Colonoscopy

All patients who are scheduled for a colonoscopy will be evaluated to minimize any undesirable outcomes. During this time a “prep option,” short for preparation, will be determined.

There are 4 prep options (MiraLAX & Dulcolax, SUFLAVE®, SUPREP®, and SUTAB®) currently offered. General instructions for each are provided below.

An electronic prescription will be sent to your pharmacy within 1-2 days after your scheduling appointment.

Please pick it up at least 2 days prior to your procedure. Sometimes insurance does not cover this prep and usually we are able to anticipate this but once in a while there is an unanticipated issue. Without insurance coverage this can cost around $100 – please do not pay that much! If you have an issue at the pharmacy, you can call our office and we can supply a sample or alternative over-the-counter preparation.

Do not eat solid foods the ENTIRE DAY before your procedure and when you take the SUFLAVE, SUPREP, OR SUTAB Bowel Prep Kit, until after you have your colonoscopy. You may have clear liquids ONLY.

Any of the following liquids are okay to drink:

• Water
• Strained fruit juices (without pulp) including apple, orange, white grape, or white cranberry
• Limeade or lemonade (without pulp)
• Coffee or tea (DO NOT use any dairy or non-dairy creamer)
• Chicken broth
• Gelatin desserts without added fruit or topping (NO RED, BLUE, OR PURPLE)

DO NOT consume:

• DO NOT drink milk
• DO NOT eat or drink anything colored red, blue, or purple
• DO NOT drink alcoholic beverages
• DO NOT smoke or use smokeless tobacco after midnight

Stop taking the following medications 14 days prior to your procedure: Adipex and GLP1’s/Semiglutides: Exanetide (Byett, Bydureon), Lixidenatide (Adlyxin), Semaglutide (Wegovy, Ozempic, Rybelsus), Liraglutide (Saxenda, Victoza), Dulaglutide (Trulicity), and Tirzepatide (Mounjaro).

Check with your prescribing physician for instructions if you take any of the following:

Medications usually stopped 5 days prior to procedure:

• Clopidogrel (PLAVIX)
• Warfarin (COUMADIN)
• Prasugrel (EFFIENT)

Medications usually stopped 2 days prior to procedure:

• Apixabaan (ELIQUIS)
• Rivaroxaban (XARELTO)
• Dabigatran (PRADAXA)

Medications to avoid 5 days before your procedure:

• Advil
• Aleve
• Ascriptin
• Celebrex
• Clinoril
• Diclofenac
• Empirin
• Feldene
• Ibuprofen
• Indocin
• Indomethacin
• Medipren
• Motrin
• Naprosyn
• Nuprin
• Piroxicam
• Sulindac

Please discontinue all vitamins and supplements and refrain from eating nuts, seeds, and granola 7 days before your procedure. Tylenol is okay to take.

DO NOT eat or drink on the day of your procedure. Only consume your SUFLAVE, SUPREP, OR SUTAB Bowel Prep.

• You must be accompanied by an adult at the time of your procedure.
• One visitor is permitted in the preoperative area (no children).
• You must have someone to drive you home.
• IMPORTANT! No drinking at least 2 hours before your colonoscopy.
• Bring your insurance card and a valid photo ID.
• If you have a Living Will, Durable Power of Attorney for Healthcare, or a Do Not Resuscitate (DNR), please bring them with you.
• If you have an implanted stimulator, you must bring the remote device to turn the stimulator on/off with you on the day of your procedure.
• If you are on medications:
  • You will be given instructions on holding certain medications.
  • Bring a list of your current medications with you.
• Remember the following:
  • Leave valuables at home including jewelry, money, etc.
  • Remove contacts and/or dentures or bring a case to put them in during your procedure.
• Transportation – Make arrangements for a responsible adult driver to accompany you on the day of your procedure and to drive you home. You can expect 2-4 hours after check-in. If your driver cannot be confirmed when you arrive, we will not be able to provide sedation, and your procedure may need to be rescheduled

Purchase at the Pharmacy:

1. 4 tablets of Dulcolax Laxative (5 mg each).
2. One bottle of Miralax (polyethylene glycol-electrolyte solution), 238g (generic is okay).
3. 64 oz. of clear Gatorade of any light, “see-through” color. (You may need to purchase two 32oz. bottles.) If diabetic, substitute 64oz. of light colored Crystal Light or Gatorade Zero.
4. 4 tablets of Gas-x or Simethicone.

The Day Before Your Procedure:

1. Only clear liquids all day (no sofid food)
2. At 12 PM take 2 Dulcolax (5mg)
3. At 3 PM take 2 Duloolax (5mg)
4. At 3 PM mix 238g Miralax wilh 64 oz Gatorade in a large container and keep in refrigerator to keep cool.
5. At 6PM drink one (801.) glass of the mixture every 1 O minutes until you finish half of it. It may help to use a straw.
6. A.t 9 PM take 2 simethicone tablets.

On the Day of Your Procedure:

For procedures before Noon:

1. At 4:00 a.m., take two anti-gas tablets and drink the second half of your bowel prep.
   formula. Your prep needs to be finished by 6:00 a.m.
2. Take only your regularly scheduled heart, blood pressure, or seizure medicines by 6:00 a.m.
3. Nothing to Eat after 6:00a.m. Your procedure will be delayed or canceled if you eat. This includes gum, mints, or any tobacco products (smoking, chewing tobacco, snuff, vaping etc.).
4. You may continue to drink clear liquids up until 3 hours prior to your arrival time.
5. If you are diabetic, please check your blood sugar level before arriving.

