Stimulant Laxative / Bowel Preparation Agent Pregnancy: §4.6: no adequate and well-controlled studies in pregnant women; long experience has shown no evidence of undesirable or damaging effects during pregnancy. Lactation: clinical data show neither the active moiety nor its glucuronides are excreted into milk. Nevertheless, should not be taken in pregnancy, especially the first trimester, or during breast-feeding unless the expected benefit is thought to outweigh any possible risk and only on medical advice.

Sodium Picosulfate

Brand names: Dulcolax Pico, Laxoberal, Picolax (with magnesium citrate)

Sodium picosulfate is a stimulant laxative used for constipation and, in higher-strength combination products, for bowel cleansing before colonoscopy or surgery.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: One to two 5 ml spoonfuls (5-10 mg)

Route: Oral

Frequency: Once daily, taken at night to produce evacuation the following morning

Max: 10 mg (two 5 ml spoonfuls) per day — the upper end of the stated adult range; §4.2 states the maximum recommended daily dose should not be exceeded

UK SPC (Dulcolax Adult Pico Liquid, 5 mg / 5 ml oral solution) §4.2: adults — one to two 5 ml spoonfuls (5-10 mg) per day. Doses are recommended to be taken at night to produce evacuation the following morning. It is recommended to start with the lowest dose; the dose may be adjusted up to the maximum recommended dose to produce regular stools. In the management of constipation, once regularity has restarted the dosage should be reduced and can usually be stopped. Can be diluted with purified water. PAEDIATRIC: should NOT be used in children or adolescents under the age of 18 years (§4.2 and §4.4) — no paediatric dose exists for this product. As with all laxatives, should not be taken on a continuous daily basis for more than five days without investigating the cause of constipation; long-term everyday use of stimulant laxatives may harm intestinal function. Prolonged excessive use may lead to fluid and electrolyte imbalance and hypokalaemia. Contains 4.8 vol% ethanol, i.e. up to 480 mg alcohol per dose, and the preservatives methyl and propyl parahydroxybenzoate. Note: §4.5 interactions was not captured in the source bundle.

Dose adjustments

Renal

§4.4: in patients suffering from fluid loss where dehydration may be harmful (e.g. renal insufficiency, elderly patients) sodium picosulfate should be discontinued and only restarted under medical supervision. No numeric dose adjustment is stated.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Ileus or intestinal obstruction
Severe painful and/or feverish acute abdominal conditions (e.g. appendicitis) potentially associated with nausea and vomiting
Acute inflammatory bowel diseases
Severe dehydration
Known hypersensitivity to sodium picosulfate or any other component of the product
Rare hereditary conditions that may be incompatible with an excipient of the product

Side effects

Diarrhoea (very common)
Abdominal discomfort, abdominal pain and abdominal cramps (common)
Nausea and vomiting (uncommon)
Dizziness (uncommon) and syncope (frequency not known) — consistent with a vasovagal response
Hypersensitivity and skin reactions such as angioedema, drug eruption, rash and pruritus (frequency not known)

Clinical monograph

How it works

It is hydrolysed by colonic bacteria into an active form that stimulates the mucosa of the large bowel, increasing motility and water secretion.

Prescribing in practice

Bowel-cleansing preparations carry a risk of fluid and electrolyte disturbance and dehydration, so maintain adequate hydration and use with caution in frail, elderly, or renally impaired patients.
It is contraindicated in intestinal obstruction, ileus, severe inflammatory bowel disease, and toxic megacolon.
Effect is typically seen within several hours, so timing of administration should account for the expected onset.

Monitoring

Monitor for signs of dehydration and electrolyte imbalance, particularly with bowel-cleansing regimens in at-risk patients.

Counselling the patient

Drink plenty of clear fluids during bowel preparation to avoid dehydration.
Expect loose, watery stools and stay near a toilet once the dose takes effect.

Evidence & guidelines

Stimulant laxatives such as sodium picosulfate are established agents for constipation and bowel preparation in UK practice.

Reference: BSG Bowel Preparation Guidelines; SPC Picolax; SPC Laxoberal; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways