Picoprep: Uses, Mechanism of Action, Administration, Contraindications, Side Effects and Interactions

It is sold under the trade names Sodipic Picofast, Laxoberal, Laxoberon, Purg-Odan, Picolax, Guttalax, Namilax, Pico-Salax, Picoprep and Prepopik, among others.

Picoprep, with the active ingredient sodium picosulfate (INN, also known as sodium picosulfate), is a contact stimulant laxative used to treat constipation or prepare the large intestine before colonoscopy or surgery.


Picoprep powder for solution contains:

  • 10 mg of sodium picosulfate; 3.5 g of magnesium oxide; 12.0 g of citric acid; and 36 mg of aspartame.
  • Picoprep does not contain lactose, sucrose, gluten, tartrazine, any azo dyes, or ‘sulfur’ medications.

What is Picoprep used for?

Picoprep is used to empty and clean the intestine before exams, x-rays, or surgical procedures that require the colon to be clear of stool, such as a colonoscopy or barium enema. It is not used to treat constipation.

Allows your doctor to see inside easily. It is sometimes used to clean the colon before a special x-ray of the kidneys. It acts on the intestine and colon, causing watery stools or bowel movements that eliminate intestinal contents.

This can be a bit uncomfortable, but it is necessary for the exam.

It depends on the type of exam you have on the procedure. One type is that a particular instrument is inserted into the intestine that allows the doctor to see inside. Another is that you will be given an enema in your intestine that contains a compound that shows up on X-rays.


It would help if you talked to your doctor about what will happen before having the procedure. Your doctor, however, may prescribe Picoprep for another purpose. Ask your doctor if you have any questions about why Picoprep has been prescribed or how you should take it.

Effects edit

Orally administered sodium picosulfate is generally used for complete bowel evacuation, usually in patients preparing for a colonoscopy. It takes 12-24 hours to work as it works in the colon.

Abdominal cramps and diarrhea are typical effects of picosulfate and should be expected.

Sodium picosulfate has also been associated with certain electrolyte disorders, such as hyponatremia and hypokalemia. Patients are often required to drink large amounts of clear fluids to compensate for dehydration and restore average electrolyte balance.

Mechanism of action

Picoprep laxatives work in two different ways.

Sodium picosulfate is a prodrug. It has no significant direct physiological effect on the intestine; however, it is metabolized by intestinal bacteria to the active compound 4,4′-dihydroxy diphenyl- (2-pyridyl) methane (DPM, BPHM).

Sodium picosulfate is activated by natural bacteria found in the colon (large intestine), so it does not start working until it reaches this part of the intestine.

This compound is a stimulant laxative and increases peristalsis in the intestine. It works by stimulating the nerve endings in the walls of the colon and rectum.

This increases muscle contractions in this part of the intestine, which moves the contents through the colon to the rectum so that the intestine can empty.

Sodium picosulfate is typically prescribed in a combination formulation with magnesium citrate, an osmotic laxative. This combination is a highly effective laxative, often prescribed to patients for bowel cleansing before colonoscopies.

It works by causing water to be drawn into the lower intestine. This increases the water content and bulk of the stool and helps to “wash” the intestine.

What should I know before taking Picoprep?

Picoprep is used to empty and clean the intestine before exams, x-rays, or surgical procedures that require the colon to be clear of stool, such as a colonoscopy or barium enema. It is not used to treat constipation.

It is essential to drink the clear liquids described above to prevent Picoprep treatment from dehydrating you. Clear fluids should include a variety of fruit juices (no pulp), soda, clear soup, tea, coffee (no milk, soy, or cream), and water. Don’t just drink water.

You should expect to start having frequent loose bowel movements after taking the first dose of Picoprep. You should make sure you have access to a toilet until the effects of the medicine have worn off.

How do I take Picoprep?

Always follow the instructions given by your doctor. Unless your doctor has given you specific instructions, follow these dosages and dietary instructions.

Two days before the test, stop eating whole wheat bread, red meat, cereals, vegetables, yellow cheese, or anything that contains seeds.

You can eat boiled or poached eggs, cottage cheese, white bread, low-fat plain yogurt, steamed white fish, cooked chicken, well-cooked peeled pumpkin, and potatoes.

You may have clear jelly, skim milk, and drink plenty of approved clear liquids. The day before your exam, no solid foods or dairy products are allowed. Drink only authorized clear beverages for breakfast, lunch, and dinner.

The day before the exam, drink only approved fluids. The time to take Picoprep depends on the time of your procedure. Two doses of Picoprep will be needed; the first should be taken 10 to 18 hours before the process and the second 4 to 6 hours before the procedure.

After the first dose, you should have at least five 250 ml clear liquid drinks spread over several hours. After the second dose, you should have at least three 250 ml clear liquid drinks spread over several hours.

It would help if you also drink clear liquids to satisfy your thirst for up to two hours before the procedure.

The usual dose for adults and children over nine years is one sachet for each dose. The amount of Picoprep to give to younger children for each dose varies with age. It is essential to follow the instructions provided by your doctor or pharmacist.

