Consumer medicine information


Sodium picosulfate; Magnesium oxide; Citric acid


Brand name


Active ingredient

Sodium picosulfate; Magnesium oxide; Citric acid




Consumer medicine information (CMI) leaflet

Please read this leaflet carefully before you start using Picosalax.

What is in this leaflet

This leaflet answers some common questions about Picosalax. It does not contain all the available information. It does not take the place of talking to your doctor or pharmacist.

All medicines have risks and benefits. Your doctor has weighed the risks of you taking Picosalax against the benefits they expect it will have for you.

If you have any concerns about taking this medicine, ask your doctor or pharmacist.

Keep this leaflet with the medicine. You may need to read it again.

What Picosalax is used for

Picosalax is used for clearance of the bowel before x-ray, endoscopy or surgery.

Picosalax produces a watery stool or bowel motion which empties and cleans the bowel before the procedure.

Each dose of Picosalax usually produces a bowel movement within 2 to 3 hours, depending on your individual response.

Ask your doctor or pharmacist if you have any questions about why this medicine has been recommended for you. Your doctor may have recommended it for another reason.

Before you take Picosalax

When you must not take it

Picosalax is not to be used as a routine laxative.

Picosalax is not for use in children under 9 years of age.

Do not take Picosalax if you have an allergy to:

  • any medicine containing sodium picosulfate or magnesium citrate
  • any of the ingredients listed at the end of this leaflet

Some of the symptoms of an allergic reaction may include:

  • shortness of breath
  • wheezing or difficulty breathing
  • swelling of the face, lips, tongue or other parts of the body
  • rash, itching or hives on the skin.

Do not take Picosalax if you are suffering from:

  • heart failure
  • perforation of the stomach or stomach obstruction
  • delayed emptying of stomach contents into the small intestine
  • holes in the lining of the stomach
  • damage to the entire thickness of the intestinal wall
  • severe distension in the colon
  • blockage in the bowel
  • nausea and vomiting
  • inflammation of the appendix
  • severe dehydration
  • muscle damage causing muscle pains, vomiting, confusion
  • high magnesium levels
  • active inflammatory bowel disease
  • severe kidney disease
  • undiagnosed abdominal symptoms.

Do not take it after the expiry date printed on the pack or if the packaging is torn or shows signs of tampering. If it has expired or is damaged, return it to your pharmacist for disposal.

If you are not sure whether you should start taking this medicine, talk to your doctor.

Before you start to take it

Tell your doctor if you have allergies to any other medicines, foods, preservatives or dyes.

Tell your doctor if you have or have had any of the following medical conditions:

  • recent gastrointestinal surgery
  • kidney problems
  • heart problems
  • inflammatory bowel disease
  • electrolyte disturbances
  • diabetes.

Tell your doctor if you are on potassium restricted diet. Picosalax contains 195 mg potassium per sachet. This should be taken into consideration if you have reduced kidney function or you are on a controlled potassium diet.

Tell your doctor if you are pregnant or plan to become pregnant or are breast-feeding. Your doctor can discuss with you the risks and benefits involved.

If you have not told your doctor about any of the above, tell him/her before you start taking Picosalax.

Taking other medicines

Tell your doctor or pharmacist if you are taking any other medicines, including any that you get without a prescription from your pharmacy, supermarket or health food shop.

Some medicines and Picosalax may interfere with each other. These include:

  • birth control medications (oral contraceptives)
  • medicines used to treat infections (antibiotics)
  • medicines used to help the kidneys get rid of salt and water by increasing the amount of urine produced (diuretics)
  • corticosteroids
  • medicines used to treat depression (antidepressants) or psychosis (antipsychotics)
  • bulk-forming laxatives
  • iron supplements
  • medicines used to treat heart failure and the associated symptoms of shortness of breath when lying flat (e.g digoxin)
  • medicines used to treat epilepsy (anti-epileptics)
  • medicines used to treat diabetes
  • medicines such as ibuprofen, used to treat pain and inflammation (NSAIDs)
  • penicillamine.

These medicines may be affected by Picosalax or may affect how well it works. You may need different amounts of your medicines, or you may need to take different medicines.

