sodium picosulfate/magnesium oxide/citric acid
Prepopik is a combination of a stimulant laxative and osmotic laxative that's used to clean out your colon in preparation for a colonoscopy. It can be used by people 9 years and older. Prepopik is a powder that you must mix with water to make a liquid that you drink. Your prescriber will give you instructions on when and how to prepare and take this bowel prep. It's typically taken as a 2-dose regimen. Side effects can include nausea and headache. The brand name Prepopik is no longer available, but you can still get the generic version of the medication.
What is Prepopik?
What is Prepopik used for?
- Colon cleansing before to colonoscopy
How Prepopik works
Prepopik 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.
Drug facts
Side effects of Prepopik
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Nausea (3%)
- Headache (up to 3%)
- Vomiting (1%)
Less Common Side Effects
- Stomach pain
- Changes in electrolyte levels
Prepopik serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- 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
Pros and cons of Prepopik
Pros
- Approved for people 9 years and older
- Need to drink a smaller amount of medication than some other colonoscopy preparations
- Two different dosing options
Cons
- Must mix the powder with water before drinking
- Can't prepare the mixture and then save it for later use
- Not safe for people with severe kidney problems
Pharmacist tips for Prepopik
- Prepare your dose of Prepopik by mixing a packet of powder with 5 ounces of cold water just before use. Make sure the powder is fully dissolved. Directly swallowing the powder can raise your risk for nausea, vomiting, dehydration, and electrolyte problems.
- Once fully mixed, drink the Prepopik liquid soon afterwards. The mixture can't be stored for later use.
- Don't refrigerate the prepared Prepopik solution or add ice to it.
- Follow your gastroenterologist's directions to drink enough clear liquids before you start taking Prepopik, while you're taking the bowel prep, and even afterwards. This helps prevent dehydration from the colonoscopy prep and its serious complications.
- The bowel prep kit includes an 8-oz cup for you to use to measure out and drink clear liquids from after you finish each dose of Prepopik. Examples of clear liquids that you can drink 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.
- Avoid solid foods, alcohol, milk (dairy and non-dairy), juices with pulp, liquids you can't see through, and anything red or purple. Drinking anything red or purple can interfere with your colonoscopy results.
- If you feel bloated or if you have stomach pain after your first dose of Prepopik, you can wait until your stomach feels better before you take the second dose. But try to completely finish the second dose before your colonoscopy within the time your provider tells you to.
- Your instructions should include information about when to take your other medications during your bowel prep so they can get absorbed into the body properly. Take any other medications you swallow at least an hour before you start Prepopik. You might need to take certain medications several hours before or after the bowel prep. Ask your care team if you're not sure when to take your other medications.
- Contact your prescriber and get medical attention right away if you vomit, have signs of dehydration, are confused, or have a seizure.
- Call your gastroenterology care team for more instructions if you don't have a bowel movement after you take Prepopik.
Common questions about Prepopik
It's not completely known whether the second dose of Prepopik works faster than the first. But a study that used the medication in the form of granules instead of a powder showed that the second dose worked faster to make people have bowel movements than the first. On average, people started to have bowel movements after about 40 minutes after the second dose. In comparison, people had bowel movements about an average of 90 minutes after the first dose.
Prepopik is a bowel prep that contains a stimulant laxative and an osmotic laxative. This combination of laxatives typically works within several minutes to a few hours to make you have a bowel movement. It's important to note that the time it takes each person to have a bowel movement after a dose of Prepopik can be different. But call your gastroenterologist to ask what to do if you don't have a bowel movement at all after you take Prepopik.
There isn't enough information to know how well Prepopik will work for you if the prepared mixture is refrigerated. Keep the packets of Prepopik powder at room temperature. Once the packet is completely mixed with cold water, drink the prepared Prepopik liquid right away. Don't place the mixture in the refrigerator or add ice to it.
There are two different Prepopik dosing regimens that are usually recommended. Depending on which regimen your gastroenterologist told you to follow, you might take your second dose in the morning before your colonoscopy (about 5 hours before) or the evening before your procedure. Carefully read the packet of instructions that your gastroenterologist's office gave you. There should be clear directions about when to take the second dose of Prepopik. Contact the office if you have questions about when to take your Prepopik doses.
Prepopik is an orange-flavored powder that you mix with water and drink in preparation for a colonoscopy.
