sodium picosulfate

(redirected from anhydrous citric acid)

sodium picosulfate/magnesium oxide/anhydrous citric acid

(soe-dee-um pi-koe-sul-fate/mag-nee-zhum ox-side/an-hye-druss sit-ric as-id) ,


(trade name)


Therapeutic: laxatives
Pharmacologic: osmotic laxatives
Pregnancy Category: B


Cleansing of the colon in preparation for colonoscopy.


Sodium picosulfate—converted by colonic bacteria to BHPM, which directly stimulates colonic peristalsis. Magnesium oxide and anhydrous citric acid—combine to form magnesium citrate, an osmotic laxative that causes water retention within the GI tract.

Therapeutic effects

With concurrent fluid ingestion produces watery diarrhea and colonic purging in preparation for colonoscopy.


Absorption: Minimal systemic absorption.
Distribution: Action is primarily local.
Metabolism and Excretion: Action is primarily local.
Half-life: Sodium picosulfate—7.4 hr.

Time/action profile (onset of watery diarrhea)

POwithin hrunknownunknown


Contraindicated in: Severely impaired renal function (CCr <30 mL/min);GI obstruction/ileus/bowel perforation/toxic colitis or megacolon/gastric retention.
Use Cautiously in: Renal impairment/concurrent medications affecting renal function (↑ risk of renal impairment);Known risk factors for arrhythmias including prolonged QT interval, recent MI, unstable angina pectoris, CHF, or cardiomyopathy;Known/suspected inflammatory bowel disease (may cause mucosal ulcerations);Electrolyte abnormalities (correct prior to administration);History of seizures or concurrent use of medications that ↓ seizure threshold (may ↑ risk of seizures);Patients at risk for aspiration; Obstetric: Use during pregnancy only if clearly needed; Lactation: Use caution if breast feeding; Pediatric: Safe and effective use in children has not been established.

Adverse Reactions/Side Effects

Central nervous system

  • seizures (life-threatening)
  • headache


  • arrhythmias (life-threatening)


  • abdominal pain
  • abdominal distention
  • abdominal pain
  • nausea
  • vomiting


  • renal impairment (life-threatening)

Fluid and Electrolyte

  • dehydration
  • fluid/electrolyte abnormalities


Drug-Drug interaction

Concurrent use of drugs affecting fluid and electrolyte status/renal function including ACE inhibitors, angiontensin receptor blockers, corticosteroids, NSAIDs, diuretics, and other laxatives may ↑ risk of dehydration, renal impairment, seizures, hypotension, and fluid/electrolyte abnormalities.Concurrent use of medications that ↓ seizure threshold, including tricyclic antidepressants or concurrent alcohol /benzodiazepine withdrawal (may ↑ risk of seizures).Absorption of oral medications taken within 1 hr of start may be altered.Prior/concurrent anti-infectives may ↓ efficacy.Concurrent use of other laxatives (may ↑ risk of mucosal ulcerations).Concurrent of use of digoxin (electrolyte abnormalities may ↑ risk of toxicity).Concurrent use of drugs that may induce the syndrome if inappropriate secretion of antidiuretic hormone (SIADH) including antipsychotics, carbamazepine, tricyclic antidepressants, and SSRIs may ↑ risk of water retention and electrolyte abnormalities.Magnesium in preparation chelates and prevents the absorption of chlorpromazine, digoxin, fluoroquinolones, penicillamine, and tetracycline ; these should be given at least 2 hr before or 6 hr after.


Each dose should be followed by 3 8-ounce drinks of clear liquid.
Oral (Adults) Split dose method—One reconstituted packet during evening before colonoscopy, repeated during the morning prior to the colonoscopy; Day-before method—One reconstituted packet during afternoon or early evening before colonoscopy, repeated 6 hr later during evening prior to the colonoscopy. Additional clear liquids are required.


Powder for oral use (requires reconstitution)orange: 10 mg sodium picosulfate/3.5 g manesium oxide/12 g anhydrous citric acid per packet

Nursing implications

Nursing assessment

  • Assess patient for abdominal distention, presence of bowel sounds, and usual pattern of bowel function.
  • Assess color, consistency, and amount of stool produced. Watery diarrhea to clear liquid should be defecated at the completion.
  • Monitor for significant vomiting or signs of dehydration (orthostatic hypotension) following medication. Consider post-colonoscopy lab tests (electrolytes, creatinine, BUN) and treat accordingly. May occur up to 7 days after colonoscopy.
  • Assess for seizures, especially in patients with a seizure disorder or patients taking medications that lower seizure threshold, withdrawing from alcohol or benzodiazepines, or with hyponatremia.
  • Monitor ECG pre-dose and post-colonoscopy in patients with increased risk of arrhythmias (history of prolonged QT interval, uncontrolled arrhythmias, recent MI, unstable angina, HF, cardiomyopathy).
  • Lab Test Considerations: May cause ↓ serum potassium, sodium, chloride, calcium, eGFR, and ↑ serum magnesium and creatinine.

