Sodium picosulfate

Sodium picosulphate is an active ingredient that is used to treat constipation and to empty the bowels. It belongs to the group of laxatives. It is very closely related to bisacodyl and is usually available as a white crystalline powder. Sodium picosulphate is a prodrug, which means that the active ingredient is present as an inactive form and is only converted into the active form, the diphenol bis-(p-hydroxyphenyl)-pyridyl-2-methane (BHPM), in the body through the conversion processes. The conversion is carried out by certain intestinal bacteria. The advantage of sodium picosulphate is that it does not need to be present in enteric-coated form because it is not absorbed.

Sodium picosulphate works by stimulating the intestinal mucosa to increase the secretion of water and electrolytes. This makes the stool softer and more fluid. Sodium picosulphate also increases the frequency of bowel movements. Both effects together are the reason for the laxative effect. Another advantage is that sodium picosulphate only acts in the large intestine and therefore does not interfere with the absorption of nutrients in the small intestine. This selectivity in the large intestine also means that there is no first-pass effect and the effect therefore occurs more quickly.

The first-pass effect occurs with most active ingredients that are absorbed in the stomach or small intestine. The active substance is absorbed through the mucous membrane of the stomach or small intestine and transported through the portal vein (vena portae) to the liver. In the liver, before the active ingredient enters the systemic circulation, it is metabolized for the first time, so that the active ingredient is then available to the body to a lesser extent. The first-pass effect has a major influence on the bioavailability of the respective active ingredients in the body. Bioavailability indicates the percentage of the active ingredient that is available in the blood.

Always take sodium picosulphate exactly as described in the package leaflet or as advised by your doctor.

The usual recommended dose for adults is between 5-10 mg sodium picosulphate.

The recommended dose for children aged 4 years and over is 2.5-5 mg sodium picosulphate.

The effect occurs after 6 to 12 hours and should be taken in the evening to induce defecation the next morning.

Sodium picosulphate should only be taken for a very short time, as the active ingredient only relieves the symptoms and not the causes of constipation.

The following side effects may occur:

Very common:

• Diarrhea

Common:

• Abdominal pain and abdominal cramps
• Flatulence

Occasional:

• Dizziness
• Nausea and vomiting

Frequency unknown:

• Hypersensitivity reactions
• Fainting
• Skin reactions such as swelling, itching or rash
• Shortness of breath (angioedema)

Prolonged or high-dose use may lead to increased loss of water and electrolytes, which may result in further symptoms such as impaired heart function or muscle weakness.

Interactions may occur if the following medicines are taken at the same time:

• taking diuretics can lead to an increased loss of potassium in the body
• taking adrenal cortex hormones (adrenocorticosteroids) can lead to an increased loss of potassium in the body
• taking antibiotics can impair the effect of sodium picosulphate
• Increased potassium loss in the body can lead to heart problems or interfere with the effect of certain medications that affect heart function.

Sodium picosulphate must NOT be taken in the following cases:

• in case of allergy to sodium picosulphate
• in case of intestinal obstruction or disorders of gastrointestinal patency
• in the case of acute inflammatory gastrointestinal diseases
• severe abdominal pain with or without fever
• in cases of severe water loss from the body

Sodium picosulfate is approved for use from the age of 4.

During pregnancy, sodium picosulphate can be taken after consultation with your doctor. Sodium picosulphate has been used in pregnant women for decades without any reports of harmful effects for the unborn baby. No harmful effects have been reported in animal studies either. However, studies on sodium picosulphate in pregnancy are very sparse.

During breastfeeding, sodium picosulphate can be taken after consultation with your doctor. Due to its very low bioavailability, it is not expected to pass into breast milk. Breastfeeding is possible without restrictions.