Pico Plus5 mg/5 ml

Pico Plus is a stimulant laxative used in the following situations:

Established / Approved Uses

• Short-term treatment of constipation (occasional or chronic constipation of various causes) when dietary and lifestyle measures are insufficient.
• Bowel cleansing (bowel preparation) prior to colonoscopy, other radiologic/endoscopic investigations, or abdominal/pelvic surgery, so that the bowel is empty and visualization/operative conditions are adequate.

Combination-Therapy Use

• For full bowel cleansing before colonoscopy, Pico Plus is frequently combined with an osmotic agent such as magnesium citrate or magnesium oxide with citric acid (e.g. in fixed-dose bowel-prep kits); the split-dose regimen (evening before and morning of the procedure) gives the best cleansing.

Pico Plus is not intended for routine, long-term management of constipation; if constipation persists beyond a few days despite use, a physician should be consulted to evaluate for an underlying cause.

Each formulation contains Sodium Picosulfate as the active pharmaceutical ingredient. It is available as tablets (commonly 5 mg or 10 mg), oral drops/solution, and as part of combination bowel-preparation powders/solutions together with magnesium oxide/magnesium citrate and citric acid. Refer to the specific product label for exact strength and excipients.

Pico Plus is a triarylmethane-type stimulant laxative belonging to the same pharmacological family as bisacodyl. It is essentially inactive when taken orally and is converted by colonic bacteria into its active metabolite, which stimulates colonic motility and alters fluid and electrolyte transport in the bowel to produce a bowel movement. It is used both for occasional constipation and, at higher doses, for bowel cleansing before colonoscopy and other procedures.

Pico Plus belongs to the therapeutic class of stimulant (contact) laxatives, specifically the triarylmethane laxative subgroup, and is also used as a component of osmotic/stimulant combination bowel-cleansing (bowel preparation) agents.

Mechanism of action: Sodium Picosulfate is a prodrug that is largely unabsorbed and pharmacologically inactive in the stomach and small intestine. In the colon, bacterial enzymes (sulfatases) cleave it to its active free diphenol metabolite, bis-(p-hydroxyphenyl)-pyridyl-2-methane (BHPM). BHPM directly stimulates sensory nerve endings in the colonic mucosa, increasing peristaltic contractions of the large bowel, and also modifies water and electrolyte transport, increasing intraluminal fluid accumulation. The combined effect softens stool and promotes evacuation.

Onset of action: Typically 6-12 hours after oral administration, which is why it is usually dosed at bedtime for a morning bowel movement.

Pharmacokinetics: Systemic absorption of both the parent drug and its active metabolite is minimal; the drug acts locally within the colon, which limits systemic pharmacokinetic effects.

Take Pico Plus orally, generally at bedtime for constipation so that an evacuation occurs the following morning. For bowel-cleansing regimens, dissolve/take the product exactly as directed (often split into an evening and a morning dose) and drink plenty of clear fluids throughout the preparation period to avoid dehydration.

Reduced absorption of concomitant oral medications: When Pico Plus is used at bowel-preparation doses, the resulting rapid bowel evacuation and diarrhea can reduce the absorption of other orally administered drugs taken around the same time; oral medications should generally be timed at least 1 hour before or several hours after dosing, or as advised by a physician.

Diuretics and corticosteroids: Concomitant use with diuretics (e.g. loop or thiazide diuretics) or corticosteroids may increase the risk of electrolyte disturbances (particularly hypokalemia), because both drug classes can independently promote potassium loss; electrolyte monitoring is advised with combined use, especially in bowel-prep regimens.

Antibiotics: Broad-spectrum antibiotics may reduce colonic bacterial activity needed to convert Pico Plus to its active metabolite, potentially reducing laxative effectiveness.

Other laxatives: Concurrent use with other laxatives is not recommended as it increases the risk of excessive purgation, dehydration, and electrolyte imbalance.

Common and important adverse effects associated with Pico Plus include:

• Abdominal cramping and pain
• Diarrhea and loose stools
• Nausea and vomiting
• Bloating and flatulence
• Dizziness or, rarely, syncope (fainting), particularly with vigorous bowel preparation
• Electrolyte disturbances (e.g. hypokalemia, hyponatremia) and dehydration, especially with the higher doses used for bowel cleansing
• Hypersensitivity reactions (rash, pruritus; rarely angioedema) — uncommon

Electrolyte disturbances and dehydration are of particular concern with bowel-preparation doses; patients should drink adequate clear fluids and seek medical attention for severe or persistent symptoms (e.g. marked weakness, palpitations, reduced urination, confusion).

Pregnancy: Data on Pico Plus use in pregnancy are limited. As a general precaution, Pico Plus should be avoided during the first trimester and used in later pregnancy only if clearly needed, after the potential benefit to the mother has been weighed against potential risk to the fetus, and under medical supervision. Bowel-preparation regimens (higher doses, risk of dehydration/electrolyte disturbance) require particular caution in pregnancy and should only be used if a physician determines it is necessary.

Lactation: Available data suggest that Pico Plus and its active metabolite are not significantly excreted into breast milk of healthy lactating women, and short-term use at usual laxative doses is generally considered acceptable; however, a physician should be consulted before use during breastfeeding, particularly for bowel-preparation doses.

Not for prolonged use: Pico Plus is intended for short-term or occasional use. Prolonged or excessive use as a laxative can lead to laxative dependence, loss of normal bowel function, and chronic electrolyte imbalance (particularly hypokalemia).

Fluid and electrolyte status: Use with caution in elderly patients and those with renal impairment, cardiac disease (including arrhythmia risk from electrolyte shifts), or conditions predisposing to fluid/electrolyte disturbance, especially when used for bowel preparation; adequate hydration and, where appropriate, electrolyte monitoring are recommended.

Undiagnosed abdominal symptoms: Do not use in patients with undiagnosed abdominal pain, as this may mask or worsen a serious underlying condition — see Contraindications.

Bowel preparation setting: Ensure adequate oral fluid intake throughout the bowel-cleansing process; patients with impaired swallowing, seizure disorder, or at risk of aspiration/regurgitation should use bowel-prep regimens only under close medical supervision.

General: Pico Plus should be taken exactly as directed by the physician or as per the product label; do not exceed the recommended dose or duration without medical advice.

Overdose or excessive use of Pico Plus may cause severe abdominal cramping, profuse diarrhea, significant fluid and electrolyte loss, and dehydration. If overdose is suspected, seek immediate medical attention or contact a poison control center; supportive treatment (rehydration and correction of electrolyte imbalance) should be provided by a healthcare professional. Do not attempt to self-treat a significant overdose at home.

Store at room temperature (below 30°C), away from light and moisture. Keep out of reach of children.

Elderly: Use with caution; elderly patients are at higher risk of dehydration and electrolyte disturbance, particularly with bowel-preparation doses. Adequate hydration and monitoring are advised.

Renal impairment: Use with caution, particularly for bowel-preparation regimens, due to increased risk of fluid and electrolyte imbalance; medical supervision is recommended.

Hepatic impairment: No specific dose adjustment is well established; use with general caution and medical guidance.

Cardiac disease: Use with caution in patients with cardiac disease, as electrolyte shifts (especially hypokalemia) can predispose to arrhythmia; this is particularly relevant for bowel-preparation doses.

Pediatric and pregnant/lactating patients: See Pediatric Uses and Pregnancy and Lactation sections.

For constipation, Pico Plus should be used for the shortest duration needed to restore normal bowel habit, typically no more than a few days to about one week, unless otherwise directed by a physician; if constipation persists, medical review is advised. For bowel preparation, it is used as a single-course regimen (evening and morning doses) immediately before the scheduled procedure, as directed.

Stimulant (contact) laxative; triarylmethane laxative; bowel-cleansing/bowel-preparation agent (often combined with magnesium oxide/magnesium citrate and citric acid).

Sodium Picosulfate is hydrolyzed by colonic bacterial enzymes to its active metabolite (BHPM), which stimulates colonic sensory nerve endings to increase peristalsis and alters intestinal fluid/electrolyte transport to increase luminal water content, producing a laxative effect within about 6-12 hours.

Pico Plus may be used in children for constipation under medical supervision, with age-based dosing: children over 10 years, 5-10 mg daily; children 4-10 years, 2.5-5 mg daily; infants and young children 1 month to 4 years, approximately 0.25 mg/kg daily. Use in infants and young children should be initiated and supervised by a physician. Safety and efficacy of Pico Plus-containing bowel-preparation products for colonoscopy have not been well established in young children, and such use should only occur under specialist medical direction.