PL Detail-Document #280602
−This PL Detail-Document accompanies the related article published in−
PHARMACIST’S LETTER / PRESCRIBER’S LETTER
June 2012
Comparison of Bowel Preps
Colonoscopy is commonly performed to screen for colon cancer and to assess gastrointestinal symptoms and complaints such as GI or rectal
bleeding, abdominal pain, and diseases of the bowel.1 To optimize visualization of the bowel during colonoscopy, bowel preparation is necessary.1,2
It’s estimated that the bowel is not optimally prepared in up to 23% of all colonoscopies.1 This significantly impacts accurate detection of lesions.
The following chart summarizes available regimens for bowel prep in the U.S. (NOTE: Miralax and Suprep fall slightly outside of the main
categories. Proceed to end of document for information on these products.) (Last modified October 2012.)
Generic
Name
Brand
Names
*Proceed to the
end of this
document for
information about
Miralax and
Suprep
Mechanism of
Action1,2,4-11
Sodium phosphate
oral products (NaP)
Visicol
OsmoPrep
According to the FDA,
OTC oral sodium
phosphate products
should not be used for
bowel prep prior to
colonoscopy because of
the risk of acute
phosphate nephropathy.
These products should
only be used for bowel
prep under the
direction of a health
care professional.
Caution if two doses of
45 mL are administered
within 24 h.3,25
Smaller volume,
hyperosmotic action
draws water into the
intestinal lumen to exert
its purgative effect
Polyethylene glycol (PEG)
electrolyte lavage solution
4 L PEG electrolyte lavage
solutions
Colyte, GoLytely, others
Magnesium citrate
(MAG)
Citroma, others
Sodium picosulfate, citric
acid, magnesium oxide
Prepopik
Hyperosmotic action draws
fluid into the intestine to
increase motility. Stimulates
release of cholecystokinin
that causes fluid and
electrolytes to accumulate
and cause secretory diarrhea
Decreases the absorption of
water and electrolytes and
increases intestinal motility
Sulfate-free
4 L PEG electrolyte lavage
solutions
NuLytely, TriLyte, others
Low-volume (2 L) PEG
electrolyte lavage solutions
HalfLytely (also sulfate free),
MoviPrep (contains
phenylalanine)11
OTC PEG 3350 with no added
electrolytes
Miralax, others (off-label use; see
page 8 for information about use of
Miralax as a bowel prep)
Larger-volume, iso-osmotic,
nonabsorbable electrolyte solution
that cleanses the intestinal lumen
through the cathartic effect that
results from the ingestion of large
volumes of this mixture
More. . .
Copyright © 2012 by Therapeutic Research Center
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(PL Detail-Document #280602: Page 2 of 10)
Generic
Name
Dosing
Sodium phosphate
oral products (NaP)
Visicol:4
Evening before
colonoscopy: Take 3 tabs
(2 tabs for last dose) with
240 mL of clear liquids
every 15 min, for a total
of 20 tabs, THEN
Day of colonoscopy:
Starting 3 to 5 h before
procedure, take 3 tabs
(2 tabs for last dose) with
240 mL of clear liquids
every 15 min, for a total
of 20 tabs.
OsmoPrep:5
Evening before
colonoscopy: Take
4 tabs with 240 mL of
clear liquids every
15 min for a total of 20
tabs, THEN
Day of colonoscopy:
Starting 3 to 5 h before
procedure, 4 tabs with
240 mL of clear liquids
every 15 min for a total
of 12 tabs.
Polyethylene glycol (PEG)
electrolyte lavage solution
Standard-volume
(GoLytely, NuLytely, etc)6-9
Day before colonoscopy: No food
for 2 to 4 h. Ingest 240 mL PEG
every 10 min till 4 L consumed or
rectal output is clear. (Split-dose
regimen may improve tolerance.
