Clenpiq
Clenpiq is used to clean out your colon in preparation for a colonoscopy. It's approved for people 9 years of age and older. Clenpiq is a ready-to-use oral solution that contains a combination of a stimulant laxative and osmotic laxative. Your prescriber will give you instructions on when and how to take Clenpiq bowel prep. It's typically taken as a 2-dose regimen, starting on the night before your colonoscopy. Some side effects can include nausea and headache.
What is Clenpiq?
What is Clenpiq used for?
Colon cleansing before colonoscopy
How Clenpiq works
Clenpiq contains a combination of laxatives.
Sodium picosulfate is a stimulant laxative. It causes your gut muscles to contract more to help push stool out.
Magnesium oxide and citric acid combine to form magnesium citrate, which is an osmotic laxative that causes water to stay in your gut. This makes it easier to pass stool.
Together, all three of these ingredients work to cause watery diarrhea, which helps to clean the colon.
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What are the side effects of Clenpiq?
Common Side Effects
- Nausea (3%)
- Headache (3%)
- Stomach pain (2%)
- Dehydration or dizziness (2%)
Other Side Effects
- Vomiting
- Rash
- Itchy skin
- Inability to control bowel movements
- Anal and rectal pain
- Changes in electrolyte levels
Serious Side Effects
- Severe dehydration (low fluids in the body): dizziness, lightheadedness, headache, dry mouth, vomiting, fainting
- Kidney problems: urinating less, swelling in your arms and legs, tiredness, nausea
- Abnormal heart rhythm: fast heartbeat, dizziness, tiredness, weakness, chest pain, sweating
- Seizures
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Dehydration—increased thirst, dry mouth, feeling faint or lightheaded, headache, dark yellow or brown urine
- Fast or irregular heartbeat
- Kidney injury—decrease in the amount of urine, swelling of the ankles, hands, or feet
- Seizures
- Sudden or severe stomach pain, bloody diarrhea, fever, nausea, vomiting
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
Pros and cons of Clenpiq
Pros
Need to drink a smaller amount of medication than some other colonoscopy preparations
Doesn't need to be mixed or diluted before drinking
Can use for children as young as 9 years old
Cons
Causes diarrhea (how the medication cleans out your colon)
Can cause severe dehydration and changes in your electrolyte levels
Not safe for people with severe kidney problems
Pharmacist tips for Clenpiq
You can drink Clenpiq right from the bottle. It's cranberry-flavored and it doesn't need to be mixed with anything before you drink the liquid.
Follow your gastroenterologist's instructions to drink enough clear liquids before you start taking Clenpiq, while you're taking the medication, and even afterwards. This helps prevent dehydration from the colonoscopy prep and its serious complications.
Use the provided 8-oz cup to measure out and drink clear liquids after you finish each bottle of Clenpiq. After finishing your first bottle, drink five or more cups of clear liquids over a span of 5 hours before bedtime. And after finishing your second bottle, drink four or more cups of clear liquids up to 2 hours before the procedure. Stop drinking all liquids at least 2 hours before your colonoscopy.
Some examples of clear liquids that you can drink during your colonoscopy prep with Clenpiq include apple juice, white grape juice, ginger ale, clear broth, and water. You can also have sports drinks, plain jello, and sodas as long as they aren't red or purple. Drinking anything red or purple can interfere with the results of your procedure.
Avoid solid foods, alcohol, milk (dairy and non-dairy), juices with pulp, liquids you can't see through, and anything red or purple.
Drink a variety of clear liquids and stand up slowly from a lying or sitting position during your colonoscopy prep with Clenpiq. This helps prevent fainting and possible falls, head injuries, and broken bones. Some people have fainted, usually within 12 hours of a dose of Clenpiq.
If you feel bloated or if you have stomach pain after drinking the first bottle of Clenpiq, it's okay to wait until your stomach feels better before you drink the second bottle. But try to completely finish the second bottle in the time your provider tells you to.
Let your care team know about all your medications. There might be instructions about when to take your other medications during your bowel prep so they can get absorbed into the body properly. Be sure to take any other medications you swallow at least an hour before you drink the first bottle of Clenpiq. You even might need to take certain medications several hours before or after Clenpiq.
Store Clenpiq at room temperature. Don't put your medication in the refrigerator or freezer.
Call your gastroenterology care team for more instructions if you don't have a bowel movement after you take Clenpiq.
Frequently asked questions about Clenpiq
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What are the risks and warnings for Clenpiq?
Clenpiq can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Dehydration and changes in electrolytes
Risk factors: Taking other medications that can cause changes in fluid and electrolyte levels | Kidney problems
Clenpiq can cause low fluid and electrolyte levels in your body. This could lead to dangerous side effects, such as abnormal heart rhythms, seizures, severe kidney problems, fainting, and falls.