Potential Nursing Diagnoses

Deficient knowledge, related to medication regimen (Patient/Family Teaching)


  • Correct fluid and electrolyte abnormalities prior to therapy.
  • Assess for difficulty swallowing or history of regurgitation or aspiration prior to administering.
  • Oral: Reconstitute powder right before use; do not prepare solution in advance. Fill the supplied dosing cup with cold water up to lower (5-oz) line on cup and pour in contents of 1 packet of Prepopik powder. Stir for 2–3 min. Reconstituted solution may become slightly warm as powder dissolves. There are 2 dosing regimens:
    • Split Dose (Preferred Method): Take dissolved first packet the night before colonoscopy followed by five 8-oz drinks (upper line of dosing cup) of clear liquid before bed. On day of colonoscopy, take dissolved second packet followed by at least 3 8-oz drinks of clear liquid before colonoscopy. Drinking clear liquids may continue until 2 hr of colonoscopy.
    • Day-Before Dosing: Take dissolved first packet in afternoon or early evening followed by five 8-oz drinks of clear liquid before next dose. Take dissolved second packet in the late evening followed by 3 8-oz drinks of clear liquid before bed. Drinking clear liquids may continue until 2 hr of colonoscopy.

Patient/Family Teaching

  • Instruct patient to consume only clear liquids (no solid food or milk) on the day before colonoscopy and up to 2 hr before time of the colonoscopy. Reconstitute powder as directed and follow dosing regimen.
  • Caution patient to hydrate adequately with clear liquids before, during, and after use of Prepopik. Clear liquids include water, clear broth, apple juice, white cranberry juice, white grape juice, gingerale, plain jello (not red or purple), and frozen juice bars (not purple or red). Do not eat solid foods or drink milk during therapy.
  • Advise patient to notify health care professional if severe bloating, distention, or abdominal pain occurs following first packet of Prepopik. Delay second packet administration until symptoms resolve.
  • Advise patient not to take any other laxatives during therapy.
  • Instruct patient to notify health care professional promptly if hives, rash, vomiting that prevents you from keeping down the additional prescribed amounts of clear liquids needed after taking medication, dizziness, urinating less than normal, or headache occur.
  • Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
  • Advise female patient to notify health care professional if pregnancy is planned or suspected or if breast feeding.

Evaluation/Desired Outcomes

  • Clean colon prior to colonoscopy.
Drug Guide, © 2015 Farlex and Partners
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References in periodicals archive ?
Some key market participants are Archer Daniels Midland, American Tartaric Products, Gadot Biochemical Industries, Citrique Belge, Foodchem International Corporation, Jungbunzlauer Suisse AG, Thai Anhydrous Citric Acid, Huangshi Xinghua Biochemical, COFCO Bio-chemical, Cargill, Weifang Ensign Industry Co., Ltd., Jiangsu Guoxin Xielian Energy Co., Ltd., RZBC Group, Rizhao Jinsui Trade Co., Ltd., Laiwu Taihe Biochemistry Co., Ltd., Rizhao Ruisite International Trade Co., Ltd., Gansu Jinbao Industry Co., Ltd., Alfa Aesar, Barker Industries, Cater Chemicals Corp., Wintersun Chemical, Penta Manufacturing Company, Bruchem, Inc., Gojira Fine Chemicals, TTCA Co., Ltd, FoodChem CorporationCA, Shanghai Billion Chemical Chemical Co.
Biopharmaceutical company Ferring Pharmaceuticals Inc revealed on Monday the availability of CLENPIQ (sodium picosulfate, magnesium oxide and anhydrous citric acid) oral solution for cleansing of the colon in adults undergoing a colonoscopy by prescription in the US.
A pack of picosulfate with magnesium citrate (Picolight powder, Pharmbio, Seoul, Korea) consists of 10 mg of sodium picosulfate, 3.5 g of magnesium oxide, and 12 g of anhydrous citric acid. An exothermic reaction occurs when magnesium oxide reacts with anhydrous citric acid to form magnesium citrate (MgO + [C.sub.6][H.sub.8][O.sub.7] + [H.sub.2]O [right arrow] [C.sub.6][H.sub.6]Mg[O.sub.7] + 2[H.sub.2]O).
Anhydrous citric acid was estimated based on the rapid method for the determination of citric acid using pyridine-acetic anhydride method of Marrier and Boulet [14] and Guebel and Torres Darias [15].
The product is a combination of sodium picosulfate (a stimulant laxative) and magnesium oxide with anhydrous citric acid, which form magnesium citrate, an osmotic laxative.
b) Citric Acid: 65 grams of anhydrous citric acid crystals (Glaxo Smith Klein Co) were dissolved in 100 ml of distilled water at room tempera-ture till the solution became saturated to ob-tain citric acid at pH 1 which was checked using pH meter.13
So, the company can now offer standard 46/50 percent aqueous solutions of anhydrous citric acid or solutions of higher concentration, if required.
Biopharmaceutical company Ferring Pharmaceuticals Inc disclosed on Wednesday the receipt of the US Food and Drug Administration's (FDA) marketing approval for CLENPIQ (sodium picosulfate, magnesium oxide, and anhydrous citric acid) oral solution for cleansing of the colon in adults undergoing a colonoscopy.
This is a Professional and in-depth market research on the current state of the Global and China Anhydrous Citric Acid industry.