Citrafleet

Leaflet attached to the packaging: information for the user

Warning! The leaflet should be kept. Information on the immediate packaging in a foreign language.

CitraFleet, (0.01 g + 3.50 g + 10.97 g)/sachet, powder for oral solution preparation
(sodium picosulfate + light magnesium oxide + citric acid)

The contents of the leaflet should be carefully read before taking the medicine, as it contains important information for the patient.

• The leaflet should be kept so that it can be read again if necessary.
• In case of any doubts, the doctor or pharmacist should be consulted.
• This medicine has been prescribed for a specific person. It should not be given to others. The medicine may harm another person, even if the symptoms of their illness are the same.
• If the patient experiences any side effects, including any side effects not listed in this leaflet, they should tell their doctor, pharmacist, or nurse. See section 4.

Table of contents of the leaflet

• 1. What is CitraFleet and what is it used for
• 2. Important information before taking CitraFleet
• 3. How to take CitraFleet
• 4. Possible side effects
• 5. How to store CitraFleet
• 6. Package contents and other information

1. What is CitraFleet and what is it used for

CitraFleet is taken to cleanse the intestines and colon before examinations that require clean intestines, such as colonoscopy (an imaging procedure of the intestine using a long, flexible instrument that the doctor inserts through the patient's anus) or radiological imaging. CitraFleet is a powder with a citrus smell and taste.
The powder contains two laxative substances mixed in each sachet. After dissolving in water and drinking, these agents will cleanse the intestines. It is essential that the patient's intestines are empty and clean so that the doctor has a clear image during the examination.
CitraFleet is indicated for use in adults aged 18 and over (including the elderly).

2. Important information before taking CitraFleet

When not to take CitraFleet:

• if the patient is allergicto sodium picosulfate, magnesium oxide, citric acid, or any of the other ingredients of this medicine (listed in section 6);
• if the patient has congestive heart failure(the heart is not able to pump blood to the whole body);
• if the patient has delayed gastric emptying(the stomach does not empty properly);
• if the patient has gastric or duodenal ulcers;
• if the patient has intestinal obstruction or evacuation disorders;
• if the patient has been informed by the doctor of intestinal wall damage(also called toxic megacolon);
• if the patient has colonic dilatation(also called colonic paralysis);
• if the patient has recently experienced nausea or vomiting;
• if the patient feels strong thirst or may be severely dehydrated;
• if the patient has been informed by the doctor of abdominal swelling due to fluid accumulation(ascites);
• if the patient has recently undergone abdominal surgery, e.g., due to appendicitis;
• if the patient may have perforation/damage or intestinal obstruction;
• if the patient has been informed by the doctor of active inflammatory bowel disease(such as Crohn's disease or ulcerative colitis);
• if the patient has been informed by the doctor of muscle tissue damage, with breakdown products entering the blood(rhabdomyolysis);
• if the patient has severe kidney diseaseor the doctor has found too high a level of magnesium in the blood (hypermagnesemia).

Warnings and precautions

Before starting to take CitraFleet, the patient should talk to their doctor if:

• the patient has recently undergone intestinal surgery;
• the patient has kidney or heart disease;
• the patient has water and electrolyte balance disorders(sodium or potassium) or is taking medicines that may affect water and electrolyte balance (sodium or potassium), such as diuretics, corticosteroids, or lithium;
• the patient has a history of epilepsyor seizures;
• the patient has low blood pressure(hypotension);
• the patient feels thirsty or suspects they may be moderately dehydrated;
• the patient is elderlyor physically weak;
• the patient has ever had low sodium or potassium levels in the blood(hyponatremia or hypokalemia).

The patient should prepare for frequent, loose stools after taking the dose of CitraFleet. They should drink large amounts of clear fluids (see section 3) to replace lost fluids and salts. Otherwise, dehydration and low blood pressure may occur, which can cause the patient to faint.

