Limitations: This safety classification applies only to preparations containing a combination of Sodium picosulfate, magnesium oxide and citric acid. The same ATC-code (A06AB58) may in some countries be used for different combinations of sodium picosulfate and other drugs which in theory may be porphyrinogenic. Please refer to the classification and monograph of each individual substance. If the combination contains a substance which is not classified (NC) or has been classified as porphyrinogenic (PRP or P), the safety classification of such a combination as PNP is no longer valid. Fasting prior to colonoscopy or intestinal X-ray carries a risk of precipitating an acute attack of porphyria secondary to caloric deficit, and motivates attention to nutritive balance of the patient. A fluid intake of about 250 ml per hour is recommended during the washout period to avoid dehydration. For carriers of acute porfyria it may be beneficial to drink beverages with a high content of carbohydrates. Prophylactic parenteral administration of glucose may also be indicated. Stress in connection with the procedure, and insomnia dependent on nausea and dehydration, are also risk factors. Sodium picosulfate, combinations is only locally active in the colon and has no significant systemic exposure.

Sodium picosulfate, combinations is used for bowel evacuation prior to colonoscopy or X-ray. It is administered as an oral solution. Common adverse reactions of sodium picosulfate, combinations that can be confused with an acute porphyric attack are abdominal pain, nausea and insomnia (secondary to diarrhoea and dehydration).

Sodium picosulphate is metabolized by colonic bacteria by desulphatation to the active compound bis hydroxyphenyl pyridyl methane, which is not absorbed in significant quantities. There are no relevant pharmacokinetic interactions. Citric acid is not significantly absorbed. In patients with severe renal insufficiency accumulation of magnesium in plasma may take place.