Adult: 5-10 mg once daily at bedtime. Child: 1 month to <4 years 0.25 mg/kg. Max: 5 mg; 4-10 years 2.5-5 mg; >10 years 5-10 mg. All doses are given at bedtime. Dosage recommendations may vary among countries or individual products (refer to specific product guidelines).
Administration
May be taken with or without food.
Contraindications
Ileus or intestinal obstruction, acute painful and/or feverish acute abdominal conditions (e.g. appendicitis) associated with nausea and vomiting; acute inflammatory bowel diseases, severe dehydration.
Special Precautions
Patient with history of inflammatory bowel disease, recent gastrointestinal surgery. Avoid long-term everyday use. Children. Pregnancy and lactation.
Adverse Reactions
Significant: Intestinal loss of fluids leading to dehydration, fluid and electrolyte imbalance, hypokalaemia. Gastrointestinal disorders: Diarrhoea, abdominal discomfort (e.g. abdominal pain, cramps). Nervous system disorders: Dizziness, syncope.
Patient Counseling Information
Should not be taken on a continuous daily basis for long periods. This drug may cause vasovagal response, dizziness and syncope, if affected, do not drive or operate machinery.
Monitoring Parameters
Monitor serum electrolytes and bowel movement patterns.
Overdosage
Symptoms: Abdominal cramps, diarrhoea, fluid and electrolyte loss, colonic mucosal ischaemia. Chronic overdose: Chronic diarrhoea, abdominal pain, secondary hyperaldosteronism, renal calculi; renal tubular damage, metabolic alkalosis, and muscle weakness secondary to hypokalaemia. Management: May perform gastric lavage or induce emesis to minimise or prevent absorption. Fluid replacement and correction of electrolyte imbalance may be needed. Administer antispasmodic agents if necessary.
Drug Interactions
Increased risk of electrolyte imbalance with diuretics or adrenocorticosteroids. Increased sensitivity with cardiac glycosides caused by electrolyte imbalance. Decreased laxative action with antibiotics.
Action
Description: Mechanism of Action: Sodium picosulfate is a locally acting laxative which has a dual action of stimulating the mucosa of both the large intestine and the rectum, resulting in peristalsis, accumulation of water and electrolytes and stimulation of defaecation, softening of stool, and reduction of transit time. Onset: Within 6-12 hours. Pharmacokinetics: Absorption: Negligible (small amount). Metabolism: Metabolised in the distal segment of the intestine via bacterial cleavage by colonic bacteria to the active form bis-(p-hydroxyphenyl)-pyridyl-2-methane (BHPM) followed by conjugation in the intestinal wall and liver to inactive BHPM glucuronide afterwards. Excretion: Via urine (10.4% as BHPM glucuronide).
Chemical Structure
Sodium picosulfate Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 68654, Sodium picosulfate. https://pubchem.ncbi.nlm.nih.gov/compound/Sodium-picosulfate. Accessed Nov. 21, 2023.
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