What is Clenpiq (sodium picosulfate and magnesium oxide)?

Clenpiq (Sodium Picosulfate and Magnesium Oxide)

Clenpiq is an FDA-approved bowel preparation medication that combines sodium picosulfate (a stimulant laxative) with magnesium oxide and anhydrous citric acid (which together form magnesium citrate, an osmotic laxative) used for cleansing the colon before colonoscopy procedures. 1

Mechanism of Action

Clenpiq works through a dual mechanism:

1. Stimulant laxative effect: Sodium picosulfate is a prodrug that is hydrolyzed by colonic bacteria to form an active metabolite (BHPM) which directly stimulates the colonic mucosa to increase peristalsis 1

2. Osmotic laxative effect: Magnesium oxide and citric acid react to create magnesium citrate in solution, which causes water retention in the gastrointestinal tract 1

Together, these mechanisms produce a purgative effect that, when combined with additional fluid intake, results in watery diarrhea that cleanses the bowel.

Administration

Clenpiq is administered as a split-dose regimen (preferred method):

• First dose: Evening before colonoscopy
• Second dose: Morning of colonoscopy
• Additional clear fluids must be consumed after each dose 1

Alternative "day-before" method:

• First dose: Afternoon/early evening before colonoscopy
• Second dose: 6 hours later in the evening before colonoscopy 1

Efficacy

Recent evidence shows that:

• Split-dose sodium picosulfate with magnesium oxide/citrate significantly improves bowel cleansing compared to traditional dosing regimens 2
• It has comparable efficacy to polyethylene glycol (PEG) preparations 3, 4
• In some studies, it demonstrates slightly better quality of bowel cleansing than PEG (pooled RR 1.06; 95% CI 1.02 to 1.11) 4

Patient Tolerability

Clenpiq offers several advantages:

• Better tolerated than PEG-based preparations 3, 4
• Higher patient compliance and willingness to repeat the regimen 3
• Lower volume requirement compared to traditional 4L PEG solutions 5

Safety Considerations and Contraindications

Clenpiq is contraindicated in patients with:

• Severe renal impairment (creatinine clearance <30 mL/min)
• GI obstruction or ileus
• Bowel perforation
• Toxic colitis or toxic megacolon
• Gastric retention
• Hypersensitivity to ingredients 1

Important safety warnings:

• Risk of fluid and electrolyte abnormalities
• Potential for cardiac arrhythmias in at-risk patients
• Increased seizure risk in susceptible individuals
• Caution in patients with mild to moderate renal impairment
• Magnesium-based preparations should be avoided in patients with chronic kidney disease 3, 1

Common Adverse Effects

The most commonly reported adverse effects include:

• Nausea
• Headache
• Vomiting
• Abdominal cramps/pain
• Dizziness (more common with sodium picosulfate than with PEG) 1, 6, 4

Clinical Pearls

1. Always ensure adequate hydration before, during, and after using Clenpiq
2. Do not take oral medications within 1 hour of starting each dose
3. If taking tetracycline, fluoroquinolone antibiotics, iron, digoxin, chlorpromazine, or penicillamine, take these medications at least 2 hours before and not less than 6 hours after Clenpiq administration 1
4. The powder must be dissolved in water before consumption; direct ingestion of undissolved powder increases risk of nausea, vomiting, and dehydration 1
5. Split-dose administration provides superior bowel cleansing, particularly in the right colon 2

By combining both stimulant and osmotic laxative properties in a low-volume preparation, Clenpiq offers an effective option for bowel preparation that balances efficacy with patient tolerability.