Picosalax may prevent absorption of oral medication taken within one hour of its administration

Your doctor and pharmacist have more information on medicines to be careful with or avoid while taking this medicine.

How to take Picosalax

The following is a summary of how to take Picosalax and explains the different regimens that your doctor may tell you to follow. For FULL instructions on how to use Picosalax, please refer to the ‘Patient Information Leaflet’ enclosed with Picosalax. The success of your examination depends on the bowel being as clear as possible. Otherwise, the examination may need to be repeated. So it is important to take all the medicine and follow all your doctor's instructions.

Follow all directions given to you by your doctor or pharmacist carefully. They may differ from the information contained in this leaflet.

If you do not understand the instructions on the box/bottle, ask your doctor or pharmacist for help.

How much to take

Adults and children 9 years and over
For adults and children 9 years and over, the usual dose is two sachets but the timing of each dose can vary and may depend on the time of your examination. The contents of each of two sachets may be taken several hours apart on the day before the examination (DAY BEFORE regimen) or over two days (SPLIT-DOSE regimen). Your doctor will advise you which way to take your Picosalax.

In some circumstances, your doctor may choose to modify these dose instructions. Follow the doctor's instructions carefully.

How to take it

The sachets must be made up in water before drinking. The detailed instructions for reconstituting the sachets are in the carton.

Your doctor will have informed you of the dose that you should take and when to take it.

It is important that you follow the instructions specifically given by the hospital and that you drink plenty of clear fluids.

If you take too much (overdose)

Immediately telephone your doctor or the Poisons Information Centre (telephone 13 11 26) for advice, or go to Accident and Emergency at the nearest hospital, if you think that you or anyone else may have taken too much Picosalax. Do this even if there are no signs of discomfort or poisoning. You may need urgent medical attention.

Symptoms of an overdose may include profuse diarrhoea with dehydration and fluid/electrolyte imbalance.

While you are taking Picosalax

You should expect frequent, loose bowel movements at any time after taking a dose. Please ensure that you have access to a toilet at all times following each dose, until the effects wear off.

Things you must do

In order to replace the fluid lost from the body, it is important to drink plenty of clear fluids whilst the effects of Picosalax persist. In general you should try to drink at least 250 mL (approximately one large glass) of clear fluid every hour during the treatment day/days.

If you are about to be started on any new medicine, remind your doctor and pharmacist that you are taking Picosalax.

Tell any other doctors, dentists, and pharmacists who treat you that you are taking this medicine.

If you are about to have any blood tests, tell your doctor that you are taking this medicine. It may interfere with the results of some tests.

Things you must not do

Do not take Picosalax to treat any other complaints unless your doctor tells you to.

Do not give your medicine to anyone else, even if they have the same condition as you.

Things to be careful of

If you feel light-headed, dizzy or faint when getting out of bed or standing up, get up slowly. Standing up slowly, especially when you get up from bed or chairs, will help your body get used to the change in position and blood pressure. If this problem continues or gets worse, talk to your doctor.

Side effects

Tell your doctor or pharmacist as soon as possible if you do not feel well while you are taking Picosalax. This medicine helps most people who require a bowel preparation but it may have unwanted side effects in a few people. All medicines can have side effects. Sometimes they are serious, most of the time they are not. You may need medical attention if you get some of the side effects.

If you are over 65 years of age you may have an increased chance of getting side effects.

Do not be alarmed by the following lists of side effects. You may not experience any of them.

  • headache, tiredness
  • nausea, vomiting
  • griping
  • sore anus
  • severe diarrhoea
  • allergic reactions
  • rash
  • convulsions
  • mild ulcers in the small bowel.

If you experience one or more of these side effects, or any other undesirable effects, please tell your doctor or pharmacist.

Ask your doctor or pharmacist to answer any questions you may have.

After taking Picosalax


Keep this medicine in the pack until it is time to take it. If you open the sachets too soon the powder may not keep well.

Keep this medicine in a cool dry place where the temperature stays below 30°C.

Do not store Picosalax or any other medicine in the bathroom or near a sink. Do not leave it on a window sill or in the car. Heat and dampness can destroy some medicines.

