Usual Adult Dose for Bowel Preparation

Split-Dose Dosing Regimen (Preferred Method):

• Dose 1: 12 grams citric acid-3.5 grams magnesium oxide-10 mg sodium picosulfate orally ONCE in the evening before the colonoscopy (e.g., at 1700 to 2100), followed by at least 40 ounces of clear liquids within 5 hours and before bed
• Dose 2: 12 grams citric acid-3.5 grams magnesium oxide-10 mg sodium picosulfate orally ONCE approximately 5 hours prior to the colonoscopy, followed by at least 24 ounces of clear liquids at least 2 hours before the colonoscopy

Day-Before Dosing Regimen (Alternative Method):

• Dose 1: 12 grams citric acid-3.5 grams magnesium oxide-10 mg sodium picosulfate orally ONCE in the evening before the colonoscopy (e.g., at 16:00 to 18:00), followed by at least 40 ounces of clear liquids within 5 hours and before the next dose
• Dose 2: 12 grams citric acid-3.5 grams magnesium oxide-10 mg sodium picosulfate orally ONCE in the evening before the colonoscopy (e.g., at 20:00 to 00:00), followed by at least 24 ounces of clear liquids within 5 hours and before bed

Comments:

• Patients should consume only clear liquids (e.g., no solid food or dairy) up until 2 hours before the time of the colonoscopy.
• Those who experience severe bloating, distention, or abdominal pain may delay the second dose until the symptoms resolve.

Use: Cleansing the colon as a preparation for colonoscopy

Usual Pediatric Dose for Bowel Preparation

9 years and older:
Split-Dose Dosing Regimen (Preferred Method):

• Dose 1: 12 grams citric acid-3.5 grams magnesium oxide-10 mg sodium picosulfate orally ONCE in the evening before the colonoscopy (e.g., at 1700 to 2100), followed by at least 40 ounces of clear liquids within 5 hours and before bed
• Dose 2: 12 grams citric acid-3.5 grams magnesium oxide-10 mg sodium picosulfate orally ONCE approximately 5 hours prior to the colonoscopy, followed by at least 24 ounces of clear liquids at least 2 hours before the colonoscopy

Day-Before Dosing Regimen (Alternative Method):

• Dose 1: 12 grams citric acid-3.5 grams magnesium oxide-10 mg sodium picosulfate orally ONCE in the evening before the colonoscopy (e.g., at 16:00 to 18:00), followed by at least 40 ounces of clear liquids within 5 hours and before the next dose
• Dose 2: 12 grams citric acid-3.5 grams magnesium oxide-10 mg sodium picosulfate orally ONCE in the evening before the colonoscopy (e.g., at 20:00 to 00:00), followed by at least 24 ounces of clear liquids within 5 hours and before bed

Comments:

• Patients should consume only clear liquids (e.g., no solid food or dairy) up until 2 hours before the time of the colonoscopy.
• Those who experience severe bloating, distention, or abdominal pain may delay the second dose until the symptoms resolve.

Use: Cleansing the colon as a preparation for colonoscopy

Renal Dose Adjustments

Mild to moderate renal dysfunction (CrCl 30 mL/min and greater): Use with caution. Baseline and post-colonoscopy electrolyte, creatinine, and blood urea nitrogen (BUN) monitoring should be considered.
Severe renal dysfunction (CrCl less than 30 mL/min): Contraindicated

Patients taking drugs that could affect renal function (e.g., ACE inhibitors, angiotensin receptor blockers, diuretics, NSAIDs): Use with caution. Baseline and post-colonoscopy electrolyte, creatinine, and BUN monitoring should be considered.

Liver Dose Adjustments

Data not available

Precautions

CONTRAINDICATIONS:

• Hypersensitivity to any of the active components or the ingredients
• Patients with:
• Bowel perforation
• Gastric retention
• Gastrointestinal obstruction/ileus
• Severe renal dysfunction (CrCl less than 30 mL/min)
• Toxic colitis or toxic megacolon

Safety and efficacy of some formulations have not been established in patients younger than 9 years; safety and efficacy of other formulations have not been established in children. The manufacturer product information for further details.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:

• The manufacturer product information should be consulted.
• Once reconstituted, the powder for oral solution formulations should be consumed immediately. Ice should not be added to the solution.

Storage requirements:

• Oral solutions: Store at 25C; do not refrigerate or freeze.
• Powder for oral solutions: Store between 20 to 25C; protect from moisture prior to preparation.

Reconstitution/preparation techniques:

• Oral solutions: Do not dilute the solution.
• Powder for oral solutions: The manufacturer product information should be consulted.

General:

• Limitation of use: This drug should not be used as a routine laxative.

Monitoring:

• CARDIOVASCULAR: Consider baseline and post-colonoscopy ECGs in patients at risk of serious cardiac arrhythmias
• METABOLIC: Consider baseline and post-colonoscopy laboratory tests (electrolyte panel) in patients with mild to moderate renal dysfunction, preexisting electrolyte disturbances, and/or those taking drugs that could affect renal function
• RENAL: Consider baseline and post-colonoscopy laboratory tests (creatinine, blood urea nitrogen) in patients with mild to moderate renal dysfunction and/or those taking drugs that could affect renal function

Patient advice:

• Patients should be instructed to closely follow their healthcare providers' instructions regarding bowel preparation.
• Inform patients that this drug may cause dizziness and/or fatigue, and they should avoid driving or operating machinery if these side effects occur.
• Advise patients to remain adequately hydrated while using this drug.