Ingest 2 or 3 L the evening before
colonoscopy. Ingest remainder 4 to
6 h before colonoscopy.)12-16
Low-volume (HalfLytely)10
Day before colonoscopy: Clear
liquid diet. Take 2 bisacodyl tabs
(10 mg) with water. After bowel
movement or 6 h with no bowel
movement, ingest 240 mL PEG
every 10 min till 2 L consumed.
MoviPrep11
Split-dose regimen
Evening before colonoscopy:
Ingest 1 L PEG over 1 h (240 mL
every 15 min), then 0.5 L clear
fluids, THEN
Morning of colonoscopy: Ingest
1 L PEG over 1 h (240 mL every
15 min), then 0.5 L clear fluids at
least 1 h prior to colonoscopy.
Evening-only regimen
Evening before colonoscopy:
Ingest 1 L PEG over 1 h (240 mL
every 15 min). Repeat in 1.5 h.
Ingest 1 L of additional clear fluids
the evening before colonoscopy.
Magnesium citrate
(MAG)
Usually
not
used
monotherapy.1,2,16
as
Example protocols:14,16
Evening before colonoscopy:
Ingest 240 mL magnesium
citrate plus bisacodyl 20 mg
PO, THEN
Morning before colonoscopy:
Take bisacodyl 10 mg
rectally.
Evening before colonoscopy:
Ingest 300 mL magnesium
citrate, THEN
Day of colonoscopy: Ingest
300 mL magnesium citrate
3 to 5 h before colonoscopy.
(Bisacodyl may be added to
this regimen.)
For the above regimens,
adequate hydration is
important (i.e., at least 2 L of
clear fluid the day before
colonoscopy).15
Sodium picosulfate, citric
acid, magnesium oxide
Split-dose regimen
Evening before
colonoscopy: Ingest one
sachet dissolved in 150 mL
of cold water. Follow with
five 240 mL portions of
clear liquids, THEN
Day of colonoscopy: Ingest
one sachet dissolved in
150 mL of cold water about
5 h prior to colonoscopy.
Follow with at least three
240 mL portions of clear
liquids.24
Day-before regimen
Evening before
colonoscopy: Ingest one
sachet dissolved in 150 mL
of cold water during
afternoon or early evening
(4 PM to 6 PM). Follow
with five 240 mL portions
of clear liquids. Ingest a
second sachet dissolved in
150 mL cold water about
6 h later. Follow with three
240 mL portions of clear
liquids.24
More. . .
Copyright © 2012 by Therapeutic Research Center
3120 W. March Lane, Stockton, CA 95219 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249
www.PharmacistsLetter.com ~ www.PrescribersLetter.com ~ www.PharmacyTechniciansLetter.com
(PL Detail-Document #280602: Page 3 of 10)
Generic
Name
Efficacy
Tolerability
Sodium phosphate
oral products (NaP)
Generally considered
more effective than
PEG16,17
Polyethylene glycol (PEG)
Magnesium citrate
electrolyte lavage solution
(MAG)
Generally
considered
less Efficacy supported by few
effective than NaP, but preferred clinical trials
for patients at high risk of
complications from electrolyte • Superior or equal to NaP
Results of 16 RCT vs shifts and dehydration12
in 1 of 1 trial1
1
PEG
• MAG + bisacodyl + diet
1
• Superior to PEG in Results of 16 RCT vs NaP
kit more effective than
6 of 16 trials
• Superior
to
NaP
in
NaP + liquid diet in
1 of 16 trials
• Equal to PEG in
1 of 1 trial1
• Equal
to
NaP
in • PEG 2 L + MAG more
9 of 16 trials
9 of 16 trials
effective than PEG 4 L1
1
Results vs MAG
• Inferior to MAG in • PEG 2 L + MAG more
effective than PEG 4 L1
1 of 1 trial
• Inferior to MAG + • GoLytely appears to be more