To prevent serious complications, be sure to stay hydrated and drink plenty of fluids before you take Clenpiq, while you're taking the medication, and also afterwards. Let your care team know about your medical conditions and the medications you take; having kidney problems and taking certain medications can put you at risk for these complications. Tell your care team right away if you experience vomiting, dizziness, less urination, or headache.
Seizures
Risk factors: History of seizures | Electrolyte imbalance | Low sodium levels in the blood | Taking other medications that raise the risk for seizures | Withdrawing from alcohol or benzodiazepines
Some people have had seizures when they used bowel prep medications like Clenpiq, even when they haven't had any seizures before. Most seizures happened because there was an imbalance of electrolytes in the blood.
The risk of having a seizure is greater if you have a history of seizures, are taking certain medications that can raise the likelihood of a seizure, or are going through withdrawal from alcohol or benzodiazepines. Make sure to discuss your complete medical history and all of your medications with your care team before you use Clenpiq. In addition, it's important to remain hydrated while you're using Clenpiq to minimize the risk for seizure.
Potential risk for kidney problems
Risk factors: Taking other medications that can cause changes in fluid and electrolyte levels in the body | Kidney problems
Let your care team know if you have any kidney problems before you start Clenpiq. There might be a risk for worsening kidney injury or electrolyte problems. Also check with your care team about any medications you might need to avoid before your procedure. Some medications can affect how the kidneys work and raise your risk for kidney injury when they're taken with Clenpiq.
While you're taking Clenpiq, it's important to continue to stay hydrated. Tell your care team if you're urinating less or if you develop swelling in your arms or legs, feel very tired, or feel nauseous. These could be signs of kidney problems.
Changes in heart rhythm (cardiac arrhythmia)
Risk factors: Heart problems
Although rare, there are some reports of people who've had severe changes in heart rhythm while they used osmotic laxatives, such as Clenpiq. People who have heart problems, including a recent heart attack and congestive heart failure, are at higher risk for this dangerous side effect. Let your care team know about your medical history. Your gastroenterologist might recommend that you get an electrocardiogram (ECG) done before you use Clenpiq and after your colonoscopy to check your heart rhythm if you're at risk.
Stomach and bowel problems
Risk factors: History of bowel problems | Taking other stimulant laxative medications
Clenpiq can cause stomach and bowel problems, including blockages in the gut and damage to the wall of the gut (e.g., ulcers, perforation). Some of these problems are dangerous and require hospitalization. Don't use additional stimulant laxatives while you're using Clenpiq because this can raise your risk for stomach and bowel problems.
Notify your care team right away if you have symptoms such as sudden, severe stomach pain; stomach swelling; nausea or vomiting; severe constipation; problems passing gas; fever; or chills. These could be signs of problems with your gut.
Choking
Risk factors: History of choking | Gag reflex problems
Talk to your gastroenterologist before you use Clenpiq if you have gag reflex problems. People who have gag reflex issues might be at risk of spitting up (regurgitation) or inhaling the medication into the lungs (aspiration) while they're taking Clenpiq.
Clenpiq dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 2 bottles of 10mg/3.5g/12g | 1 carton | $181.08 | $181.08 |
Typical dosing for Clenpiq
Clenpiq is taken as two separate doses over two days.
Day 1 (the evening before the colonoscopy): Drink 1 whole bottle of Clenpiq in the evening. Then, drink at least five cups of clear liquids over the next 5 hours before bedtime.
Day 2 (the morning of the colonoscopy): Drink 1 whole bottle of Clenpiq in the morning, about 5 hours before the colonoscopy. Then, drink at least four cups of clear liquids up to 2 hours before the colonoscopy.
How much does Clenpiq cost?
Clenpiq contraindications
Severe kidney problems
A blockage in your intestine
Inflammation or swelling of the colon
Difficulty emptying food or fluid from your stomach
An opening or hole in the wall of your bowels (bowel perforation)
What are alternatives to Clenpiq?
Cleansing the colon to prepare for colonoscopy
Cleansing the colon to prepare for barium enema x-ray examination (Golytely, Colyte, Gavilyte-C, and certain generic preps only)
Clenpiq images
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References
Best studies we foundAmerican Society for Gastrointestinal Endoscopy. (2015). Bowel preparation before colonoscopy. Gastrointestinal Endoscopy.
Ferring Pharmaceuticals Inc. (2023). CLENPIQ - sodium picosulfate, magnesium oxide, and anhydrous citric acid liquid [package insert]. DailyMed.
Gu, P., et al. (2020). Comparing the real-world effectiveness of competing colonoscopy preparations: Results of a prospective trial. American Journal of Gastroenterology.
Lichtenstein, G.R., et al. (2007). Review article: Bowel preparation for colonoscopy – The importance of adequate hydration. Alimentary Pharmacology and Therapeutics.
Liu, F., et al. (2021). Cleansing efficacy and safety of bowel preparation protocol using sodium picosulfate/magnesium citrate considering subjective experiences: An observational study. World Journal of Clinical Cases.
MedlinePlus. (2022). Gastrointestinal perforation.
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