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Overview: Sodium picosulfate/magnesium oxide/anhydrous citric acid is taken to clean out your intestines before a colonoscopy. It works by stimulating muscles to help move stool (poop) along and by pulling water into your intestines to cause watery diarrhea. Common side effects include nausea, stomach pain, and headache. It is important for you to follow any instructions from your healthcare provider about foods, drinks, and medicines while you are taking sodium picosulfate/magnesium oxide/anhydrous citric acid.

Uses

What is sodium picosulfate/magnesium oxide/anhydrous citric acid used for?

Sodium picosulfate/magnesium oxide/anhydrous citric acid is commonly used to clean the colon to prepare for a colonoscopy, which is a procedure done to prevent, treat, or monitor medical conditions of your large intestine.

Sodium picosulfate/magnesium oxide/anhydrous citric acid may also be used for other conditions as determined by your healthcare provider.

How does sodium picosulfate/magnesium oxide/anhydrous citric acid work (mechanism of action)?

Sodium picosulfate/magnesium oxide/anhydrous citric acid works two ways to clean out your intestines. Sodium picosulfate is a stimulant laxative. It helps move stool (poop) along by stimulating the muscles in your intestines. Magnesium oxide and citric acid act as an osmotic laxative, pulling water into the colon (the part of the digestive system where poop is formed). This makes poop watery and easy to pass. Together these cause watery diarrhea, which helps clean out the colon, making it easier for your healthcare provider to see inside your colon during a colonoscopy.

How is sodium picosulfate/magnesium oxide/anhydrous citric acid supplied (dosage forms)?

Brands and other names

  • Clenpiq

Dosage forms and strengths

  • 10 mg/3.5 g/12 g per 175 mL bottle of oral solution or packet for oral solution

How should I store sodium picosulfate/magnesium oxide/anhydrous citric acid?

Sodium picosulfate/magnesium oxide/anhydrous citric acid should be stored at room temperature, between 68 F to 77 F (20 C to 25 C). It can be exposed to temperatures between 59 F to 86 F (15 C to 30 C) for shorter periods of time, such as when transporting it. Store in a cool, dry place. Do not refrigerate or freeze it. 

Side Effects

What are the most common side effects of sodium picosulfate/magnesium oxide/anhydrous citric acid?

The most common side effects of sodium picosulfate/magnesium oxide/anhydrous citric acid are listed below. These side effects may vary depending on age. Tell your healthcare provider if you have any of these side effects that bother you.

  • Nausea 
  • Vomiting
  • Headache
  • High magnesium levels in the blood
  • Stomach pain
  • Dehydration (see below)
  • Dizziness

There may be other side effects of sodium picosulfate/magnesium oxide/anhydrous citric acid that are not listed here. Contact your healthcare provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of sodium picosulfate/magnesium oxide/anhydrous citric acid?

While less common, the most serious side effects of sodium picosulfate/magnesium oxide/anhydrous citric acid are described below, along with what to do if they happen.

Severe Allergic Reactions. Sodium picosulfate/magnesium oxide/anhydrous citric acid may cause allergic reactions, which can be serious. Stop taking sodium picosulfate/magnesium oxide/anhydrous citric acid and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching, skin rash, or pale red bumps on the skin called hives
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Dehydration. Sodium picosulfate/magnesium oxide/anhydrous citric acid may cause dehydration. Dehydration may lead to low blood pressure, especially when you stand up (orthostatic hypotension), or kidney damage. Call your healthcare provider right away if you have any of the following symptoms of dehydration, low blood pressure, or kidney damage.

  • Dizziness or lightheadedness
  • Weakness or unusual tiredness
  • Confusion
  • Unsteadiness
  • Peeing less than normal
  • Swelling in your legs, ankles, and feet
  • Loss of appetite or nausea
  • Difficulty catching your breath or chest pain or pressure
  • Seizures
  • Extreme thirst

Electrolyte Changes. Sodium picosulfate/magnesium oxide/anhydrous citric acid may cause changes to the levels of certain minerals in your body, called electrolytes. For example, it may cause high magnesium levels (hypomagnesemia), low potassium levels (hypokalemia), low sodium levels (hyponatremia), or low chloride levels (hypochloremia). These changes can be serious. Keep appointments for blood work so that your healthcare provider can check your electrolyte levels, especially if you take certain other medicines. Call your healthcare provider if you have any of the following symptoms of electrolyte changes. 

  • Weakness
  • Unusual tiredness
  • Muscle cramps or twitching
  • Constipation
  • Nausea, vomiting, or loss of appetite
  • Dizziness
  • Restlessness or irritability
  • Difficulty breathing
  • Confusion or decreased alertness

Fainting. Sodium picosulfate/magnesium oxide/anhydrous citric acid may cause you to faint. This can lead to falls and broken bones. To help prevent this, it is important to stay hydrated. Follow any instructions given to you about drinking plenty of liquids. Be careful not to get up too quickly. If you feel dizzy, sit or lie down right away until the dizziness stops, then take your time getting up again. 

Heart Effects. Sodium picosulfate/magnesium oxide/anhydrous citric acid may cause abnormal heart rhythm (arrhythmia). Call your healthcare provider or get medical attention right away if you have chest pain, a fast or irregular heartbeat, or if you feel your heartbeat more than usual.

Seizures. Some people who have taken sodium picosulfate/magnesium oxide/anhydrous citric acid have reported having seizures. Your risk may be higher if you have had a seizure in the past. There are many different types of seizures and some of them are not easy to recognize. Stop taking sodium picosulfate/magnesium oxide/anhydrous citric acid and call your healthcare provider if you have any of the following signs that a seizure is happening or could happen.

  • Muscle twitching, jerking, spasms, tremors, or other uncontrolled movements
  • Stiffening of your arms and legs
  • Feeling anxious, nervous, confused, or a sense of dread
  • Feeling dizzy or lightheaded
  • Falling or losing consciousness

Bowel Problems. Sodium picosulfate/magnesium oxide/anhydrous citric acid may cause bowel problems, including ulcers or ischemic colitis. Call your healthcare provider right away if you have severe stomach pain or rectal bleeding.

Warnings & Precautions

Who should not use sodium picosulfate/magnesium oxide/anhydrous citric acid?

Allergies to Ingredients. People who are allergic to any of the following should not take sodium picosulfate/magnesium oxide/anhydrous citric acid.

  • Sodium picosulfate/magnesium oxide/anhydrous citric acid
  • Clenpiq
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific sodium picosulfate/magnesium oxide/anhydrous citric acid products they stock.

Kidney Problems. Sodium picosulfate/magnesium oxide/anhydrous citric acid should not be used if your kidneys are not working as well as they should be. If there is a concern about the health of your kidneys, your healthcare provider may do tests to determine if they are working well enough to take this medicine.

Stomach or Bowel Conditions. Sodium picosulfate/magnesium oxide/anhydrous citric acid should not be used if you have any of the following conditions related to the stomach or bowel.

  • Gastrointestinal or bowel obstruction, which is a blockage in your gut
  • Bowel perforation, which is a tear in the stomach or intestines
  • Gastric retention, a condition where you have problems emptying food and liquids from the stomach
  • Toxic megacolon (toxic colitis) which is when your intestine swell and do not work properly
  • Ileus, which is slowed or no movement in the gut

What should I know about sodium picosulfate/magnesium oxide/anhydrous citric acid before using it?

Do not take sodium picosulfate/magnesium oxide/anhydrous citric acid unless it has been prescribed to you by a healthcare provider. Take it as prescribed. Follow the “Instructions for Use” to mix (if needed) and drink this medicine. Your healthcare provider will likely give you a detailed list of what you can eat or drink the day before and while taking sodium picosulfate/magnesium oxide/anhydrous citric. Ask your healthcare provider if you have any questions. 

Do not share sodium picosulfate/magnesium oxide/anhydrous citric acid with other people, even if they have the same condition as you. It may harm them.

Keep sodium picosulfate/magnesium oxide/anhydrous citric acid out of the reach of children.

Some forms of sodium picosulfate/magnesium oxide/anhydrous citric acid are ready to drink and do not require mixing. Others require you to mix it with water before drinking it. Do not take the powder without mixing it according to the instructions. Mix it just before taking it. Do not add ice to it or refrigerate it.

Do not take or use any other laxatives while taking sodium picosulfate/magnesium oxide/anhydrous citric acid.

People who are 65 or older can be at greater risk for some side effects from sodium picosulfate/magnesium oxide/anhydrous citric acid. Talk to your healthcare provider about your risks if you are in this age group.

What should I tell my healthcare provider before using sodium picosulfate/magnesium oxide/anhydrous citric acid?

Tell your healthcare provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if sodium picosulfate/magnesium oxide/anhydrous citric acid is right for you.

In particular, make sure that you discuss any of the following.

Current and Past Health Conditions. Tell your healthcare provider if you have any of the following.