bisacodyl + diet kit in
effective than Miralax18-20
1 of 1 trial
• Split-dose (AM/PM) regimen
appears to be more effective
than one-day regimen12,13,16,21,22
Considered
more Considered least tolerable of all Generally less tolerable
than NaP1,2
tolerable
than agents1,2
1,2,14,16,17
PEG
• Equal to or more tolerable than • Less tolerable than NaP
in 1 of 1 trial
NaP
in
• More tolerable than
1 of 16 trials
PEG in 7 of 16 trials
• MAG + bisacodyl + diet
kit more tolerable than
• Equal to PEG in • Equal to NaP in 7 of 16 trials
NaP + liquid diet in
7 of 16 trials
• PEG 2 L + MAG more
1 of 1 trial
• More tolerable than
tolerable than PEG 4 L
MAG in 1 of 1 trial
• Split-dose (AM/PM) regimen • PEG 2 L + MAG more
tolerable than PEG 4 L
appears to be more tolerable
than one-day regimen12,21
• Miralax may be better tolerated
than GoLytely18-20
Sodium picosulfate, citric
acid, magnesium oxide
Similar in efficacy to
PEG1
Has not been compared to
MAG1
More tolerable than PEG1
Not compared to MAG1
More. . .
Copyright © 2012 by Therapeutic Research Center
3120 W. March Lane, Stockton, CA 95219 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249
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(PL Detail-Document #280602: Page 4 of 10)
Generic
Name
Contraindications1-11,14,24
•
•
(Not a
comprehensive list.)
•
•
•
•
Precautions1,2,4-11,24
(Not a
comprehensive list.)
Sodium phosphate
oral products (NaP)
Congestive heart
failure
Gastrointestinal
obstruction
Hypercalcemia
Hyperparathyroidism
(relative
contraindication)
Kidney disease
Advanced liver
disease
Use caution in patients
who are elderly,
debilitated, or
dehydrated; or with poor
gut motility, sodiumrestricted diet, small
intestine disorder, low
seizure threshold, preexisting electrolyte
disturbance(s),
hypertension, or coronary
artery disease; or those
on diuretics,
antihypertensives (ACE
inhibitors or ARBs), or
NSAIDs
•
•
•
•
•
•
Polyethylene glycol (PEG)
electrolyte lavage solution
Bowel perforation
Gastric retention
Gastrointestinal obstruction
Ileus
Severe or toxic colitis
Toxic megacolon
Use caution in patients with
impaired gag reflex, those prone to
regurgitation or aspiration, or
unconscious or semiconscious
Magnesium citrate
(MAG)
Abdominal
pain
or
bleeding
Intestinal obstruction
Impaired renal function
Undiagnosed nausea or
vomiting
Sodium picosulfate, citric
acid, magnesium oxide
• Acute abdomen
• Gastrointestinal
obstruction or
perforation
• Gastric retention
• Ileus
• Nausea and vomiting
• Severe renal
dysfunction
• Toxic colitis or toxic
megacolon
Use caution in the elderly,
those on a low-sodium diet,
or with renal insufficiency or
renal failure
Use caution in patients with
electrolyte disturbances,
impaired gag reflex, renal
impairment, heart disease,
seizure history, or
inflammatory bowel disease
•
•
•
•
More. . .
Copyright © 2012 by Therapeutic Research Center
3120 W. March Lane, Stockton, CA 95219 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249
www.PharmacistsLetter.com ~ www.PrescribersLetter.com ~ www.PharmacyTechniciansLetter.com
(PL Detail-Document #280602: Page 5 of 10)
Generic
Name
Adverse
Reactions1,2,4-11,24
(Not a
comprehensive list.)
