Sodium Picosulfate

Uses and Administration

Sodium picosulfate is a stimulant laxative related to bisacodyl ( Refer to ) used for the treatment of constipation ( Refer to ) and for evacuation of the colon before investigational procedures or surgery. When taken orally it is metabolised by colonic bacteria to an active form that stimulates bowel movements. It is usually effective within 6 to 12 hours although when used with magnesium citrate for bowel evacuation an effect may be seen within 3 hours.

For constipation it is given as a single oral dose of 5 to 10 mg, usually at bedtime. (For doses in children see Refer to .)

For bowel evacuation, a dose of sodium picosulfate 10 mg with magnesium citrate (Refer to) is given in the morning and again in the afternoon of the day before examination.

(last reviewed 2010-08-17; last modified 2008-07-14)

References.

(last reviewed 2010-08-17; last modified 2009-07-17)

References

1. Hoy SM, et al.. Sodium picosulfate/magnesium citrate: a review of its use as a colorectal cleanser.Drugs. 2009; 69: 123–36. PubMed

Administration in children

In the UK, the following oral doses of sodium picosulfate have been recommended for children in the treatment of constipation; the dose is usually given at night:

1 month to 4 years: 250 micrograms/kg (maximum 5 mg)

4 to 10 years: 2.5 to 5 mg

over 10 years: 5 to 10 mg

Most UK licensed product information gives similar doses to those above forbowel cleansing. Alternatively, some recommend that children may be given the following doses of a sachet containing sodium picosulfate 10 mg (with magnesium citrate):

1 to 2 years: ¼ sachet in the morning and ¼ sachet in the afternoon

2 to 4 years: ½ sachet in the morning and ½ sachet in the afternoon

4 to 9 years: 1 sachet in the morning and ½ sachet in the afternoon

over 9 years: 1 sachet in the morning and 1 sachet in the afternoon

(last reviewed 2010-08-17; last modified 2007-07-28)

Adverse Effects, Treatment and Precautions

Adverse Effects and Precautions

As for Bisacodyl, Refer to and Refer to .

(last reviewed 2010-08-17; last modified 2010-08-18)

Bowel evacuation

The National Patient Safety Agency in the UK released a warning¹about oral bowel cleansing preparations after reports of fatalities and harm from the improper use of these products. Particularly highlighted were electrolyte imbalance or dehydration due to inappropriate fluid intake or use of these products despite a clinical contra-indication. In Australia, the Adverse Drug Reactions Advisory Committee has also warned that low volume sodium picosulfate solutions may cause marked dehydration, hyponatraemia, other electrolyte abnormalities, and associated complications. Patients at particular risk include infants, the elderly, the frail, and those with congestive heart failure or with renal impairment.²It may be appropriate to carry out bowel preparation in hospital for those at risk.^1,3,4Accumulation of magnesium may occur in patients with severe renal impairment given some magnesium-containing preparations, and an alternative should be used. Bowel cleansing preparations may affect the absorption of oral medicines given at the same time. Caution is also advised when these preparations are given with other medicines that affect fluid and electrolyte balance.¹

A grand mal seizure in a 64-year-old female given sodium picosulfate with magnesium citrate was assumed to have been caused by hyponatraemia; the patient had normal electrolyte concentrations in the period before taking the bowel preparation. Care is needed when sodium picosulfate solutions are used in those with a low seizure threshold or potential sodium depletion.⁵

Although caution is advised with the use of bowel cleansing preparations in patients with inflammatory bowel disease, sodium picosulfate with magnesium citrate was considered a safe and effective bowel cleansing agent in adults⁶ and children⁷with these problems. They tolerated the preparation as well as patients with other colonic disorders with no adverse effect on their disease symptoms. Patients should be kept well hydrated and this treatment should not be used in suspected toxic dilatation of the colon.

(last reviewed 2010-08-17; last modified 2010-08-17)

References

1. National Patient Safety Agency. Rapid Response Report: reducing risk of harm from oral bowel cleansing solutions (issued 19th February, 2009). Available at: Link (accessed 08/06/09)

2. Adverse Drug Reactions Advisory Committee (ADRAC). Electrolyte disturbances with sodium picosulphate bowel cleansing products.Aust Adverse Drug React Bull. 2002; 21: 2. online

3. Lewis M, et al.. Bowel preparation at home in elderly people.BMJ. 1997; 314: 74. PubMed

4. Hanning CD. Bowel preparation at home in elderly people.BMJ. 1997; 314: 74. PubMed

5. Frizelle FA, et al.. Hyponatremia and seizures after bowel preparation: report of three cases.Dis Colon Rectum. 2005; 48: 393–6. PubMed

6. McDonagh AJG, et al.. Safety of Picolax (sodium picosulphate-magnesium citrate) in inflammatory bowel disease.BMJ. 1989; 299: 776–7. PubMed

7. Evans M, et al.. Safety of Picolax in inflammatory bowel disease.BMJ. 1989; 299: 1101–2. PubMed

Porphyria

The Drug Database for Acute Porphyria, compiled by the Norwegian Porphyria Centre (NAPOS) and the Porphyria Centre Sweden, classifies sodium picosulfate as not porphyrinogenic; it may be used as a drug of first choice and no precautions are needed.¹

(last reviewed 2010-08-17; last modified 2011-11-15)

References

1. The Drug Database for Acute Porphyria. Available at: Link (accessed 07/10/11)

Pharmacokinetics

Like bisacodyl ( Refer to ), sodium picosulfate is metabolised by colonic bacteria to the active compound bis(p-hydroxyphenyl)pyridyl-2-methane . Only a small amount of sodium picosulfate is absorbed after an oral dose; this is subsequently excreted in the urine.