Keep it where children cannot reach it. A locked cupboard at least one-and-a -half metres above the ground is a good place to store medicines.


If your doctor tells you to stop taking this medicine or the expiry date has passed, ask your pharmacist what to do with any medicine that is left over.

Product description

What it looks like

Picosalax sachets contain a white crystalline powder. It is supplied in boxes containing 2 sachets.


Each Picosalax sachet contains 10 mg of sodium picosulfate, 3.5 g of light magnesium oxide and 12 g of citric acid (forming magnesium citrate in solution) as the active ingredients. It contains the following inactive ingredients:

  • potassium bicarbonate
  • saccharin sodium
  • orange flavour.

The orange flavour contains lactose (approximately 4.5 mg per sachet).

This medicine contains 195 mg potassium per sachet.

This medicine does not contain, sucrose, gluten, tartrazine or any other azo dyes.


Picosalax is supplied in Australia by:

Ferring Pharmaceuticals Pty Ltd
Suite 2, Level 1, Building 1
20 Bridge Street
Pymble NSW 2073

AUST R 138775

Picosalax powder for oral administration

This leaflet was prepared in August 2019.

PICOSALAX and FERRING are registered trademarks of Ferring B.V.

Published by MIMS October 2019


Brand name


Active ingredient

Sodium picosulfate; Magnesium oxide; Citric acid




1 Name of Medicine

Citric acid.
Light magnesium oxide.
Sodium picosulfate.

2 Qualitative and Quantitative Composition

Active ingredients.

Sodium picosulfate 10 mg with magnesium citrate formed in solution from light magnesium oxide 3.5 g and citric acid 12 g.


Potassium bicarbonate (equivalent to 5 mmol (195 mg) potassium), saccharin sodium, orange flavour (containing lactose monohydrate (equivalent to 4.5 mg of lactose)).

3 Pharmaceutical Form

White crystalline powder for solution.

4 Clinical Particulars

4.1 Therapeutic Indications

For clearance of the bowel prior to examination by radiography, endoscopy or surgery.

4.2 Dose and Method of Administration

Instructions for timing of dose and dietary and fluid restrictions vary greatly between centres and may over-ride the recommendations given below. Clinical studies with Picosalax have shown the following regimens to be effective.

Adults (including the elderly) and children aged 9 years of age and older.

(If the procedure is scheduled for the afternoon, it is recommended that the split dose regimen be used).

Split dose regimen (evening before and day of the procedure).

The first Picosalax sachet is taken the night before the procedure, and the second is taken the next day, in the morning prior to the procedure.

On the day before the procedure - 1 sachet.

The first reconstituted sachet is taken in the evening (e.g. 5:00 to 9:00 pm), followed by at least five 250 mL drinks of clear liquids, spread over several hours.

On the day of the procedure - 1 sachet.

The second reconstituted sachet is taken in the morning (5-9 hours before the procedure), followed by at least three 250 mL drinks of clear liquids, spread over several hours.
Clear liquids may be consumed until 2 hours before the time of the procedure.

Day before regimen (evening before the procedure only).

The first Picosalax sachet is taken in the afternoon or early evening and the second is taken approximately 6 hours later, the night before the procedure.

On the day before the procedure - 2 sachets.

The first reconstituted sachet is taken in the afternoon or early evening (e.g. 4:00 to 6:00 pm), followed by at least five 250 mL drinks of clear liquids, spread over several hours.
The second reconstituted sachet is taken in the late evening (e.g. 10:00 pm to 12:00 am), followed by at least three 250 mL drinks of clear liquids, spread over several hours.
Clear liquids may be consumed until 2 hours before the time of the procedure.

Directions for reconstitution.

Immediately before use, mix the contents of one sachet in approximately 150 mL (2/3 of a cup) of water. Stir for 2-3 minutes, the solution should now become an off white, cloudy liquid with a faint odour of orange. If it becomes warm wait until it cools sufficiently to drink. Drink the solution. Do not prepare the solution in advance.

Further information.