•
•
•
•
•
•
•
•
•
Advantages
Over other
Bowel Cleansing
Regimens1,2,14,16,17
•
•
•
Sodium phosphate
oral products (NaP)
Hyperphosphatemia
Hypokalemia in 20%
of patients
Hypocalcemia
Hypernatremia
Hyponatremia
Acidosis
Drop in SBP by
>10 mmHg in 16% to
28% of patients; drop
in SBP by >20 mmHg
in 12% to 16% of
patients
Acute
phosphate
nephropathy
Acute renal failure
with calcification of
renal tissue
Intestinal erosions
Generally
more
effective and better
tolerated than standard
4 L PEG regimens
Smaller
volumes
improve
tolerability
and patient acceptance
•
•
•
•
•
•
•
•
Polyethylene glycol (PEG)
electrolyte lavage solution
Drop in SBP by up to 20 mmHg
Pulmonary aspiration
Mallory-Weiss tear
Cardiac dysrhythmia
Pancreatitis
Colitis
Syndrome
of
inappropriate
antidiuretic hormone
Dysnatremia
• Does not cause significant
water or electrolyte shifts
• Preferred in patients with renal
failure,
congestive
heart
failure, or advanced liver
disease with ascites
• Does not alter the mucosal
cells of the colon so it will not
interfere with diagnosis when
used
in
those
with
inflammatory bowel disease
Magnesium citrate
(MAG)
Hypermagnesemia
Electrolyte abnormalities
causing seizures
Dizziness
Weakness
Sodium picosulfate, citric
acid, magnesium oxide
• Hyponatremia
• Decreased chloride,
increased magnesium
• Dehydration
• Seizures
• Nausea, vomiting,
diarrhea
• Abdominal pain
• Proctalgia
• Rash, hives, itching,
anaphylactoid reaction
• Relatively
inexpensive
compared
to
other
products
• MAG combinations are
generally well tolerated.
Addition of MAG has
allowed the use of lower
volume PEG solutions
with improved tolerability.
• More tolerable than
standard PEG regimens
with comparable efficacy
•
•
•
•
More. . .
Copyright © 2012 by Therapeutic Research Center
3120 W. March Lane, Stockton, CA 95219 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249
www.PharmacistsLetter.com ~ www.PrescribersLetter.com ~ www.PharmacyTechniciansLetter.com
(PL Detail-Document #280602: Page 6 of 10)
Generic
Name
Disadvantages
Compared with
Other Bowel
Cleansing
Regimens1,2
Approximate
Cost per
Procedure
(WAC)
Sodium phosphate
oral products (NaP)
• Increased risk of •
significant electrolyte
and fluid imbalances •
compared to PEG
• Risk
of
acute
phosphate
nephropathy
and
renal
failure
in
certain
patient
populations
• May induce aphthoid
erosions and alter the
features
of
the
intestinal
mucosal
cells
that
may
contribute
to
confusion
during
diagnosis
•
•
Visicol – $150
OsmoPrep – $110
•
•
Polyethylene glycol (PEG)
electrolyte lavage solution
Relatively large volumes are •
needed to achieve cleansing
5% to 38% of patients do not •
finish the cleansing regimen
secondary to poor taste or large
volume
•
•
4 L products – $20
2 L products – $60
•
Magnesium citrate
(MAG)
Risk
of
electrolyte
abnormalities
Clinical
trials
and
comparative literature are
limited
Requires
combination
with other cathartics to
increase effectiveness15
Elimination is primarily
via the kidneys
Sodium picosulfate, citric
acid, magnesium oxide
• Risk of electrolyte
abnormalities
• Not as extensively
studied as PEG
• Limited safety
information about
biochemical,
hemodynamic, or
histologic effects
• More expensive than
MAG and PEG
regimens
Less than $3 per 300 mL •
bottle
More. . .
