have moderate interactions with at least 135 other drugs.
• Citric Acid, Magnesium Oxide, and Sodium Picosulfate have minor interactions with no other drugs.

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist about all your products. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions or concerns.

Contraindications

Hypersensitivity to Citric Acid, Magnesium Oxide, and Sodium Picosulfate

• Kidney disease.
• A bowel obstruction, ileus, colitis, or toxic megacolon.
• A dilated intestine.
• A perforation (a hole or tear) of your intestines; or
• Slow digestion.

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Citric Acid, Magnesium Oxide, and Sodium Picosulfate?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Citric Acid, Magnesium Oxide, and Sodium Picosulfate?”

Cautions

• This medicine can cause severe dehydration, which can lead to a serious electrolyte imbalance, seizures, kidney failure, or abnormal heartbeats that can cause death.
• The risk of dehydration is highest in people with heart problems or kidney disease, or if you take certain other medicines. Tell your doctor about all your current medicines and any you start or stop using.
• Call your doctor if you are sick with vomiting and cannot drink enough water for your bowel prep, or if you have a headache, dizziness, or decreased urination.
• Do not take other laxatives during your colon prep.

Pregnancy and Lactation

• No data are available regarding use in pregnant women. Tell your doctor if you are pregnant 
• Lactation
  • There are no data on presence of magnesium oxide or anhydrous citric acid in either human or animal milk, effects on breastfed infant, or on milk production; published data on lactating women indicate that active metabolite of sodium picosulfate, bis-(p-hydroxyphenyl)-pyridyl-2-methane (BHPM) remained below limit of detection (1 ng/mL) in breast milk after both single and multiple doses of 10 mg/day; there are no data on effects of sodium picosulfate on breastfed infant or on milk production; the developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for Prepopik and any potential adverse effects on breastfed infant or underlying maternal condition. Tell your doctor if you are breastfeeding.