Sodium Picosulfate

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.