Makindo Medical Notes

🚽 Magnesium citrate + sodium picosulfate (e.g. Picolax/Citrafleet) is a bowel cleansing prep used before colonoscopy, radiology, or surgery. ⚠️ The main risks are dehydration and electrolyte disturbance (especially in frail/CKD/heart failure). Encourage clear-fluid intake as directed and follow local endoscopy/radiology protocol.

About

• 📚 Always check the BNF for product-specific instructions and safety advice.
• 🧾 Used for bowel evacuation prior to endoscopy, radiological procedures (e.g. CT colonography), or surgery.
• ⏱️ Expect multiple watery stools; ensure patients plan access to a toilet and avoid travel immediately after dosing.

Mode of action

• 🧲 Magnesium citrate = osmotic effect → draws water into the bowel → softens stool and increases volume.
• ⚡ Sodium picosulfate = stimulant laxative prodrug → activated by colonic bacteria → increases peristalsis and propulsion.
• 🤝 Together: flush + push → effective bowel cleansing when combined with adequate fluid intake.

Indication / Dose (typical regimen — follow local protocol)

• 🧪 Bowel prep / colonoscopy: often 2 sachets total split dose.
• 🥤 Reconstitution: dissolve 1 sachet in 150 mL of cold water (about half a glass). Let it stop fizzing, then drink.
• 🕗 Split dose example: 1 sachet taken before 08:00, then 1 sachet 6–8 hours later (timing may vary with morning vs afternoon procedure).
• 💧 Fluids: take plenty of clear fluids as instructed (this is crucial for effectiveness + safety).
• 🚫 Usually avoid solids once the prep starts (follow the endoscopy unit’s dietary sheet).

Practical counselling points 💡

• 🚻 Stay near a toilet after each dose; urgency is expected.
• 🧻 Consider barrier cream to prevent perianal soreness.
• 🚗 Do not drive long distances after dosing; plan transport for procedure day.
• 💊 Ask about medication timing: diarrhoea can reduce absorption of oral meds — take essential meds earlier where possible and follow unit advice.

Interactions

• 📚 See BNF for full list.
• 💊 Reduced absorption of oral medicines (e.g. oral contraceptives, antiepileptics, immunosuppressants) due to rapid transit/diarrhoea — timing matters.
• 🧂 Drugs affecting electrolytes/volume (diuretics, ACEi/ARBs) may increase risk of dehydration, hypotension, and electrolyte derangement.

Cautions

• 🧓 Frailty, older age, low body weight — higher dehydration risk.
• 🫀 Heart failure / significant cardiac disease (volume shifts can destabilise).
• 🫘 Chronic kidney disease (risk of electrolyte disturbance).
• 💧 Baseline dehydration or poor oral intake; consider alternative prep or supervised regimen.
• 🧪 Abnormal electrolytes at baseline (especially sodium/potassium/magnesium) — correct and plan monitoring if high-risk.

Contraindications

• ⛔ Suspected/known bowel obstruction or ileus.
• 🚨 Severe active colitis/toxic megacolon.
• 🫄 Significant ascites (often specialist decision; many units choose alternative preps).
• 🩺 Any acute surgical abdomen / severe abdominal pain of unclear cause → do not give until assessed.

Side effects

• 😖 Abdominal cramping, bloating, nausea, vomiting.
• 🚽 Profuse diarrhoea (expected), perianal soreness.
• 📉 Dehydration, dizziness, postural symptoms.
• 🧂 Electrolyte disturbance (hyponatraemia, hypokalaemia ± magnesium changes), especially if frail/CKD/diuretics.

References

• BNF – Magnesium citrate with sodium picosulfate

Revisions