Copyright © 2012 by Therapeutic Research Center
3120 W. March Lane, Stockton, CA 95219 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249
www.PharmacistsLetter.com ~ www.PrescribersLetter.com ~ www.PharmacyTechniciansLetter.com
$75
(PL Detail-Document #280602: Page 7 of 10)
Generic
Name
Comments
•
•
•
Sodium phosphate
oral products (NaP)
Concomitant use of
carbohydrateelectrolyte solutions
such as Gatorade
improves safety and
tolerability
by
reducing fluid and
electrolyte shifts1,3
Addition of bisacodyl
does not increase the
efficacy of NaP1
Prescription products
must be dispensed
with a Medication
Guide3
Save for patients <55
years old and with a
low risk of renal
problems
•
•
•
•
Polyethylene glycol (PEG)
electrolyte lavage solution
Split-dose regimens are
considered standard of care2,15
Addition of senna to lower
volumes of PEG does not result
in additional benefit1,2
HalfLytely and MoviPrep must
be dispensed with a Med Guide
Add citrus-flavored Crystal
Light or lemon juice to counter
salty taste, or rub a lime on the
tongue. Chilling PEG before
ingestion or drinking it through a
straw might also improve taste.
Magnesium citrate
(MAG)
• Magnesium is primarily
eliminated by the kidneys
• MAG is usually used in
combination with other
laxatives and is rarely used
alone as a colonoscopy
preparation1,2,16
Sodium picosulfate, citric
acid, magnesium oxide
• Consider over PEG for
patients without kidney
or heart failure due to
better tolerability
• Efficacy
and
safety
appear to be good, but
lacking
in
adequate
comparative data with
other agents1
• Adequate hydration may
improve
safety
and
tolerability
by
minimizing electrolyte
and
fluid
shifts.
Hydration may also
contribute to the bowel
cleansing effect.1
• May cause mild aphthoid
ileal ulcers, which could
be
mistaken
for
inflammatory
bowel
disease24
COMPARISON OF PEG
PRODUCTS:
• Generic 4 L products are the
•
least expensive Rx PEG.15 A
generic 4 L PEG (with
directions to use only half) plus
OTC bisacodyl is less
expensive than 2 L PEG.
• Sulfate-free and low-volume
PEG regimens may be better
tolerated and as effective as 4 L
PEG regimens1,2,8,15
• PEG 3350 without electrolytes
(e.g., Miralax) may taste better
than PEG with electrolytes, but
fluid and electrolyte loss can
occur since PEG 3350 without
electrolytes is not iso-osmotic13
Abbreviations: ACE inhibitor = angiotensin converting enzyme inhibitor; ARB = angiotensin receptor blocker; MOA = mechanism of action;
NSAID = nonsteroidal anti-inflammatory drug; OTC = over-the-counter; PO = per oral; RCT = randomized controlled trial, SBP = systolic blood
pressure; WAC = wholesale acquisition cost.
More. . .
Copyright © 2012 by Therapeutic Research Center
3120 W. March Lane, Stockton, CA 95219 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249
www.PharmacistsLetter.com ~ www.PrescribersLetter.com ~ www.PharmacyTechniciansLetter.com
(PL Detail-Document #280602: Page 8 of 10)
Dietary restrictions (clear fluids and a low residue diet) initiated in the days prior to colonoscopy and enemas (tap water or sodium phosphate) can
improve cleansing with cathartic regimens.2
Brand/Generic/Cost
Miralax
(PEG 3350 without
electrolytes; OTC)
WAC:
$11/238 g bottle
Bowel cleansing is an
off-label use of PEG
without electrolytes20
MOA
Larger-volume,
nonabsorbable
solution that
cleanses the
intestinal lumen
through the
cathartic effect that
results from the
ingestion of large
volumes of this
mixture2
Dose
Example protocols:2,16,19,20
The regimens below utilize
PEG 3350 238 g (1 bottle)
with 64 ounces (~2 L)
Gatorade (light colored) or
other clear liquid.
