A fixed-dose combination laxative containing Sodium Picosulfate, a stimulant prodrug, and Milk of Magnesia (Magnesium Hydroxide), an osmotic agent. This synergistic combination provides a dual mechanism for effective bowel evacuation, primarily used for bowel cleansing prior to colonoscopy and for the relief of occasional constipation. Sodium Picosulfate is hydrolyzed by colonic bacteria to its active form, while Magnesium Hydroxide draws water into the intestinal lumen.
Adult: **For Bowel Preparation:** Typically administered as a 'split-dose' regimen. Evening before procedure: 1 sachet/tablet (3.75mg+5mg) dissolved in 150-200ml of water. Morning of procedure (at least 5 hours before): Repeat dose. Must be followed by clear fluid intake as per protocol (e.g., 2-3 liters over several hours). **For Constipation:** 1 sachet/tablet (3.75mg+5mg) at bedtime, not to be taken daily for more than 5-7 days.
Note: Take on an empty stomach. Dissolve powder/granules from sachet or crush tablet in a glass (150-200 ml) of plain water. Stir well and drink immediately. Follow with additional clear fluids (water, clear broth, strained fruit juice without pulp) as directed (typically 2-3 liters in total for bowel prep). Do not take with milk or antacids. For bowel prep, adhere strictly to the prescribed dietary restrictions (clear liquid diet).
The combination exerts a synergistic effect. Sodium Picosulfate is a prodrug that remains inactive until it reaches the colon, where bacterial sulfatases hydrolyze it to the active metabolite BHPM. BHPM directly stimulates the colonic mucosa, increasing propulsive peristalsis and inhibiting segmental contractions. Magnesium Hydroxide is poorly absorbed and acts as an osmotic agent, drawing water into the intestinal lumen by osmosis, increasing intraluminal fluid volume, and softening stool. The combined action results in effective bowel evacuation.
Pregnancy: Category C (US FDA). Animal studies are insufficient. Use only if clearly needed and potential benefit justifies potential risk to the fetus, typically for essential bowel preparation. Should be avoided for routine constipation. Dehydration risk is a concern.
Driving: May cause dizziness, weakness, or syncope due to dehydration or vasovagal response. Patients should be cautioned not to drive or operate machinery until they know how the medication affects them, especially on the day of bowel preparation.
| Diuretics (e.g., Furosemide, Hydrochlorothiazide) | Increased risk of dehydration and electrolyte depletion (hypokalemia, hyponatremia). | Major |
| ACE Inhibitors (e.g., Ramipril), ARBs (e.g., Telmisartan) | Increased risk of hyperkalemia or hyponatremia when combined with electrolyte disturbances. | Moderate |
| Digoxin | Hypokalemia induced by laxatives can potentiate digoxin toxicity. | Major |
| Oral Medications (especially antibiotics, contraceptives, antiepileptics) | Reduced absorption due to accelerated gastrointestinal transit. Administer other drugs at least 2 hours before or 6 hours after this laxative. | Moderate |
| Tetracycline, Fluoroquinolone antibiotics, Bisphosphonates (e.g., Alendronate) | Magnesium can chelate these drugs, severely reducing their absorption. | Major |
| Other Laxatives | Increased risk of excessive bowel activity, dehydration, and electrolyte loss. | Major |
| CNS Depressants (e.g., Opioids, Benzodiazepines) | Risk of CNS depression may be additive if hypermagnesemia occurs. | Moderate |