• Cleansing of the colon in preparation for colonoscopy.

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
• OB: Use during pregnancy only if clearly needed
• Lactation: Use caution if breastfeeding
• Pedi: Safe and effective use in children has not been established.

CNS: SEIZURES, headache.

CV: ARRHYTHMIAS.

GI: abdominal pain, abdominal distention, abdominal pain, nausea, vomiting.

GU: RENAL IMPAIRMENT.

F and E: dehydration, fluid/electrolyte abnormalities.

Drug-Drug:

• 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.

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

• PO (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.

Prepopik

• 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.

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

Therapeutic Classification: laxatives

Pharmacologic Classification: osmotic laxatives, stimulant laxatives

Absorption: Minimal systemic absorption.

Distribution: Action is primarily local.

Metabolism/Excretion: Action is primarily local.

Half-life: Sodium picosulfate — 7.4 hr.

(onset of watery diarrhea)

• 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 breastfeeding.

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