Prepopik (Citric Acid / Magnesium Oxide / Sodium Picosulfate)

See the Instructions for Use on the outer product carton for dosing. You must read, understand, and follow these instructions to take Prepopik the right way.

• Take exactly as your healthcare provider tells you to take it. Your healthcare provider will prescribe the Split-Dosing option or the Day Before Dosing option, depending on colonoscopy scheduling, distance traveled, and other personal circumstances.
• A complete preparation requires 2 packets of Prepopik for oral solution taken separately, each followed by additional fluids.
• It is important for you to drink the additional prescribed amount of clear liquids after dosing to prevent fluid loss (dehydration).
• Examples of clear liquids include water, clear broth, apple juice, white cranberry juice, white grape juice, and ginger ale, plain jello (not red or purple) and frozen juice bars(not purple or red).
• Do not eat solid foods or drink milk
• Drink clear liquids until your colonoscopy.
• Do not take other laxatives.
• Stop drinking Prepopik temporarily or allow for longer time between each dose if you have bloating, distension, or stomach (abdominal) pain until your symptoms improve.
• Stop taking Prepopik and, and call your healthcare provider right away if you develop hives or rash after you take your first packet of Prepopik. These may be signs of an allergic reaction.

See the Instructions for Use on the outer product carton for dosing. You must read, understand, and follow these instructions to take Prepopik the right way.

1. Split-Dose (evening-before and day of the procedure) Dosing

   Take your first packet the night before your colonoscopy, and take your second dose the next day, in the morning before your colonoscopy.

   On the day before your colonoscopy procedure – 1 packet:

   • Dissolve 1 packet of powder in 5 ounces of cold water in the evening, followed by five 8-ounce drinks (upper line on the dosing cup) of clear liquids before bed.

   On the day of the colonoscopy procedure – 1 packet:

   • Dissolve 1 packet of powder in 5 ounces of cold water in the morning (5 hours before the colonoscopy), followed by at least three 8-ounce drinks of clear liquids before the colonoscopy.

   You may continue to drink clear liquids until 2 hours before the time of the colonoscopy.

2. Day-Before (afternoon and evening-before the procedure) Dosing

   Take your first packet in the afternoon or early evening and take your second packet 6 hours later, the night before the colonoscopy.

   On the day before the colonoscopy procedure – 2 packets:

   • Dissolve 1 packet of powder in 5 ounces of cold water in the afternoon or early evening, followed by five 8-ounce drinks (upper line on the dosing cup) of clear liquids before the next dose.
   • Dissolve 1 packet of powder in 5 ounces of cold water in the late evening (followed by three 8­ ounce drinks (upper line on the dosing cup) of clear liquids before bed.

   You may continue to drink clear liquids until 2 hours before the time of the colonoscopy.

Prepopik can cause serious side effects, including:

• See Important information about Prepopik
• changes in certain blood tests. Your healthcare provider may do blood tests after you take this medicine to check your blood for changes. Tell your healthcare provider if you have any symptoms of too much fluid loss, including:
  • Vomiting
  • Nausea
  • Bloating
  • Dizziness
  • Stomach(abdominal) cramping
  • Urinating less than usual
  • Trouble drinking clear liquids
  • Trouble swallowing
  • Seizures
  • Heart problems (arrhythmia). Prepopik may cause irregular heartbeats
  • Ulcers of the bowel or bowel problems (ischemic colitis). Tell your healthcare provider right away if you have severe stomach (abdominal) pain or rectal bleeding. These may be symptoms of decreased blood flow to the intestine.

The most common side effects include:

• nausea
• headache
• vomiting

Tell your healthcare provider if you have any side effect that bothers you or that does not go away.

These are not all the possible side effects of Prepopik. For more information, ask your healthcare provider or pharmacist. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA­ 1088.

Do not take Prepopik if your healthcare provider has told you that you have:

• serious kidney problems
• a blockage in your intestine (bowel obstruction)
• an opening in the wall of your stomach or intestines (bowel perforation)
• a very dilated intestine (toxic megacolon)
• problems with the emptying of food and fluid from your stomach (gastric retention)
• an allergy to any of the ingredients in Prepopik. See the end of this leaflet for a complete list of ingredients.

Before taking this medicine

Before you take Prepopik, tell your healthcare provider if you:

• have heart problems
• have stomach or bowel problems
• have ulcerative colitis
• have problems with swallowing or gastric reflux
• are withdrawing from drinking alcohol and benzodiazepines
• have kidney problems
• have low blood salt (sodium) level
• any other medical conditions
• are pregnant. It is not known if this medicine will harm your unborn baby. Talk to your provider if you are pregnant or plan to become pregnant.
• are breastfeeding or plan to breastfeed. It is not known if this medicine passes into your breast milk.

You and your healthcare provider should decide if you will take Prepopik while breastfeeding.

Tell your healthcare provider about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements.

Prepopik may affect how other medicines work. Medicines taken by mouth may not be absorbed properly when taken within one hour before the start of Prepopik.

Especially tell your healthcare provider if you take:

• medicines for blood pressure or heart problems medicines for kidney problems
• medicines for seizures
• water pills (diuretics)
• nonsteroidal anti-inflammatory medicines (pain medicines)
• medicines for depression or mental health problems
• laxatives
• the following medicines should be taken at least 2 hours before starting, and not less than 6 hours after taking Prepopik:
  • tetracycline
  • fluoroquinolone antibiotics
  • iron
  • digoxin (Lanoxin) chlorpromazine
  • penicillamine (Cuprimine, Depen)

Ask your healthcare provider or pharmacist for a list of these medicines if you are not sure if you are taking the medicines listed above.

Know the medicines you take. Keep a list of them to show your healthcare provider and pharmacist when you get a new medicine.

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

Do not use other laxatives while taking this product.