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 strong "washout" effect combined with stimulation of peristalsis, aimed at bowel cleansing before radiological examination, colonoscopy, or surgical procedures. 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 versus Klean-Prep (one sachet contains 59 g polyethylene glycol 3350, 5.685 g sodium sulfate, 1.685 g sodium bicarbonate, 1.465 g sodium chloride, and 0.7425 g potassium chloride; to be dissolved in 1 litre of water). Treatment groups were: CitraFleet administered the day before the procedure (2 sachets 5 hours apart during the afternoon and evening the day before colonoscopy, n=229); Klean-Prep administered the day before the procedure (4 sachets administered during the afternoon and evening the day before colonoscopy, n=227); and CitraFleet administered on the morning of the procedure (2 sachets 3 hours apart in 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 versus Klean-Prep), whereas significantly higher proportions of patients achieved good/excellent cleansing with the CitraFleet morning-of-procedure regimen compared with 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 reporting 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 CitraFleet regimens: split dosing (1 sachet in the evening the day before colonoscopy and the second sachet in the morning before colonoscopy, n=159) and morning-before regimen (1 sachet before 8:00 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). Good/excellent bowel cleansing was achieved by a significantly higher proportion of patients in the split-dose regimen (79.9% vs. 30.8% in the morning-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 and morning-before groups, respectively. More patients in the split-dose group than in the morning-before group experienced nausea (23.3% vs. 13.5%) and overall physical discomfort (29.6% vs. 17.3%), while more patients in the morning-before group experienced hunger (46.2% vs. 32.1% with the split-dose regimen). No serious adverse events occurred. Overall, mean changes in electrolyte values and other laboratory parameters were small in both groups.
⚠️ Warnings
Citrafleet should not be used as a routine laxative.
In rare cases, Citrafleet may 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.
Particular care should be taken when prescribing Citrafleet to any patients with regard to the known contraindications. In addition, special attention should be given to the importance of adequate hydration and, in at-risk patients (as identified 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 special care.
Citrafleet should be used with caution in patients with diagnosed fluid and/or electrolyte disturbances or in patients taking medicinal products that may affect fluid and/or electrolyte balance, such as diuretics, corticosteroids, lithium (see section
4.5
).
Caution should also be exercised in patients who have recently undergone gastrointestinal surgery or who have renal impairment, mild to moderate dehydration, hypotension, or cardiac disease.
The duration of bowel preparation should not exceed 24 hours, as prolonged preparation may increase the risk of fluid and electrolyte imbalance.
Diarrhoea resulting from the purgative action of Citrafleet may lead to fluid and electrolyte loss, hypovolaemia, and hypotension. In addition, vasovagal reflexes may be triggered by abdominal stimuli, e.g. pain, which may result in low blood pressure and loss of consciousness. Adequate intake of clear fluids is essential, see section
4.2
.
Citrafleet may alter the absorption of regularly prescribed oral medications, and therefore should be used with caution. For example, isolated cases of seizures have been reported in patients taking antiepileptic drugs in whom epilepsy was previously well controlled (see sections
4.5
and
4.8
).
Citrafleet may induce aphthoid ulcers 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 should be taken into consideration in patients with reduced renal function and in patients on a controlled potassium diet.
This medicinal product contains less than 1 mmol (23 mg) sodium per sachet, that is to say essentially sodium-free.
This product contains sulfites including disulfites and hydrogen sulfites, which are formed from maltodextrin present in the lemon flavouring. Rarely, it may cause severe hypersensitivity reactions and bronchospasm.
👨⚕️
Verified by medical editor
Dr. Ozarchuk, PharmD · April 2026
User Reviews
Reviews reflect personal experiences and are not medical advice. Always consult your doctor.