Patients should be warned to expect frequent, loose bowel movements. To avoid dehydration it is recommended to drink a sufficient amount of clear liquids whilst the effects of Picosalax persist. Apart from the liquid intake together with the treatment regimen (Picosalax + additional liquids), a normal, thirst driven intake of clear liquids is recommended. Clear liquids may include water, clear soup, fruit juice without pulp, soft drinks, tea and/or coffee without milk (including soy and cream). Patients should be advised not to drink just water alone but to also drink a balanced electrolyte solution; drinking only water to replace fluid losses may lead to electrolyte imbalance, particularly hypokalemia or hyponatraemia and possibly seizures (see Section 4.4 Special Warnings and Precautions for Use). Patients should be instructed to consume only clear fluids (no solid food or milk) on the day before the procedure up until 2 hours before the time of the procedure.

4.3 Contraindications

Picosalax is contraindicated in patients with congestive heart failure, clinically significant renal impairment, known or suspected gastrointestinal obstruction or perforation, gastric retention, gastro-intestinal ulceration, toxic colitis, toxic megacolon, ileus, those with a stoma, nausea and vomiting, acute surgical abdominal conditions such as acute appendicitis, severe dehydration, rhabdomyolysis, hypermagnesemia, active inflammatory bowel disease or hypersensitivity to any of the ingredients.
In patients with severely reduced renal function, accumulation of magnesium in plasma may occur. Another preparation should be used in such cases.
Picosalax should not be used in patients with undiagnosed abdominal symptoms.

4.4 Special Warnings and Precautions for Use

Use with caution in patients with recent gastrointestinal surgery, renal impairment, heart disease or inflammatory bowel disease. Those patients with kidney disease or impaired renal function should be monitored, as should those with pre-existing electrolyte disturbances. Diabetics may need adjustment of their medication and careful monitoring of their blood glucose.
Patients using diuretics or other medications (such as corticosteroids, lithium) that may affect water and/or electrolyte balance should also be monitored (see Section 4.5 Interactions with Other Medicines and Other Forms of Interactions).
In all patients, adequate fluid intake should be maintained. An insufficient or excessive oral intake of water and electrolytes could create clinically significant deficiencies, particularly in less fit patients. In this regard, patients with low bodyweight, children, the elderly, debilitated individuals and patients at risk of hypokalaemia or hyponatremia may need particular attention. Prompt corrective action should be taken to restore fluid/ electrolyte balance in patients with signs or symptoms of hypokalemia or hyponatraemia. Drinking only water to replace the fluid losses may lead to electrolyte imbalance which may in severe cases lead to complications such as seizures and coma. In rare cases, Picosalax can cause severe or life-threatening electrolyte problems or impaired renal function in fragile or debilitated patients. Nephrocalcinosis and renal impairment may occur following use of oral sodium phosphate products in ‘at risk’ or inappropriate patient groups.
The period of bowel cleansing should not exceed 24 hours because longer preparation may increase the risk of water and electrolyte imbalance (see Section 4.2 Dose and Method of Administration).
Picosalax may modify the absorption of regularly prescribed oral medication and should be used with caution e.g. there have been isolated reports of seizures in patients on antiepileptics, with previously controlled epilepsy.
This medicine contains 5 mmol (or 195 mg) potassium per sachet. This should be taken into consideration by patients with reduced kidney function or patients on a controlled potassium diet.
Picosalax contains lactose as a component of the flavour (4.5 mg per sachet). Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine.
Picosalax is not intended for use as a routine laxative.

Use in the elderly.

As described, see Section 4.4 Special Warnings and Precautions for Use.

Use in children.

Picosalax should not be used in children under 9 years of age.

Effects on laboratory tests.

No data available.

4.5 Interactions with Other Medicines and Other Forms of Interactions

As a purgative, Picosalax increases 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.
Broad spectrum antibiotics may decrease the effect of Picosalax by interfering with the colonic bacteria needed to break down sodium picosulfate to form its active substance.
Medicines with the potential to chelate with magnesium (e.g. tetracyclines 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 Picosalax.
Care should be taken with patients already 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 Picosalax is used in patients on NSAIDs or drugs known to induce SIADH (syndrome of inappropriate antidiuretic hormone secretion), e.g. tricyclic antidepressants, selective serotonin reuptake inhibitors, antipsychotic drugs and carbamazepine as these drugs may increase the risk of water retention and/or electrolyte imbalance.
The efficacy of Picosalax is lowered by bulk forming laxatives.