To complete a dose with a whole sachet, the contents should be shaken in 150 ml of cold water for two to three minutes until all the powder has dissolved.

The solution in the glass may feel hot as the Picoprep powder dissolves; wait until it cools before drinking it.

If you use less than a whole sachet to complete a dose (for example, for young children), you should use 50 ml of water for each tablespoon of powder needed.

Stir for two to three minutes, until all the powder has dissolved. The solution in the glass may feel hot as the Picoprep powder dissolves; wait until it cools before giving it to your child.

If a third packet is required: The day before the exam, drink approved fluids only. Beginning the day before the exam (at approximately 1 pm), dissolve the entire contents of one sachet of Picoprep in a glass (250 ml) of warm water.

If you prefer to chill it in a refrigerator before drinking it.

Drink the contents of the glass, followed by a glass of water. Continue to drink approved clear liquids, at least one glass per hour: the more, the better to ensure adequate body hydration.

In the afternoon of the same day (at approximately 5 pm), Repeat the above with another sachet of Picoprep, that is, dissolve it in a glass of warm water, cool it if you prefer, then drink the contents followed by a glass of water.

Continue to drink approved clear liquids, at least one glass per hour the more, the better to ensure adequate hydration of the body.

In the afternoon of the same day (approximately at 9 pm), repeat the above with the third envelope of Picoprep, dissolve it in a glass of warm water, cool it if you prefer, and drink the content followed by a glass of water.

Continue drinking approved clear liquids at least one glass per hour for six (6) hours before the exam.

No food or drink should be taken six (6) hours before the exam. Follow all instructions given by your doctor or pharmacist carefully. If you do not understand the instructions, ask your doctor or pharmacist for help.

The first bowel movement should occur approximately 2 to 3 hours after starting the dose. Onset may be faster in individual patients.

If you forget to wear it

It would help if you took Picoprep precisely as prescribed. If you forget to take a dose, contact your doctor as soon as possible, as the exam time may need to be changed. Do not double an amount to make up for a missed dose.

If you take too much (overdose)

Immediately call your doctor or the Poisons Information Center (tel 13 11 26) for advice, or go to the victim at the nearest hospital if you think they may have taken too much Picoprep, even if there are no signs of discomfort or poisoning.

You may need urgent medical attention. Have the phone numbers for these places handy.

If you take too much Picoprep, you may experience a severe headache and a fast or irregular heartbeat. If you are not sure what to do, contact your doctor or pharmacist.

Do not take Picoprep if the packaging is torn or shows tampering. Do not take Picoprep if the expiry date printed on the pack has passed. If you take this medicine after the expiration date, it may not work as well.

Contact your doctor if you are not sure whether you should start taking Picoprep.

Preparation of solutions

Dissolve the contents of one sachet in a full glass (approximately 250 ml) of warm water. This can be chilled in a refrigerator before use if you prefer. Where “glass” is mentioned, this must be at least 250 things.

Approved clear fluids

Water, clear salty liquids (such as chicken noodle soup), clear broth, clear fruit juice, gelatin, black tea or coffee (without milk), sports drinks, Gastrolyte, clear fruit cordials (lemon/lime), (no red/purple dyes).

A good combination of these clear liquids, including 2-3 cups of strained chicken noodle soup, will give a variation in fluid intake.

Barley sugar can also be sucked in if necessary. Before starting, people with diabetes should discuss their requirements and dosage schedule with their doctor.

Picoprep produces watery stools or bowel movements that empty and cleans the intestine before the exam or surgery. It should be prepared and taken according to the following instructions unless otherwise directed by your doctor.

Before you start taking Picoprep

You should talk to your doctor about the use of Picoprep if:

  • You are allergic to any medicine, food, dye, or preservative; you’re older. You have or have had other health problems or medical conditions, including:
  • Any stomach or intestinal problems include severe ulcerative colitis (ulcers in the large intestine) or kidney disease. Impaired kidney function (the kidneys do not work correctly).
  • Difficulty swallowing or eating again after eating. Electrolyte (blood chemical) problems, a heart condition.

If you have any of the above conditions, you should discuss your situation with your doctor before taking Picoprep. Your doctor may not want you to take Picoprep or take special precautions or take them another way.

While you are taking Picoprep

Things you should do

If you are about to start any new medicine, tell your doctor or pharmacist that you must take Picoprep. Please do not take any other medications, whether they require a prescription, without first checking with your doctor.

Tell all doctors and pharmacists who are treating you that you must take Picoprep. Tell your doctor if, for any reason, you have not taken your medicine exactly as prescribed.

Things you should not do

Only take half the dose or none at all. Give the medicine to someone else.

Things to keep in mind

Due to the watery bowel movement caused by Picoprep, you should not plan any other activities until after the test. It will help if you drink adequate fluids while using Picoprep. Be careful driving or operating machinery until you know how Picoprep affects you.

Who should not take Picoprep?