Typically, you can drink Prepopik at a pace that's comfortable for you; you just need to make sure that you finish each dose of the bowel prep within the time that your gastroenterologist instructed you to. Keep in mind that after you finish each dose, you'll need to drink a lot of clear liquids over a certain period of time as well. Be sure to give yourself enough time to finish each Prepopik dose and the clear liquids afterwards. Carefully review the instructions that your gastroenterologist's office gave you; there will be exact instructions about drinking Prepopik and clear liquids over a specific span of time.
Yes, you have to drink and finish both doses of Prepopik to clean out your colon properly before your procedure. You'll also need to drink at least five cups of clear liquid after the first dose and at least three cups of clear liquid after the second dose. Be sure to follow all the steps for your bowel prep as instructed. This helps prevent serious side effects (related to dehydration or changes in your electrolyte levels) and any delays to your procedure.
Prepopik and Clenpiq both contain the same ingredients and are used to clean out the colon before a colonoscopy. But Clenpiq is a ready-to-drink liquid, whereas Prepopik is available as powder packets that need to be mixed with cold water before drinking. Both products require you to drink two doses before your colonoscopy. Clenpiq is only available as a brand-name medication, and Prepopik is only available as a generic. Talk to your gastroenterologist to find out which formulation is best for you.
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Risks and warnings for Prepopik
Prepopik 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
Prepopik 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, it's important to stay hydrated and drink plenty of fluids before you take Prepopik, while you're taking the medication, and also afterwards. Tell your care team about your medical conditions and the medications you take; having kidney problems and taking certain medications can put you at risk for these complications. Let your care team know right away if you vomit, feel dizzy, have a severe headache, or notice less urination. These can be signs of dehydration.
Changes in heart rhythm (cardiac arrhythmia)
- Risk factors: Heart problems
Although rare, there are some reports of people who've had serious changes in heart rhythm while they used osmotic laxatives, such as Prepopik, for bowel prep. Tell your care team about your medical history. People who have heart problems, like a recent heart attack or heart failure, are at higher risk for changes in heart rhythm. Your gastroenterologist might recommend that you get an electrocardiogram (ECG) done before you use Prepopik and after your colonoscopy to check your heart rhythm if you're at risk.
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 Prepopik, even when they haven't had any seizures in the past. 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. Discuss your complete medical history and all of your medications with your care team before you use Prepopik so they can check for the risk for seizures. It's important to drink plenty of liquids while you're using Prepopik to lessen 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
Make sure your care team knows if you have any kidney problems before you start Prepopik. There might be a risk for worsening kidney injury or electrolyte problems. Also check with your care team whether there are any medications you'll need to avoid taking before your procedure. Some medications can affect how the kidneys work and raise your risk for kidney injury when they're taken with Prepopik.
While you're taking Prepopik, it's important to continue to stay hydrated to help prevent kidney injury. Tell your care team if you're urinating less or if you start to have swelling in your arms or legs, feel very tired, or feel nauseous. These could be signs of kidney problems.
Stomach and bowel problems
- Risk factors: History of bowel problems | Taking other stimulant laxative medications
Prepopik 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 can be dangerous and can require hospitalization. Don't use additional stimulant laxatives while you're using Prepopik because this can raise your risk for stomach and bowel problems.
Tell 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 gut problems.
Choking
- Risk factors: History of choking | Gag reflex problems
Speak with your gastroenterologist before you use Prepopik 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 Prepopik.
Prepopik dosage
Typical dosage for Prepopik
Prepopik is taken as two separate doses. Carefully follow your prescriber's instructions to know how they'd prefer you to complete your bowel prep. There are two dosing regimens that are typically recommended.
Split-dose regimen:
- Day 1 (the evening before the colonoscopy): Mix 1 packet of Prepopik with 5 ounces of cold water and drink the mixture. Then, drink at least five 8-oz cups of clear liquids over the next 5 hours before bedtime.
- Day 2 (the morning of the colonoscopy): Mix 1 packet of Prepopik with 5 ounces of cold water and drink the mixture, about 5 hours before the colonoscopy. Then, drink at least three 8-oz cups of clear liquids up to 2 hours before the colonoscopy.
Day-before regimen:
- Dose 1 (the day before the colonoscopy, in the afternoon or early evening): Mix 1 packet of Prepopik with 5 ounces of cold water and drink the mixture. Then, drink at least five 8-oz cups of clear liquids within 5 hours and before the next dose.
- Dose 2 (the night before the colonoscopy): Mix 1 packet of Prepopik with 5 ounces of cold water and drink it 6 hours after the first dose. Then, drink at least three 8-oz cups of clear liquids within 5 hours before bedtime.
Prepopik contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Prepopik will not be safe for you to take.
- 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)