(last reviewed 2010-08-17; last modified 2007-04-16)

Preparations: Single-Ingredient

The following preparations list represents a compilation of all available salt forms or related substances for this drug product.

The symbol ¤ denotes a preparation which is discontinued or no longer actively marketed.

ARGENTINA: Agarol; Chicle; Cirulaxia; Dagol; Dulcolax; Factor Laxante; Feen-A-Mint; Gotalax; Granulax; Kritel; Laxagar; Laxamin; Modaton; Modernel¤; Opalino; Rapilax; Rogelina; Trali; Verilax; Yodolin;AUSTRALIA: Dulcolax SP;AUSTRIA: Agaffin; Agiopic¤; Guttalax; Laxasan;BELGIUM: Dulcolax Picosulphate; Fructines; Guttalax¤; Laxoberon; Obstilax¤; Picolaxine;BRAZIL: Cronoplex; Diltin; Dulcolax Liquid¤; Forlax¤; Guttalax; Picolax¤; Rapilax;CHILE: Aguala; Cronolax; Dulcolax; Guttalax; Laxantil; Laxoberal¤;CZECH REPUBLIC: Agiolax Pico¤; Antocile¤; Darmol¤; Gallax; Guttalax; Laxygal; Progut¤; Regulax Pikosulfat;DENMARK: Actilax; Laxoberal; Picolon¤;FINLAND: Laxoberon; Picorion;FRANCE: Fructines;GERMANY: Abfuhrtropfen¤; Agiolax Pico; AgioPico Plus¤; Darmol Pico¤; Darmol¤; Dulcolax NP; Laxans-ratiopharm Pico¤; Laxoberal; Liquidepur mit Natriumpicosulfat¤; Mandrolax Pico¤; Midro Pico¤; Regulax Picosulfat;GREECE: Guttalax; Laxatol¤;HONG KONG: Sur-Lax;HUNGARY: Guttalax; Laxygal¤;INDIA: Asilax Plus; Colax; Coso; Cremalax; Dyrset-Eze; Laxatab; Laxicare; Laxkair; Laxopic; Laxsure; Novalax Plus; Oslax;INDONESIA: Laxoberon; Pisucon;IRELAND: Agiolax Pico¤; Dulcolax Pico; Laxoberal¤;ITALY: Euchessina CM; Falquigut; Gocce Antonetto¤; Gocce Lassative Aicardi; Guttalax; Neopax¤; Picolax¤;JAPAN: Chaldol; Falestack¤; Farthrough; Konsuben¤; Laxoberon; Laxodate; Picoben¤; Picodarm; Picorula; Shinluck; Sultimin¤; Sunailin; Youpis;MEXICO: Anara; Laxoberon; Motilaxil;NETHERLANDS: Dulcodruppels; Dulcopearls; Laxoberon¤; Pico-Salax¤; Pikopil;NORWAY: Laxoberal;PHILIPPINES: Dulcolax SP; Laxoberal¤;POLAND: Pikopil;PORTUGAL: Dulcogotas; Fructines; Guttalax¤; Laxodal; Minvoso¤; Picolax;RUSSIAN FEDERATION: Guttalax (Гутталакс); Guttasil (Гуттасил); Laxigal (Лакигал); Regulax Picosulphate (Регулакс Пикосульфат); Slabicap (Слабикап); Slabilen (Слабилен);SINGAPORE: Sur-Lax¤;SPAIN: Contumax; Dulcolaxo; Elimin¤; Evacuol; Ezor; Gutalax¤; Laxonol¤; Lubrilax; Skilax¤;SWEDEN: Cilaxoral; Laxoberal;SWITZERLAND: Dulcolax Picosulfat; Fructines; Guttalax¤; Laxoberon;TURKEY: Dulcolax; Picocap;UNITED KINGDOM: Dulcolax Pico; Laxoberal¤;UKRAINE: Agiolax Pico (Агиолакс Пико)¤; Guttalax (Гутталакс); Picolax (Пиколакс); Slabilax (Слабилакс);VENEZUELA: Lasoberon;

Preparations: Multi-Ingredient

The following preparations list represents a compilation of all available salt forms or related substances for this drug product.

The symbol ¤ denotes a preparation which is discontinued or no longer actively marketed.

Preparations: Pharmacopoeial

The following preparations list represents a compilation of all available salt forms or related substances for this drug product.

BP 2019: Compound Sodium Picosulfate Powder for Oral Solution; Sodium Picosulfate Oral Solution;

Therapeutic Use

Gastrointestinal Drugs

Last Updated 1/21/20

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