Pharmacotherapeutic group: sodium picosulfate, combinations, ATC code: A06AB58. The active ingredients of Citrafleet are sodium picosulfate, a stimulant laxative acting locally in the colon, and magnesium citrate, which acts as an osmotic laxative by retaining moisture in the colon. These substances produce a powerful "washout" effect combined with stimulation of peristalsis, aimed at bowel cleansing prior to radiological examination, colonoscopy, or surgical intervention. The product is not intended for use as a routine laxative.
In a randomised, multicentre, blinded study in adults, bowel cleansing before colonoscopy was compared using two different regimens with CitraFleet and the following product Klean-Prep (one sachet contains 59 g polyethylene glycol 3350, 5.685 g sodium sulphate, 1.685 g sodium bicarbonate, 1.465 g sodium chloride, and 0.7425 g potassium chloride; to be dissolved in 1 litre of water). The treatment groups were: CitraFleet administered the day before the procedure (2 sachets 5 hours apart during the afternoon and evening before colonoscopy, n=229); Klean-Prep administered the day before the procedure (4 sachets administered during the afternoon and evening before colonoscopy, n=227); and CitraFleet administered on the morning of the procedure (2 sachets 3 hours apart on the morning before colonoscopy, n=56). Bowel cleansing was assessed using a categorical scale (excellent, good, acceptable, and poor). Good/excellent cleansing was recorded in 68.1% of patients with the CitraFleet day-before regimen (statistically non-significant difference compared to Klean-Prep), while significantly higher proportions of patients achieved good/excellent cleansing with the CitraFleet morning-of-procedure regimen compared to both day-before regimens (p<0.05). Both CitraFleet regimens were rated by patients as substantially easier to complete than Klean-Prep (p<0.001). All regimens were well tolerated, with only 2.2% of patients experiencing adverse events with the CitraFleet day-before regimen. No serious adverse events occurred.
In a randomised, multicentre, blinded study in adults, bowel cleansing before colonoscopy was compared using two different regimens with CitraFleet: split dosing (1 sachet in the evening before colonoscopy and the second sachet in the morning before colonoscopy, n=159) and a morning day-before regimen (1 sachet before 8:00 AM the day before colonoscopy and the second sachet 6–8 hours later, n=156). Bowel cleansing was assessed using a categorical scale (excellent, good, acceptable, and poor). A significantly higher proportion of patients achieved good/excellent bowel cleansing with the split-dose regimen (79.9% vs. 30.8% with the morning day-before regimen, p<0.0001). Over 93% of patients in both groups rated the regimens as "easy" or "very easy" to take. Both regimens were well tolerated, with 1.9% and 2.5% of patients experiencing adverse events in the split-dose group and the morning day-before group, respectively. More patients in the split-dose group than in the morning day-before group experienced nausea (23.3% vs. 13.5%) and overall physical discomfort (29.6% vs. 17.3%), while more patients in the morning day-before group experienced hunger (46.2% vs. 32.1% with the split-dose regimen). No serious adverse events occurred. Overall, the mean changes in electrolyte values and other laboratory parameters were small in both groups.
⚠️ Warnings
Citrafleet should not be used as a routine laxative.
Citrafleet could in rare cases lead to serious and potentially fatal electrolyte disturbances or renal impairment in frail or debilitated patients. Therefore, the benefit/risk balance of Citrafleet must be carefully evaluated in this at-risk population before initiating treatment.
Special attention is required when prescribing Citrafleet to any patients with regard to the known contraindications. Furthermore, special attention should be paid to the importance of adequate hydration and, in at-risk patients (as described below), to the importance of determining electrolyte levels at baseline and after completion of treatment.
Elderly and debilitated patients, as well as patients at risk of developing hypokalaemia or hyponatraemia, may require particular care.
Citrafleet should be used with caution in patients with diagnosed disturbances of water and/or electrolyte balance or in patients taking medicinal products that may affect water and/or electrolyte balance, such as diuretics, corticosteroids, or lithium (see section 4.5).
Caution is also required in patients who have recently undergone gastrointestinal surgery or who suffer from renal impairment, mild to moderate dehydration, hypotension, or cardiac disease.
The bowel cleansing period should not exceed 24 hours, as prolonged preparation may increase the risk of water and electrolyte imbalance.
Diarrhoea caused by the evacuant effect of Citrafleet may result in fluid and electrolyte loss, hypovolaemia, and hypotension. Additionally, a vasovagal reflex may be triggered through abdominal stimuli, e.g. pain, which may lead to low blood pressure and loss of consciousness. Adequate intake of clear fluids is necessary, see section 4.2.
Citrafleet may alter the absorption of commonly prescribed oral medicinal products and should therefore be used with caution. For example, isolated cases of seizures have been reported in patients taking antiepileptic drugs whose epilepsy was previously well controlled (see sections 4.5 and 4.8).
Citrafleet may induce aphthoid ulceration of the colonic mucosa, and serious cases of colitis (including ischaemic colitis) requiring hospitalisation have been reported. Consequently, this diagnosis should be considered in cases of severe and/or persistent abdominal pain, with or without rectal bleeding, following administration of Citrafleet.
This product contains 5 mmol (or 195 mg) of potassium per sachet. This must be taken into consideration in patients with reduced renal function and in patients on a low-potassium diet.
This medicinal product contains less than 1 mmol (23 mg) of sodium per sachet, meaning it is essentially sodium-free.
This medicinal product contains sulphites including disulphites and hydrogen sulphites, which arise from the maltodextrin present in the lemon flavouring. Rarely, these may cause severe hypersensitivity reactions and bronchospasm.
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Verified by medical editor
Dr. Ozarchuk, PharmD · April 2026
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