Those people who have the following:

  • People who feel sick or vomit. Very dehydrated people. People with an ulcer in the stomach or intestines. People with a known or suspected blockage or perforation in the stomach or intestines.
  • People with active inflammatory bowel disease, such as ulcerative colitis or Crohn’s disease. People with reduced ability of the stomach to empty (gastric retention).
  • People with reduced muscle activity in the intestines (ileus). People with severe inflammation of the large intestine (toxic colitis). People with a sudden expansion of the large intestine are seen with advanced ulcerative colitis or Crohn’s disease (toxic megacolon).
  • People with abdominal conditions who need urgent surgery, such as appendicitis. People with congestive heart failure. People with severely decreased kidney function.
  • People who have a high magnesium level in the blood (hypermagnesemia). People with a condition called rhabdomyolysis, where there is a breakdown of muscle fibers.
  • Picoprep sachets contain lactose and should not be used by people with rare hereditary problems of galactose intolerance, Lapp-lactase deficiency, or glucose-galactose malabsorption.
  • Picoprep should only be taken by adults or children over nine years. Do not take Picoprep if you think any of the ingredients listed at the end of this leaflet may be allergic or cause a reaction.

Some of the symptoms of an allergic reaction may include hives or an itchy rash, swelling of the face, lips, or tongue, trouble breathing, or fainting. It is doubtful that you will have an allergic reaction to Picoprep.

The product contains a sweetener called aspartame which is present only in small amounts but can upset people with phenylketonuria. If you are one of these people, you should discuss this with your doctor.

Who may need extra monitoring while taking Picoprep?

  • Older adults. Weak or debilitated people. People with heart disease. People who suffer from inflammatory bowel diseases, such as ulcerative colitis or Crohn’s disease.
  • People who have recently had surgery on the stomach or intestines. People with kidney problems. People are taking diuretics, corticosteroids, or lithium medications.
  • People who have disturbances in the normal levels of electrolytes (such as sodium and potassium) in the blood. People on a potassium-controlled diet. People with epilepsy.

Can I use Picoprep while pregnant or breastfeeding?

Picoprep should preferably be avoided during pregnancy. Make sure your doctor knows if you are pregnant or think you might be. Picoprep can be used by breastfeeding mothers. It is not expected to have any harmful effect on a nursing infant.

What are the possible side effects of Picoprep?

Tell your doctor or pharmacist as soon as possible if you do not feel well while taking Picoprep.

All medicines can have side effects. Picoprep can have unwanted side effects on some people. Sometimes they are serious; most of the time, they are not.

You may need medical treatment if you experience some of the side effects. Ask your doctor or pharmacist any questions you may have.

Medications and their possible side effects can affect individual people in different ways. The following are some of the side effects known to be associated with Picoprep.

Just because a side effect is listed here does not mean that all people using Picoprep will experience that effect or any other side effect.

Common (affects 1 in 10 to 1 in 100 people)

  • Headache.
  • I was feeling sick.
  • Pain around the anus (proctalgia).

Tell your doctor if you notice any of the following and they worry you: nausea, abdominal swelling, or a feeling of gas in the stomach. These are the most common side effects of Picoprep.

Uncommon (affects between 1 in 100 and 1 in 1000 people)

  • Decreased levels of potassium or sodium in the blood.
  • Vomiting
  • Abdominal pain.
  • Confusion.
  • Seizures

Allergic reactions

Other side effects not mentioned can also occur in some patients. Don’t be alarmed by this list of possible side effects. You may not experience any of them.

Tell your doctor if you notice anything else that makes you feel unwell. Ask your doctor or pharmacist if you don’t understand anything on this list.

For more information on any other possible risks associated with Picoprep, read the information provided with the medicine or consult your doctor or pharmacist.

Can I take Picoprep with other medicines?

Before starting treatment with Picoprep, check with your doctor or pharmacist what medicines you are taking, including those bought without a prescription and herbal medicines.

If you take other medications by mouth, you should take them at least two hours before and no less than six hours after taking a dose of Picoprep.

This is to prevent the other medication from sticking to the magnesium in Picoprep and to prevent it from flushing out through the intestine without having time to be absorbed.

This is particularly important for the following medicines (ask your pharmacist for further advice):

  • Antibiotics
  • Antidiabetics.
  • Antiepileptics
  • Chlorpromazine.
  • Digoxin.
  • Iron.
  • Oral contraceptives.
  • Penicillamine.

Picoprep can sometimes cause an imbalance in the number of fluids and salts (electrolytes) in your body. This may be more likely if you are also taking one of the medications listed below.

Consult your doctor or pharmacist for more information and advice if you are taking one of these medications:

  • ACE inhibitors, e.g., captopril, enalapril, antidepressants, amitriptyline, citalopram. Angiotensin II receptor antagonists, eg losartan, valsartan, diuretic drugs, eg furosemide or bendroflumethiazide.
  • Non-steroidal anti-inflammatory pain relievers (NSAIDs), eg, diclofenac, indomethacin, steroid drugs, e.g., prednisolone, dexamethasone.