Sodium picosulfate is a locally acting stimulant laxative of the diphenol group, used for the treatment of constipation and for bowel cleansing prior to colonoscopy or surgery. It is a prodrug that is activated by colonic sulfatase enzymes to its active metabolite, bis-(p-hydroxyphenyl)-pyridyl-2-methane (BHPM), which directly stimulates the colonic mucosa, increasing peristalsis and fluid secretion.
Adult: For constipation: 5 mg to 10 mg (5ml to 10ml of 5mg/5ml solution) orally, usually as a single bedtime dose. For bowel preparation: As per specific regimen, often 15-20 mg (15-20ml) in divided doses with large volumes of clear liquids, the evening before and morning of the procedure. Always follow manufacturer's or institution's specific protocol.
Note: Take orally, preferably at bedtime for constipation. For bowel prep, mix with water or clear liquid as directed. Do not take with other liquids like milk. Shake the bottle well before use. Use the provided measuring cup or syringe. Maintain adequate hydration, especially during bowel preparation.
Sodium picosulfate is a prodrug. It passes unchanged through the stomach and small intestine. In the colon, it is hydrolyzed by sulfatase enzymes produced by the resident bacterial flora into its active metabolite, BHPM. This active form directly stimulates the mucosal nerve plexus (myenteric plexus) of the colon, leading to intensified peristaltic contractions and inhibition of segmental contractions. It also enhances fluid and electrolyte secretion into the colonic lumen, resulting in soft stool and defecation.
Pregnancy: Category C. Animal studies are insufficient. Use only if clearly needed and potential benefit justifies potential risk to the fetus, typically for essential bowel preparation. Avoid for routine constipation.
Driving: May cause dizziness. Patients should be cautioned about driving or operating machinery if they experience dizziness, especially after the first dose.
| Diuretics (e.g., Furosemide, Hydrochlorothiazide) | Increased risk of dehydration and electrolyte depletion (hypokalemia, hyponatremia). | Major |
| ACE Inhibitors (e.g., Enalapril, Ramipril) / ARBs (e.g., Losartan) | Increased risk of dehydration-induced renal impairment and hyperkalemia/hyponatremia. | Moderate |
| NSAIDs (e.g., Ibuprofen, Diclofenac) | Increased risk of renal impairment when combined with dehydration. | Moderate |
| Corticosteroids (e.g., Prednisolone) | Increased risk of electrolyte depletion, particularly hypokalemia. | Moderate |
| Digoxin | Hypokalemia can potentiate digoxin toxicity (arrhythmias). | Major |
| Oral Contraceptives, Antiepileptics (e.g., Phenytoin) | The diarrhea caused by sodium picosulfate may reduce the absorption and efficacy of these drugs. Advise alternative contraception during bowel prep. | Moderate |
| Antibiotics (broad-spectrum) | May reduce colonic bacterial flora, potentially decreasing the activation of sodium picosulfate and reducing its efficacy. | Moderate |
Same composition (Sodium Picosulfate (5mg/5ml)), different brands: