Citrafleet

Citrafleet is an oral bowel‑preparation product that combines sodium picosulfate, magnesium oxide and citric acid. It is supplied as a powder that is reconstituted with water for oral intake. The formulation uses the stimulant action of sodium picosulfate together with the osmotic effects of magnesium oxide and citric acid to promote intestinal cleansing. Citrafleet is marketed in the European Union for diagnostic colonoscopy procedures.

Citrafleet is indicated for bowel cleansing in preparation for visualising the colon during endoscopic or radiological examinations, ensuring optimal visibility of the mucosal surface.

- Bowel preparation before colonoscopy, providing a clear colon for lesion detection. - Cleansing prior to flexible sigmoidoscopy or other endoscopic procedures. - Preparation for radiological studies such as CT colonography or barium enema. - Use when a rapid, thorough intestinal evacuation is required, typically completed within 24 hours. - May be employed in clinical research protocols that mandate a clean colon for accurate assessment.

The most frequently reported adverse events with Citrafleet are related to its laxative action and electrolyte shifts.

Common: - Abdominal cramping or discomfort that may be intermittent. - Diarrhoea or loose stools occurring several times per hour. - Nausea, occasionally accompanied by mild vomiting. - Increased thirst or sensation of mild dehydration. - Transient headache, often relieved with fluid intake.

Serious: - Severe dehydration that can lead to clinically significant electrolyte imbalance. - Acute renal impairment, particularly in patients with pre‑existing kidney disease. - Marked electrolyte disturbances such as hyponatraemia, hypermagnesaemia, or metabolic acidosis. - Allergic reactions, including rash, pruritus, or angio‑edema. - Persistent vomiting that prevents adequate oral rehydration.

When using Citrafleet, several precautionary measures should be observed to minimise risk and ensure safe bowel preparation.

- Assess renal function before administration, especially in patients with known kidney disease. - Verify electrolyte status; correct existing imbalances prior to dosing. - Ensure adequate fluid intake (minimum 2 L of clear liquids) during the preparation period. - Use with caution in elderly or frail patients who may be more susceptible to dehydration. - Avoid in individuals with known hypersensitivity to any component of the formulation. - Consider postponing use in patients with active gastrointestinal obstruction or perforation. - Discuss with a healthcare professional before use during pregnancy or lactation.

Citrafleet may interact with other medicines or substances that affect fluid balance, electrolytes, or gastrointestinal motility.

Avoid: - Concomitant use of other potent laxatives or stimulant agents, which can increase the risk of severe diarrhoea and electrolyte loss. - Loop or thiazide diuretics without close monitoring, due to additive dehydration and electrolyte disturbances. - Medications that prolong the QT interval, as electrolyte shifts may exacerbate cardiac risk.

Use with caution: - Antacids containing aluminium or calcium, which may reduce the osmotic effect of magnesium oxide. - Oral rehydration solutions or electrolyte supplements; adjust dosing to avoid hypermagnesaemia. - NSAIDs or other nephrotoxic drugs, especially in patients with reduced renal function. - ACE inhibitors or ARBs, requiring monitoring of blood pressure and renal parameters.