Back to Journals » Clinical and Experimental Gastroenterology » Volume 8

Serum magnesium concentrations in patients receiving sodium picosulfate and magnesium citrate bowel preparation: an assessment of renal function and electrocardiographic conduction

Authors Bertiger G, Jones E, Dahdal D, Marshall D, Joseph R

Received 13 December 2014

Accepted for publication 3 April 2015

Published 28 July 2015 Volume 2015:8 Pages 215—224


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Professor Andreas M Kaiser

Gerald Bertiger,1 Edward Jones,2 David N Dahdal,3 Dennis C Marshall,3 Raymond E Joseph3

1Hillmont GI, Flourtown, PA, USA; 2Delaware Valley Nephrology and Hypertension Associates, Philadelphia, PA, USA; 3Ferring Pharmaceuticals Inc., Parsippany, NJ, USA

Background: We performed a post hoc analysis of two clinical trials to assess whether sodium picosulfate and magnesium (Mg2+) citrate (Prepopik® [P/MC]), a dual-action bowel preparation for colonoscopy, has an impact on serum Mg2+ levels and cardiac electrophysiology. Although rare, hypermagnesemia has been reported in patients consuming Mg2+-containing cathartics, especially patients who are elderly and have renal impairment.
Methods: Data were analyzed from two prospective, Phase III, randomized, assessor-blinded, active-control, multicenter, pivotal studies that investigated split-dose/day-before P/MC. Serum Mg2+ and creatinine clearance (CrCl) were measured at screening, on the day of colonoscopy, and 24–48 hours, 7 days, and 4 weeks after colonoscopy; electrocardiograms also were obtained at these time points.
Results: In total, 304 patients received split-dose P/MC and 294 patients received day-before P/MC. Only 10% of the patients had serum Mg2+ above the upper limit of normal (1.05 mmol/L) on the day of colonoscopy. There was a slight inverse correlation between CrCl and Mg2+ levels on the day of colonoscopy; however, even at the lowest CrCl, serum Mg2+ remained below clinically significant levels of 2.0 mmol/L. Increases in serum Mg2+ were transient, with levels returning to baseline within 24–48 hours, regardless of renal function. No patients with elevated Mg2+ experienced a corrected QT (QTc) interval >500 milliseconds or a QTc interval increase of ≥60 milliseconds from baseline. P/MC had no impact on PR or QRS interval.
Conclusion: P/MC produces little impact on serum Mg2+ levels with no clinically significant effect on cardiac conduction in patients, including those with mild-to-moderate renal impairment.

bowel preparation, hypermagnesemia, renal impairment, sodium picosulfate

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]