For Procedures after Noon:

1. At 7:00 a.m., take two simelhicone tablets and complete the second half of your bowel prep formula. Your prep needs to be finished by 9:00 a.m.
2. Take only your regularly scheduled heart, blood pressure, or seizure medicines by 9:00 a.m.
3. Nothing to Eat after 9:00a.m. Your procedure will be delayed or canceled if you eat. This includes gum, mints, or any tobacco products (smoking, chewing tobacco, snuff, vaping etc.).
4. You may continue to drink clear liquids up until 3 hours prior to your arrival time.
5. If you are diabetic, please check your blood sugar level before arriving.

SUFLAVE is a split-dose (2-day) regimen. A total of 2 bottles are required for complete preparation for a colonoscopy. You will take 2 bottles of liquid in 2 separate doses. One dose of SUFLAVE is equal to 1 bottle plus 1 flavor-enhancing packet.

Day 1, Dose 1: Early Evening Before Your Colonoscopy:

Step 1 – Open one flavor-enhancing packet and pour the contents into 1 bottle.
Step 2 – Fill the provided bottle with lukewarm water up to the fill line. After capping the bottle, gently shake the bottle until all powder has mixed well (dissolved).
For best taste, refrigerate the solution for an hour before drinking. Do not freeze. Use within 24 hours.
Step 3 – Drink 8 ounces of solution every 15 minutes until the bottle is empty.
Step 4 – Drink an additional 16 ounces of water before going to bed.

IMPORTANT: If nausea, bloating, or abdominal cramping occurs, pause or slow the rate of drinking the solution and additional water until symptoms diminish.

Day 2, Dose 2: The Morning of Your Colonoscopy

(5 to 8 hours before colonoscopy, but no sooner than 4 hours from taking Day 1, Dose 1)

Step 1 – Repeat Step 1 to Step 3 from Day 1, Dose 1.
Step 2 – Drink an additional 16 ounces of water during the morning.

IMPORTANT: Do not drink for the last 2 hours before your procedure
in order to be eligible to receive anesthesia.

SUPREP is a split-dose (2-day) regimen. Both 6-ounce bottles are required for a complete prep.

FIRST DOSE – Begin Step 1 at 5:00 p.m. the evening before your procedure and proceed as shown below:

You must complete Steps 1 through 4 using one (1) 6-ounce bottle before going to bed:

Step 1 – Pour ONE (1) 6-ounce bottle of SUPREP liquid into the mixing container.
Step 2 – Add cool drinking water to the 16-ounce line on the container and mix. NOTE: Dilute the solution concentrate as directed prior to use.
Step 3 – Drink ALL the liquid in the container.
Step 4 – You must drink two (2) more 16-ounce containers of water over the next 1 hour.

SECOND DOSE – Begin Step 1 at 4:00 a.m. the morning before your procedure and proceed as shown above.

IMPORTANT: Do not drink for the last 2 hours before your procedure in order to be eligible to receive anesthesia.

SUTAB is a split-dose (2-day) regimen. A total of 24 tablets is required for complete preparation. You will take the tablets in 2 doses of 12 tablets each. Water must be consumed with each dose of SUTAB, and additional water must be consumed after each dose.

DOSE 1 – On the Day Prior to Your Colonoscopy at 5:00 p.m.

Take the tablets with water.
STEP 1 – Open 1 (one) bottle of 12 tablets.
STEP 2 – Fill the provided container with 16 ounces of water (up to the fill line). Swallow each tablet with a sip of water, and drink the entire amount of water over 15 to 20 minutes.
Drink additional water
STEP 3 – Approximately 1 (one) hour after the last tablet is ingested, fill the provided container again with 16 ounces of water (up to the fill line), and drink the entire amount over 30 minutes.
STEP 4 – Approximately 30 minutes after finishing the second
container of water, fill the provided container with 16 ounces of water (up to the fill line), and drink the entire amount over 30 minutes.

DOSE 2 – Day of Your Colonoscopy at 4:00 a.m.

• Continue to consume only clear liquids until after the colonoscopy.
• The morning of the colonoscopy (5 to 8 hours prior to the colonoscopy and no sooner than 4 hours from starting Dose 1), open the second bottle of 12 tablets.
• Repeat STEP 1 to STEP 4 from Dose 1.

IMPORTANT: If you experience preparation-related symptoms (for example, nausea, bloating, or cramping), pause or slow the rate of drinking the additional water until your symptoms diminish.

IMPORTANT: You must complete all SUTAB tablets and required water at least 2 (two) hours before your colonoscopy.

IMPORTANT: Do not drink for the last 2 hours before your procedure
in order to be eligible to receive anesthesia.

You may not drive/operate heavy equipment or power tools that day after you have received sedation for your colonoscopy. Don’t forget that ride! You may return to work and all other activities the following day without restrictions.

If you notice increased pain and bloating, call the number listed. If it is after-hours, you can ask to speak to the surgeon on-call. If it is a more minor issue, you can call and talk to one of the nurses during business hours the next day. However, if you have sudden severe chest pain, shortness of breath, or are feeling increasingly sick or lightheaded, you should call 911 and be taken to the emergency room right away.