Using this type of prep may cause fluid and electrolyte imbalances, as well as renal complications. It is not recommended for patients with heart failure, renal impairment, end-stage liver disease, risk factors for electrolyte abnormalities, or those above the age of 65.
A Patient's Guide to Choosing the Right Colonoscopy Preparation
Preparing for a colonoscopy is a crucial step in ensuring its success. By choosing the most suitable preparation method, you increase the likelihood of completing the prep and achieving effective results. Ineffective preparation may require repeating the colonoscopy, resulting in additional time and expenses. This guide will help you understand the different options available for colonoscopy preparation and make an informed decision based on your preferences and needs.
Factors to Consider
When selecting a colonoscopy preparation method, there are two primary factors to consider:
- Amount to Drink: The volume of solution you are comfortable consuming.
- Cost: The price range of the preparation method.
Optimal Results with a Low Residue Diet
To enhance the effectiveness of your bowel prep, it is advisable to maintain a low residue diet starting seven days before your colonoscopy.
Polyethylene Glycol (PEG) - Large Volume Preparations ($ / Drink More)
Large volume preps require drinking 135 ounces of fluid, which is equivalent to consuming 11 bottles of Coca Cola within 4-6 hours. This method is necessary if you have a higher risk of electrolyte disturbances, are elderly, or have kidney problems.
Commonly Used Large Volume Preps:
| Brand Name | Approximate Cost |
|---|---|
| GoLYTELY® | $9-$40 |
| NuLYTELY® | $9-$40 |
| Trilyte® | $14-$24 |
Polyethylene Glycol (PEG) - Low Volume Preparations ($$ / Drink Less)
Low-volume PEG-based solutions, as well as sodium phosphate, sodium picosulfate, and sodium sulfate-based preparations, are hyperosmotic and require ingesting 2-3 liters of fluid.
Commonly Used Low Volume Preps:
| Brand Name | Approximate Cost |
|---|---|
| Suprep® | $31-$78 |
| Moviprep® | $35-$60 |
| Prepopik® | No Longer Available |
| Clenpiq® (same as Prepopik) | $160-$170 |
| Plenvu® | $140-$160 |
Tablets ($$$)
Using this type of prep may cause fluid and electrolyte imbalances, as well as renal complications. It is not recommended for patients with heart failure, renal impairment, end-stage liver disease, risk factors for electrolyte abnormalities, or those above the age of 65.
Commonly Used Tablet Preps:
| Brand Name | Number of Tablets Required | Liquids Required | Risks / Side Effects | Approximate Cost |
|---|---|---|---|---|
| OsmoPrep® 1.5g sodium phosphate tablets | 20 tablets PM (evening before) / 12 tablets AM (3-5 hours before the procedure) | 40 Oz of water PM (evening before) / 24 Oz of water (3-5 hours before the procedure) | Note: there are warnings on the box about the risk of acute phosphate nephropathy | $271 |
| Sutab® 1.479g sodium sulfate/0.225g magnesium sulfate/0.188g potassium chloride | 12 tablets PM (evening before) / 12 tablets AM (5-8 hours before the procedure) | 48 Oz of water PM (evening before) / 48 Oz of water AM (5-8 hours before the procedure) | Nausea, vomiting, abdominal distension, and upper abdominal pain occurred at a higher rate with Sutab | $137 |
Non-FDA approved preps
Using this type of prep may cause fluid and electrolyte imbalances, as well as renal complications. It is not recommended for patients with heart failure, renal impairment, end-stage liver disease, risk factors for electrolyte abnormalities, or those above the age of 65.
| Brand Name | Liquids Required | Risks / Side Effects | Approximate Cost |
|---|---|---|---|
| MiraLAX® 238g PEG 3350 powder | Dissolved in 64 oz of a sports drink such as Gatorade | MiraLax® mixed with Gatorade is hypotonic and carries a risk of hyponatremia (low sodium). It should only be used in non-constipated younger patients with no kidney disease. | $17 |
| Magnesium Citrate | Three 10 fluid ounce bottles (Lemon or Lime flavor only) | $6-$10 |
Options to avoid
- Bisacodyl
- Any adjunctive agents
Adjunctive agents have not definitively shown to improve outcomes and may increase the risk of colonic mucosal ulcerations and ischemic colitis.
By understanding the various options available and considering your personal circumstances, you can select the most suitable colonoscopy preparation method. Remember to follow the instructions provided by your healthcare provider to ensure a successful colonoscopy experience.