CitraFleet and other medicines

The patient should tell their doctor or pharmacist about all medicines they are taking or have recently taken, as well as any medicines they plan to take.
Taking CitraFleet with other medicines may affect their action. Other medicines may also affect the action of CitraFleet. If the patient is taking medicines from any of the following groups, the doctor may decide to prescribe a different medicine or adjust the dose of CitraFleet. If the patient has not yet spoken to their doctor about the following medicines, they should go back to their doctor and ask how to proceed:

• oral contraceptives, as their action may be weakened;
• medicines used in diabetesor to treat epilepsy(seizures), as their action may be weakened;
• antibiotics, as their action may be weakened;
• other laxatives, including bran;
• diuretics, such as furosemide (diuretics);
• corticosteroidssuch as prednisone used in diseases such as arthritis, asthma, hay fever, skin inflammation, and inflammatory bowel disease;
• digoxin, used to treat heart failure;
• non-steroidal anti-inflammatory drugs (NSAIDs)such as acetylsalicylic acid and ibuprofen, used to treat pain and inflammation;
• tricyclic antidepressantssuch as imipramine and amitriptyline and selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, paroxetine, and citalopram used to treat depression and anxiety;
• antipsychotic drugssuch as haloperidol, clozapine, and risperidone used to treat schizophrenia;
• lithiumused to treat manic-depressive psychosis (bipolar disorder);
• carbamazepineused to treat epilepsy;
• penicillamineused to treat rheumatoid arthritis and other diseases.

Pregnancy, breastfeeding, and fertility

If the patient is pregnant or breastfeeding, thinks they may be pregnant, or plans to have a child, they should consult their doctor or pharmacist before taking this medicine.

Driving and using machines

If, after taking CitraFleet, the patient starts to feel tired or dizzy, they should not drive or operate machines.

CitraFleet contains potassium and sodium

CitraFleet contains 5 mmol (or 195 mg) of potassium per sachet, which should be taken into account in patients with reduced kidney function and in patients controlling their potassium intake.
This medicine contains less than 1 mmol of sodium (23 mg) per sachet, i.e., the medicine is considered "sodium-free".

3. How to take CitraFleet

This medicine should always be taken according to the doctor's recommendations, as if the intestines are not completely cleansed, it may be necessary to repeat the examination. In case of doubts, the doctor or pharmacist should be consulted.

The patient should prepare for frequent, loose stools at any time after taking the dose of CitraFleet.

After taking the dose of CitraFleet, it is normal and indicates that the medicine is working. The patient should ensure they have access to a toilet until the bowel movements stop.
It is essential to follow a special diet (low-residue) on the day before the examination. From the start of taking the medicine to the time of the examination, no solid foods should be consumed. The patient should always follow the doctor's recommendations regarding diet. If there are any questions, the doctor or pharmacist should be contacted.
Unless the doctor recommends otherwise, the patient should not take a dose larger than recommended within 24 hours.

Treatment plan

The patient should receive two sachets of CitraFleet. Each sachet contains a single dose intended for an adult.
Treatment should be carried out using one of the following schemes:

• One sachet in the evening on the day before the examination/procedure, the second sachet in the morning on the day of the examination/procedure, or
• One sachet in the afternoon, the second sachet in the evening on the day before the examination/procedure. This scheme is recommended when the examination/procedure is scheduled for early in the morning, or
• Both sachets in the morning on the day of the examination/procedure. This scheme is suitable only if the examination/procedure is scheduled for the afternoon or evening.

In each of the above schemes, there should be at least a 5-hour interval between the administration of the first and second sachets.
The contents of the sachet should be dissolved in a cup of water. After taking the medicine, no fluids should be consumed for a short time to avoid further dilution of the product.
After taking each sachet, the patient should wait about 10 minutes and then drink about 1.5-2 liters of clear fluids, in amounts of about 250 ml (a glass) to 400 ml every hour. To prevent dehydration, it is recommended to consume clear soups and/or balanced electrolyte drinks. Drinking pure water is not recommended.
After taking the second sachet of CitraFleet and drinking about 1.5-2 liters of fluids, the patient should not eat or drink for at least 2 hours before the examination or procedure, or follow the doctor's recommendations.

RECOMMENDATIONS FOR USE:

Adults (including the elderly) aged 18 and over.

• Step 1- Pour the contents of 1 sachet into a cup of cold water (about 150 ml).
• Step 2- Mix for 2-3 minutes. If the contents heat up during mixing, wait until it cools down before drinking the entire solution. The suspension should be drunk immediately after preparation. The suspension will be cloudy.