4.6 Fertility, Pregnancy and Lactation

Effect on fertility.

Studies with Picosalax in animals have shown no impairment of fertility or embryo-fetal toxicity. In studies with sodium picosulfate alone, embryofetal toxicity has been observed in rats and. rabbits at very high doses.
Whilst animal reproduction studies with sodium picosulfate have revealed no evidence of a harmful action on the fetus, clinical experience of the use of Picosalax during pregnancy is limited and caution should be observed, particularly during the first trimester.
Neither sodium picosulfate nor magnesium citrate has been shown to be excreted in breast milk. As there is no experience with the use of Picosalax in nursing mothers, the product should only be used if clearly indicated.

4.7 Effects on Ability to Drive and Use Machines

Not relevant.

4.8 Adverse Effects (Undesirable Effects)

The most common adverse reactions are vomiting, nausea, abdominal pain and headache. Hyponatraemia is rare but is the most commonly reported serious adverse reaction. Adverse reactions from spontaneous reports are presented by frequency category based on incidence in clinical trials when known. Frequency from spontaneous reports for adverse reactions never observed in clinical trials is based on an algorithm as recommended in the European Commission SmPC guideline, 2009, rev 2. See Table 1.
Diarrhoea and faecal incontinence are the primary clinical effect of Picosalax.
Hyponatraemia has been reported with or without associated convulsions.
Reporting suspected adverse reactions after registration of the medicinal product is important. It allows continued monitoring of the benefit-risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions at

4.9 Overdose

Overdosage would lead to profuse diarrhoea with dehydration and fluid/ electrolyte imbalance. Treatment is by general supportive measures and correction of fluid and electrolyte imbalance.
For information on the management of overdose, contact the Poison Information Centre on 131126 (Australia).

5 Pharmacological Properties

5.1 Pharmacodynamic Properties

Mechanism of action.

The active components of Picosalax are sodium picosulfate, which stimulates bowel movements following metabolism by colonic bacteria, and magnesium citrate which acts as an osmotic laxative by increasing intestinal osmotic pressure thereby promoting retention of fluid within the bowel. The combined action of these components results in evacuation of the bowel contents.
Sodium picosulfate itself is pharmacologically inactive but is metabolised to an active metabolite, desacetylbisacodyl (bis(p-hydroxyphenyl)pyridyl-2-methane), which influences the chemoreceptors in the mucosa to increase intestinal motility. Desacetylbisacodyl is the same active metabolite formed following ingestion of bisacodyl, is insoluble in water and is minimally absorbed from the gastro-intestinal tract.

Clinical trials.

No data available.

5.2 Pharmacokinetic Properties

No data available.

5.3 Preclinical Safety Data


No data available.


No data available.

6 Pharmaceutical Particulars

6.1 List of Excipients

See Section 2 Qualitative and Quantitative Composition.

6.2 Incompatibilities

Incompatibilities were either not assessed or not identified as part of the registration of this medicine.

6.3 Shelf Life

3 years. The expiry date can be found on the packaging.

6.4 Special Precautions for Storage

Store below 30°C.

6.5 Nature and Contents of Container

Picosalax sachets contain a white crystalline powder. It is supplied in boxes containing 2 sachets.

6.6 Special Precautions for Disposal

In Australia, any unused medicine or waste material should be disposed of in accordance with local requirements.

6.7 Physicochemical Properties

Sodium picosulfate.

Molecular formula: C18H13NNa2O8S2. MW 481.4. CAS: 10040-45-6.

Light magnesium oxide.

Molecular formula: MgO. MW: 40.3. CAS: 1309-48-4.

Citric acid.

Molecular formula: C6H8O7. MW: 192.1. CAS: 77-92-9.

7 Medicine Schedule (Poisons Standard)


Summary Table of Changes