citric acid + light magnesium oxide + sodium picosulfate: clinical use

Prescribing considerations

• Confirm bowel cleansing is required for a diagnostic procedure; this is not a routine laxative.
• Assess hydration, ability to consume clear fluids, renal and cardiac function, blood pressure, frailty and electrolyte disorders.
• Review medicines whose absorption may be impaired or which increase the risk of hypokalaemia, hyponatraemia or water retention.
• Use particular caution after recent gastrointestinal surgery and in mild-to-moderate dehydration or renal impairment.
• Account for the formulation's potassium content in renal impairment or a controlled-potassium diet.

Contraindications and cautions

• Hypersensitivity to an active ingredient or excipient
• Congestive cardiac failure or severe dehydration
• Severely reduced renal function or hypermagnesaemia
• Gastric retention, gastrointestinal ulceration, ileus, obstruction or perforation
• Toxic colitis, toxic megacolon or active inflammatory bowel disease
• Nausea and vomiting, ascites or an acute surgical abdomen
• Rhabdomyolysis

Monitoring

• Consider baseline and post-treatment electrolytes in frail or debilitated people and those at risk of hyponatraemia or hypokalaemia.
• Consider renal-function assessment with kidney impairment, restricted fluid intake or another dehydration risk.
• Assess for dehydration, hypotension, altered mental state and inadequate bowel response.

Clinical pharmacology

Sodium picosulfate is a locally acting stimulant cathartic in the colon. Magnesium citrate retains water osmotically, combining evacuation with peristaltic stimulation. Detectable systemic absorption is not expected, but magnesium may accumulate in severe renal impairment.

Formulation and product differences

• Lemon-flavoured white crystalline powder supplied in unit-dose sachets for oral solution.
• Reconstitution produces a cloudy solution and may generate heat; allow it to cool and use immediately.
• Each sachet contains potassium and is classified as essentially sodium-free under the product-information threshold.
• Excipients include potassium hydrogen carbonate, saccharin sodium and lemon flavour containing maltodextrin and tocopherol.