The makers of PREPOPIK have introduced a new FDA-approved, ready-to-drink, low volume bowel prep.
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Action (MOA)

PREPOPIK® has 3 active ingredients: sodium picosulfate, magnesium oxide, and anhydrous citric acid, which are responsible for its dual mechanism of action—osmotic laxative and stimulant laxative.2
Magnesium oxide and anhydrous citric acid react to create magnesium citrate, which produces osmotic water retention and causes water to be retained in the gastrointestinal tract.2
Free magnesium pulls water into the intestinal lumen, causing a softening of the stool.2
Sodium picosulfate is converted by intestinal bacteria in the colon to an active metabolite that stimulates colonic peristalsis to effectively remove waste by emitting regular, wavelike contractions to clear the colon.2
PREPOPIK® must be stirred for 3 minutes to activate the solution.2

Make sure you instruct your patients on the importance of proper hydration both before and after each dose of PREPOPIK®, and after the procedure.3

An exothermic reaction takes place over a period of time (up to 3 minutes). This time is necessary in order to complete the reaction and activate the ingredient (magnesium citrate).2

Overall Colon (primary endpoint)1*†
Percentage of patients achieving excellent or good visualization (Split-Dose PREPOPIK® vs Day-Before comparator)
Mid Colon (secondary endpoint)1*†
Percentage of patients achieving successful cleansing in the mid colon (Split-Dose PREPOPIK® vs Day-Before comparator)
Ascending Colon (secondary endpoint)1*†
Percentage of patients achieving successful cleansing in the ascending colon (Split-Dose PREPOPIK® vs Day-Before comparator)
Rectosigmoid Colon (secondary endpoint)1*†
Percentage of patients achieving successful cleansing in the rectosigmoid colon (Split-Dose PREPOPIK® vs Day-Before comparator)
*Split-Dose PREPOPIK® was studied in a head-to-head trial to demonstrate noninferiority with the Day-Before Regimen of 2L PEG+E plus 2 x 5 mg bisacodyl tablets. The primary efficacy endpoint was the proportion of patients with successful colon cleansing, defined as bowel preparation with >90% of the mucosa seen and mostly liquid stool, assessed by blinded colonoscopists using a modified Aronchick scale. The secondary endpoints were the quality of cleansing of the ascending, mid (transverse and descending), and rectosigmoid segments of the colon using the Ottawa scale. Patients were considered to be successfully cleansed after administration of prescribed treatment if colon cleansing on the Ottawa Scale was rated excellent, good, or fair.
†Mid colon refers to the transverse and descending segments of the colon.
Overall Colon (primary endpoint)4*†
Percentage of patients achieving excellent or good visualization (Day-Before PREPOPIK® vs Day-Before comparator)
Mid Colon (secondary endpoint)4*†
Percentage of patients achieving successful cleansing in the mid colon (Day-Before PREPOPIK® vs Day-Before comparator)
Ascending Colon (secondary endpoint)4*†
Percentage of patients achieving successful cleansing in the ascending colon (Day-Before PREPOPIK® vs Day-Before comparator)
Rectosigmoid Colon (secondary endpoint)4*†
Percentage of patients achieving successful cleansing in the rectosigmoid colon (Day-Before PREPOPIK® vs Day-Before comparator)
*Day-Before PREPOPIK® was studied in a head-to-head trial to demonstrate noninferiority with the Day-Before Regimen of 2L PEG+E plus 2 x 5 mg bisacodyl tablets. The primary efficacy endpoint was the proportion of patients with successful colon cleansing, defined as bowel preparation with >90% of the mucosa seen and mostly liquid stool, assessed by blinded colonoscopists using a modified Aronchick scale. The secondary endpoints were the quality of cleansing of the ascending, mid (transverse and descending), and rectosigmoid segments of the colon using the Ottawa scale. Patients were considered to be successfully cleansed after administration of prescribed treatment if colon cleansing on the Ottawa Scale was rated excellent, good, or fair.
†Mid colon refers to the transverse and descending segments of the colon.

- The overall incidence of treatment-emergent adverse reactions was similar among patients ≥65 years of age and those <65 years of age

The most common adverse reactions associated with PREPOPIK® were nausea, headache, and vomiting.*
Reaction
Reaction
*Data on abdominal bloating, distension, pain/cramping, and watery diarrhea not requiring an intervention were not collected.
†2L PEG+E = Two liters polyethylene glycol plus electrolytes solution administered in a day-before regimen.

The SEE CLEAR I (Split-Dose PREPOPIK®) and SEE CLEAR II (Day-Before PREPOPIK®) studies were phase 3, randomized, multicenter, assessor-blinded, noninferiority studies in patients preparing for colonoscopy. The primary endpoints were the evaluation of overall colon cleansing with PREPOPIK® vs a Day-Before comparator (2L PEG+E plus 2 x 5 mg bisacodyl tablets) using the modified Aronchick scale. The primary efficacy endpoint was the proportion of patients with successful colon cleansing, defined as bowel preparations with >90% of the mucosa seen and mostly liquid stool, assessed by blinded colonoscopists.
In each study, tolerability was measured via a patient questionnaire about orange-flavored PREPOPIK®, which included the questions: “Would you ask your doctor for this preparation again if you needed another colonoscopy?” and “How easy or difficult was it to consume the prescribed bowel preparation?”
References: 1. Rex DK, Katz PO, Bertiger G, et al. Split-dose administration of a dual-action, low-volume bowel cleanser for colonoscopy: the SEE CLEAR I study. Gastrointest Endosc. 2013;78(1):132-141. 2. PREPOPIK® [Prescribing Information]. Parsippany, NJ: Ferring Pharmaceuticals Inc. 3. Lichtenstein GR, Cohen LB, Uribarri J. Review article: bowel preparation for colonoscopy—the importance of adequate hydration. Aliment Pharmacol Ther. 2007;26(5):633-641. 4. Katz PO, Rex DK, Epstein M, et al. A dual-action, low-volume bowel cleanser administered the day before colonoscopy: results from the SEE CLEAR II study. Am J Gastroenterol. 2013:108(3):401-409.
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