COLONOSCOPY PREPARATION INSTRUCTIONS
MIRALAX WITH GATORADE SPLIT PREP
Colonoscopy is a procedure with a flexible fiber optic tube passed throughout the colon or large intestine. This test is
used for colon cancer screening, to diagnose a reason for bleeding, inflammation, polyp removal and small tissue
samples (biopsies.) Our nurse anesthetist will give you medication through your vein to sedate you during the
procedure. The colonoscope is passed and withdrawn slowly allowing the lining of the colon to be examined, polyps
removed or biopsies taken. After the procedure, you will be monitored in a recovery room until most of the effects of
sedation have worn off and you have spoken with your doctor.
ATTENTION PATIENTS ON BLOOD THINNERS!
You may remain on aspirin unless otherwise instructed. If you are taking Coumadin (warfarin), Plavix, Effient, Jantoven,
Aggrenox, Persantine, Pradaxa, Xarelto or other blood thinners, YOUR PRESCRIBING PHYSICIAN WILL DIRECT YOU
ON HOW TO DISCONTINUE. PLEASE CONTACT THEIR OFFICE FOR INSTRUCTIONS.
ITEMS NEEDED:


Purchase from pharmacy: Two (2) Dulcolax (Bisacodyl) 5mg oral tablets (laxative)
Purchase from pharmacy: One (1) 238 gram bottle of Miralax (no prescription needed)
 Purchase one (1) 64oz bottle of Gatorade (NO RED FLAVORS) or may use 64oz of Crystal Light
FIVE DAYS BEFORE YOUR PROCEDURE: ___________________________
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Do not skip any doses of blood pressure medicine
Stop taking iron.
For diabetic medication instructions the day before and day of procedure, please call your primary care doctor.
Read and familiarize yourself with the preparation instructions.
Please call us with any questions.
TWO DAYS BEFORE YOUR PROCEDURE: ___________________________
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Make arrangements for your driver. Due to sedation that you will be given, you MUST have someone to drive you
to and from your appointment. If you do not have a driver, your procedure will not be done. All drivers must report
in with the patient.
Eat a well-balanced diet. Avoid nuts, seeds, popcorn, raw fruits, raw vegetables and salads.
THE DAY BEFORE YOUR PROCEDURE: _____________________________
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In the a.m., mix the 238 gram bottle of Miralax powder into the 64oz bottle of Gatorade. Shake the solution until
Miralax is dissolved. Chill in the refrigerator until time to begin prep.
Consume a regular breakfast before 8am, then begin a clear liquid diet. Drink as much as possible throughout the
day.
A clear liquid diet may include: water, soft drinks, coffee or tea without cream, Jell-O, non-pulpy juice
(orange, apple, white grape, white cranberry), popsicles, broth and bouillon.
Do not drink any RED colored beverages or eat RED Jell-O. No dairy products.
2:00 pm - Take two (2) Dulcolax 5mg oral tablets with water.
4:00 pm - Begin drinking the Miralax prep. Drink 8oz every 15-30 minutes until one half (½) of the solution is
gone. Continue to drink clear liquids. If you become nauseated during the ingestion of the Miralax prep, stop the
prep for 45 minutes then resume.
THE DAY OF YOUR EXAM: _________________________________________

5 hours prior to your arrival time, drink the remaining half of the Miralax prep, 8oz every 15-30 min
Example: Arrive at 9:15 for 10:00am procedure: Begin 2nd half of prep at 4:15am
Arrive at 1:45 for 2:30pm procedure: Begin 2nd half of prep at 8:45am
ALL LIQUID MUST BE CONSUMED 4 HRS PRIOR TO PROCEDURE!
PRESCRIPTION MEDICATIONS:
Do not take oral diabetic medicine.
 Take all other oral medications 4 hours prior to your procedure. Inhalers and nebulizers may be used up to the time
of your procedure.
 Do not skip any doses of blood pressure medicine.
________________________
APPOINTMENT DATE
_________________________
ARRIVAL TIME
(Revised 2/27/15)
NOTHING
BY MOUTH FOUR (4) HOURS PRIOR TO YOUR PROCEDURE! FAILURE TO DO THIS
MAY RESULT IN THE NEED TO RESCHEDULE YOUR APPOINTMENT!
If you have any changes in your medical history between the day of scheduling and the appointment date, please
contact our office. WE REQUIRE A 48 HOUR (BUSINESS DAY) NOTICE IF THERE IS A NEED FOR CHANGE OR
CANCELLATION OF YOUR PROCEDURE. Please leave all jewelry and valuables at home. We do not provide a
secure area for these items.
SALEM ENDOSCOPY CENTER
PIEDMONT ENDOSCOPY CENTER
1901 S. Hawthorne Rd., Ste. 308
Winston-Salem, NC 27103
875 Bethesda Rd.
Winston-Salem, NC 27103
PHONE: (336) 448-2427
The preparation for your colonoscopy is the most challenging part of your procedure. A thorough cleansing
of the colon is essential to having a complete, successful examination.
Please follow these instructions closely. Improper cleansing may result in rescheduling!
OVERVIEW: PREPARING FOR YOUR PROCEDURE
5 DAYS
BEFORE YOUR
PROCEDURE
2 DAYS
BEFORE YOUR
PROCEDURE
 Purchase your
Miralax, Dulcolax
and Gatorade.
 Confirm your
transportation.
 If you are taking
Coumadin
(warfarin) Plavix or
other blood
thinners, contact
the prescribing
physician for
specific
instructions.
 Stop taking iron.
(Revised 2/27/15)
1 DAY
BEFORE YOUR
PROCEDURE
 Mix Miralax and
Gatorade. Shake well
and chill.
 Avoid nuts,
seeds, popcorn,  Eat a regular breakfast.
raw fruits and
vegetables and  800am: Begin a clear
salads.
liquid diet.
 2:00 pm: Take two (2)
Dulcolax tablets.
 4:00 pm: Drink only ½ of
Miralax prep (8 oz every
15-30 min.)
THE DAY OF
YOUR
PROCEDURE
 Drink remaining ½ of
Miralax prep (5) hours
prior to your arrival
time.
 No solid foods.
 You may have clear
liquids up until (4)
hours before
procedure.
 NOTHING should be
consumed four (4)
hours prior to your
procedure! This
includes water!