  • Heart problems, such as a recent heart attack, heart failure, cardiomyopathy, abnormal heart rhythm
  • Kidney problems or take medicine for kidney problems
  • Problems with dehydration 
  • Electrolyte problems, such as low sodium levels (hyponatremia)
  • Stomach or bowel problems, including ulcerative colitis
  • Swallowing problems or problems with your gag reflex
  • Problems with regurgitation (foods or liquids come back up after swallowing) or aspiration (accidentally inhaling food or liquids into the lungs)
  • Acid reflux (gastroesophageal reflux disease, or GERD)
  • A history of seizures or take medicine for seizures
  • A history of fainting
  • Recently stopped drinking alcohol or taking a benzodiazepine, which is a medicine used for anxiety, muscle spasms, or seizures

Other Medicines and Supplements. Sodium picosulfate/magnesium oxide/anhydrous citric acid may interact with other medicines and supplements. Before taking sodium picosulfate/magnesium oxide/anhydrous citric acid, tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Pregnancy. It is not known if or how sodium picosulfate/magnesium oxide/anhydrous citric acid could affect pregnancy or harm an unborn baby. Tell your healthcare provider if you are or plan to become pregnant. 

Breastfeeding. It is not known if sodium picosulfate/magnesium oxide/anhydrous citric acid passes into breast milk. Tell your healthcare provider if you are breastfeeding or plan to breastfeed. Your healthcare provider will advise you if you should take sodium picosulfate/magnesium oxide/anhydrous citric acid while breastfeeding.

Interactions

Does sodium picosulfate/magnesium oxide/anhydrous citric acid interact with foods or drinks?

Your healthcare provider will likely give you a detailed list of what you can eat and drink before and while taking sodium picosulfate/magnesium oxide/anhydrous citric acid. While taking sodium picosulfate/magnesium oxide/anhydrous citric acid, you should not eat any solid food or dairy. You should not drink milk or eat or drink anything that is red or purple. These things may keep sodium picosulfate/magnesium oxide/anhydrous citric acid from working or be confused for blood during your procedure.

Avoid drinking alcohol while taking sodium picosulfate/magnesium oxide/anhydrous citric acid. The risk of dehydration and dizziness may be increased if you drink alcohol while taking sodium picosulfate/magnesium oxide/anhydrous citric acid.

Does sodium picosulfate/magnesium oxide/anhydrous citric acid interact with other medicines (drug interactions)?

Always tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before taking sodium picosulfate/magnesium oxide/anhydrous citric acid.

  • A medicine to treat an electrolyte imbalance
  • A blood pressure or heart medicine
  • Any medicine for seizures, such as carbamazepine, phenytoin, or phenobarbital
  • A diuretic, also called a water pill, which is a medicine used to reduce edema (fluid retention) and blood pressure
  • An angiotensin-converting enzyme (ACE) inhibitor or angiotensin II receptor blocker (ARB), which is a medicine for high blood pressure, heart failure, and certain kidney problems
  • A nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen, naproxen, and others, which is in many prescription and OTC products for pain, swelling, and fever
  • A laxative, which is a medicine used to treat constipation by softening stools or stimulating your bowels
  • A medicine for depression or any other mental health condition
  • A tricyclic antidepressant, such as amitriptyline, nortriptyline, or protriptyline, even if it is not used for depression
  • An antibiotic, which is a medicine used for bacterial infections
  • Digoxin (Lanoxin), which is a medicine used to treat irregular heartbeat and some types of heart failure
  • A supplement containing iron, which is used to prevent or treat anemia
  • Chlorpromazine, which is a medicine that may be used to treat certain mental health conditions or severe nausea and vomiting
  • Penicillamine (Cuprimine and others), which is a medicine used for Wilson’s disease, rheumatoid arthritis, and other conditions
  • Medicines that can cause QT prolongation, which is a potentially dangerous heart rhythm problem

Sodium picosulfate/magnesium oxide/anhydrous citric acid may affect the absorption of some other medicines. Tell your healthcare provider about all medicines that you take or have recently taken.

This may not be a complete list of medicines that can interact with sodium picosulfate/magnesium oxide/anhydrous citric acid. Always check with your healthcare provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much sodium picosulfate/magnesium oxide/anhydrous citric acid?

If you or someone else has used too much sodium picosulfate/magnesium oxide/anhydrous citric acid, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of sodium picosulfate/magnesium oxide/anhydrous citric acid?

Sodium picosulfate/magnesium oxide/anhydrous citric acid is usually taken in one or two doses. Follow the instructions given to you. If you forget to take your dose or are not able to drink all of it, call your healthcare provider to see if you need to reschedule your procedure.