Taking a higher dose of CitraFleet than recommended

If a higher dose of CitraFleet than recommended is taken, the doctor or pharmacist should be contacted immediately.

4. Possible side effects

Like all medicines, CitraFleet can cause side effects, although not everybody gets them.
Known side effects resulting from taking CitraFleet are described below in the order of frequency:

Very common (may occur more often than 1 in 10 people):

Abdominal pain.

Common (may occur no more often than 1 in 10 people):

Abdominal bloating, feeling of thirst, feeling of discomfort in the anal area, and pain in the anal area, fatigue (feeling of fatigue), sleep disturbances, headache, dry mouth, nausea.

Uncommon (may occur no more often than 1 in 100 people):

Dizziness, vomiting, inability to control bowel movements (fecal incontinence).

Other side effects, for which the frequency is not known (cannot be determined from available data):

Anaphylactic reaction or hypersensitivity, which are severe symptoms of an allergic reaction. If there are problems with breathing, redness, or any symptoms indicating a severe allergic reaction, the patient should go to the hospital immediately.
Hyponatremia (low sodium level in the blood), hypokalemia (low potassium level in the blood), epilepsy, seizures, orthostatic hypotension (low blood pressure when standing up, which can lead to dizziness or instability), confusion, rash including urticaria, itching, and purpura (bleeding under the skin).
Bloating (gas) and pain.
The medicine is intended to cause regular, loose stools, similar to what happens with diarrhea. However, if after taking this medicine, bowel movements become troublesome or worrying, the patient should contact their doctor.

Reporting side effects

If any side effects occur, including any side effects not listed in the leaflet, the doctor, pharmacist, or nurse should be informed. Side effects can be reported directly to the Department of Monitoring of Adverse Reactions to Medicinal Products of the Office for Registration of Medicinal Products, Medical Devices, and Biocidal Products
Al. Jerozolimskie 181C
02-222 Warsaw
tel.: + 48 (22) 49 21 301
fax: + 48 (22) 49 21 309
website: https://smz.ezdrowie.gov.pl
By reporting side effects, more information can be gathered on the safety of the medicine.

5. How to store CitraFleet

The medicine should be stored out of sight and reach of children.
Do not store above 25°C.
Do not use this medicine after the expiry date stated on the packaging. The expiry date refers to the last day of the given month.
Medicines should not be disposed of via wastewater or household waste containers. The pharmacist should be asked how to dispose of medicines that are no longer used. This will help protect the environment.

6. Package contents and other information

What CitraFleet contains

• The active substances of the medicine are: sodium picosulfate 0.01 g (10.0 mg), light magnesium oxide 3.50 g, citric acid 10.97 g.
• Other ingredients are: potassium hydrogen carbonate, sodium saccharin, lemon flavor (lemon flavor, maltodextrin, RRR-α-tocopherol (E 307)). See section 2.

What CitraFleet looks like and what the package contains

CitraFleet is a white, crystalline powder for oral solution preparation, available in packages containing 2, 50, or 100 sachets. Each sachet contains a single dose for an adult in the amount of 15.08 g.
For more detailed information, the marketing authorization holder or parallel importer should be contacted.

Marketing authorization holder in Germany, the country of export:

Casen Recordati, S.L., Autovía de Logroño, Km 13,300, 50180 Utebo - Zaragoza, Spain

Manufacturer:

Casen Recordati, S.L., Autovía de Logroño, Km 13,300, 50180 Utebo - Zaragoza, Spain

Parallel importer:

Delfarma Sp. z o.o., ul. Św. Teresy od Dzieciątka Jezus 111, 91-222 Łódź

Repackaged by:

Delfarma Sp. z o.o., ul. Św. Teresy od Dzieciątka Jezus 111, 91-222 Łódź
German authorization number, country of export: 68805.00.00

Parallel import authorization number: 44/22

This medicinal product is authorized in the Member States of the European Economic Area under the following names:

Citrafleet: Croatia, Czech Republic, Denmark, Norway, Slovenia
CitraFleet: Austria, Belgium, Bulgaria, Cyprus, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Spain, Sweden, United Kingdom (Northern Ireland).
Date of leaflet approval: 20.01.2022
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