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
What are the side effects of Prepopik?
Common Side Effects
- Nausea (3%)
- Headache (up to 3%)
- Vomiting (1%)
Other Side Effects
- Stomach 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
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.
Frequently asked questions about Prepopik
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What are the 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 forms
Typical dosing 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
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 Prepopik?
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)
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References
Best studies we foundCamber Pharmaceuticals, Inc. (2022). Sodium picosulfate, magnesium oxide and anhydrous citric acid- sodium picosulfate, magnesium oxide and anhydrous citric acid powder, metered [package insert]. DailyMed.
Lichtenstein, G. R., et al. (2007). Review article: Bowel preparation for colonoscopy – the importance of adequate hydration. Alimentary Pharmacology and Therapeutics.
Liu, F. X., 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.
Saltzman, J. R., et al. (2015). Bowel preparation before colonoscopy. Gastrointestinal Endoscopy.
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