As a purgative, PICOPREP increases the gastrointestinal transit rate. The absorption of other orally administered medicines (e.g. anti-epileptics, contraceptives, anti-diabetics, antibiotics) may therefore be modified during the treatment period (see Precautions). Oral medication administered within one hour of the start of administration of PICOPREP solution may be flushed from the GI tract and the medication may not be absorbed. Tetracycline and fluoroquinolone antibiotics, iron, digoxin, chlorpromazine and penicillamine, should be taken at least 2 hours before and not less than 6 hours after administration of PICOPREP to avoid chelation with magnesium.
The efficacy of PICOPREP is lowered by bulk-forming laxatives.
Prior or concomitant use of antibiotics with PICOPREP® may reduce efficacy of PICOPREP as conversion of sodium picosulfate to its active metabolite BHPM is mediated by colonic bacteria.
Use caution when prescribing PICOPREP for patients with conditions or who are using medications that increase the risk for fluid and electrolyte disturbances or may increase the risk of seizure, arrhythmias, and prolonged QT in the setting of fluid and electrolyte abnormalities. This includes patients receiving drugs which may be associated with hypokalaemia (such as diuretics or corticosteroids, or drugs where hypokalaemia is a particular risk i.e. cardiac glycosides). Caution is also advised when PICOPREP is used in patients on angiotensin converting enzyme inhibitors, angiotensin receptor blockers, NSAIDs or drugs known to induce Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) e.g. tricyclic antidepressants, selective serotonin re-uptake inhibitors, antipsychotic drugs and carbamazepine as these drugs may increase the risk of water retention and/or electrolyte imbalance.