How does this medication work? What will it do for me?

This is a combination product that contains three ingredients: picosulfate sodium, magnesium oxide, and citric acid. This medication is used to cleanse the bowel in preparation for a colonoscopy, barium enema x-ray exam, or surgical procedures that require a clean colon.

Picosulfate sodium belongs to the class of medications called stimulant laxatives, which activate the colon and stimulate the muscles in the colon to contract, causing a bowel movement. Magnesium oxide and citric acid combine to form magnesium citrate, which is an osmotic laxative that increases water in the colon. The combined effect clears out the bowels. Full bowel cleansing usually occurs within 3 to 6 hours or less.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

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What form(s) does this medication come in?

Picoflo is no longer being manufactured for sale in Canada. For brands that may still be available, search under picosulfate sodium - magnesium oxide - citric acid. This article is being kept available for reference purposes only. If you are using this medication, speak with your doctor or pharmacist for information about your treatment options.

How should I use this medication?

The usual dose depends on age and weight. The usual adult dose is 2 sachets 6 to 8 hours apart the day before the exam or surgery. The usual dose for children ages 1 to 6 years is ¼ sachet in the morning and ¼ sachet in the afternoon (6 to 8 hours later) the day before the procedure. For children ages 6 to 12 the usual dose is ½ sachet in the morning and ½ sachet in the afternoon (6 to 8 hours later) the day before the procedure.

The day before your procedure, dissolve one dose into 150 mL of water. The exact hour you should take this depends on what time your procedure is scheduled for, and your doctor will give you specific instructions. The second dose is dissolved in 150 mL water 6 to 8 hours later.

It is important to drink 1.5 L to 2 L of clear fluids that are not red or purple (water; sports drinks; clear fruit juices such as apple, white grape, or white cranberry juice; broths) between doses. Drink about 250 mL of fluid each hour after each dose until the effects of the medication have worn off and bowel movements have stopped.

In preparation for a procedure, your doctor may give you additional dietary restrictions and adjust other medication use. Talk to your doctor for more information.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as recommended by your doctor.

If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take this medication if you:

  • are allergic to picosulfate sodium, magnesium oxide, citric acid, or any ingredients of the medication
  • have acute conditions in the abdomen area that require surgery (e.g., acute appendicitis)
  • have congestive heart failure
  • have gastric retention (where stomach contents aren't moved to the small intestine)
  • have a gastrointestinal obstruction or perforation
  • have ileus (a partial or completely blocked bowel)
  • have nausea and vomiting
  • have severely reduced kidney function
  • have toxic colitis or toxic megacolon (a complication of gastrointestinal conditions where the colon expands)
  • have ulcers

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • abdominal pain
  • allergic reaction or hypersensitivity (e.g., rash, hives, or itching)
  • anal pain
  • changes in electrolyte balance (e.g., numbness, skin tingling, muscle spasms, rapid heartbeat, muscle weakness, tremors)
  • diarrhea
  • fatigue
  • headache
  • confusion
  • nausea
  • seizures (convulsions)
  • rash
  • vomiting

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are any nutrients depleted by this medication?

Some medications can affect vitamin and nutrient levels in the body. Below is a list of nutrient depletions associated with this medication. Talk to your doctor or pharmacist about whether taking a supplement is recommended or if you have any questions or concerns.

Picoflo may deplete potassium

How can this nutrient deficiency affect me?
Potassium plays an important role in muscle contraction, helping maintain proper functioning of your heart and digestive system. Potassium is an electrolyte and helps maintain water balance, nerve conduction, and blood pressure. Deficiency increases the risk of low blood pressure and arrhythmias (irregular heartbeat).

What can I do about this?
Talk to your pharmacist about potassium deficiency. Potassium is available in supplement form. Before starting any nutrient supplement, always talk with your pharmacist first.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Electrolyte imbalance and water intake: This medication can upset the balance of electrolytes in the body, especially if you are not drinking enough fluid after each dose. Make sure you follow the directions on how much fluid to drink after each dose of this medication.

If you have a history of electrolyte imbalance such as hyponatremia (low blood sodium) or hypokalemia (low blood potassium) or if you are taking medications that increase the risk of electrolyte abnormalities (e.g., diuretics), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Heart disease: If you have heart disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Inflammatory bowel disease: If you have inflammatory bowel disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Kidney disease: If you have kidney disease, your doctor may monitor your blood magnesium levels because this medication may increase the amount of magnesium in the blood. Discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Prolonged use: Do not use this medication for more than 24 hours. Using it for a longer period of time than recommended increases the risk of dehydration and electrolyte imbalances.

Seizures: There have been reports of seizures in people taking this medication. If you have a seizure disorder, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. If you have a seizure while taking this medication, you should contact your doctor right away.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is not known if this medication passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication has not been established for children less than 1 year of age.

Seniors: Seniors are at higher risk of becoming dehydrated. You should make sure you drink enough water while taking this medication.

What other drugs could interact with this medication?

There may be an interaction between picosulfate sodium - magnesium oxide - citric acid and any of the following:

  • alfacalcidol
  • aluminum hydroxide
  • antibiotics (e.g., amoxicillin, azithromycin,  ciprofloxacin, penicillin, tetracycline)
  • antidiabetics (e.g., metformin, glyburide)
  • antiepileptics (e.g., carbamazepine, phenytoin)
  • antipsychotic medications (e.g., clozapine, quetiapine)
  • birth control pills
  • bisphosphonates (e.g., alendronate, etidronate, risedronate)
  • bulk-forming laxatives (e.g., psyllium)
  • calcitriol
  • calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)
  • calcium polystyrene sulfonate
  • deferiprone
  • digoxin
  • dolutegravir
  • eltrombopag
  • gabapentin
  • iron preparations and supplements
  • levothyroxine
  • lithium
  • medications taken by mouth
  • medications that affect water or electrolyte balance (e.g., diuretics, corticosteroids)
  • medications that cause constipation (e.g., opioids, cholinergics)
  • multivitamins with fluoride
  • mycophenolate
  • nonsteroidal anti-inflammatory medications (NSAIDs; e.g., ibuprofen, naproxen)
  • oral contraceptives
  • phosphate supplements
  • raltegravir
  • selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, sertraline)
  • sodium polystyrene sulfonate
  • tricyclic antidepressants (e.g., amitriptyline, doxepin)

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

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