Split-dose regimen
Evening before
colonoscopy: Ingest 1 L
PEG 3350 mixture (240 mL
every 10 min), THEN
Morning of colonoscopy:
Ingest 1 L PEG 3350
mixture (240 mL every 10
min) ~5 h prior to
colonoscopy. (Can begin
with bisacodyl 20 mg PO at
noon the day prior to the
procedure.)2
•
•
•
•
•
•
•
•
Contraindications/Precautions
Contraindications1,2
Bowel perforation
Gastric retention
Gastrointestinal obstruction
Ileus
Severe or toxic colitis
Toxic megacolon
Precautions
Use caution in patients with renal
impairment or at risk for
dehydration16
Consider same precautions related
to ingesting large volumes of fluid
as for PEG with electrolytes:
impaired gag reflex, patient prone
to regurgitation or aspiration, or
patient unconscious or in a
semiconscious state
•
•
Comments
PEG 3350 (e.g.,
Miralax)/Gatorade is
not iso-osmotic20
Split-dose GoLytely
may be more effective
than split-dose
Miralax with or
without bisacodyl.18-20
However, patient
tolerability may be
better with
Miralax.19,20
Evening-only regimen
Evening before
colonoscopy: Take
bisacodyl 20 mg PO at
noon and wait for bowel
movement for up to 6 h.
Ingest 2 L PEG 3350
mixture (240 mL every
10 min).
More. . .
Copyright © 2012 by Therapeutic Research Center
3120 W. March Lane, Stockton, CA 95219 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249
www.PharmacistsLetter.com ~ www.PrescribersLetter.com ~ www.PharmacyTechniciansLetter.com
(PL Detail-Document #280602: Page 9 of 10)
Brand/Generic/Cost
Suprep23
(sodium sulfate,
potassium sulfate,
magnesium sulfate)
WAC:
$68/2 bottle kit
MOA
Small-volume,
hyperosmotic
solution that draws
water into the
intestinal lumen to
exert its purgative
effect
Dose
Evening before
colonoscopy: Drink one
6 ounce bottle diluted to
16 ounces with water.
Drink an additional
32 ounces of water over the
next hour,
THEN
Day of colonoscopy (to be
completed at least one hour
prior to colonoscopy):
Drink one 6 ounce bottle
diluted to 16 ounces with
water. Drink an additional
32 ounces of water over the
next hour.
•
•
•
•
•
•
•
Contraindications/Precautions
Contraindications
Bowel perforation
Gastrointestinal obstruction
Gastric retention
Ileus
Toxic colitis
Toxic megacolon
•
Precautions
•
Use caution in patients at risk for
fluid
and
electrolyte
abnormalities, seizures, or renal
impairment. In patients with renal
insufficiency, ensure adequate
hydration. Observe patients at •
risk for aspiration closely.
Comments
Similar in
administration to NaP,
but does not contain
phosphate and does
not have a black box
warning for acute
phosphate
nephropathy
Most common adverse
effects include overall
discomfort, abdominal
fullness, nausea,
abdominal cramping,
and vomiting
Dispense with a
Medication Guide
Users of this PL Detail-Document are cautioned to use their own professional judgment and consult any other necessary or appropriate sources prior to making
clinical judgments based on the content of this document. Our editors have researched the information with input from experts, government agencies, and national
organizations. Information and Internet links in this article were current as of the date of publication.
More. . .
Copyright © 2012 by Therapeutic Research Center
3120 W. March Lane, Stockton, CA 95219 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249
www.PharmacistsLetter.com ~ www.PrescribersLetter.com ~ www.PharmacyTechniciansLetter.com
(PL Detail-Document #280602: Page 10 of 10)
Project Leaders in preparation of this PL DetailDocument: Margaret S.W.Wong, B.Sc.Phm (Original),
Neeta O’Mara, Pharm.D. (November 2010 update),
Stacy A. Hester, R.Ph., BCPS (June 2012 and October
2012 update)
References
1.
Barkun A, Chiba N, Enns R, et al. Commonly used
preparations for colonoscopy: efficacy, tolerability
and
safety–A
Canadian
Association
of
Gastroenterology position paper.
Can J
Gastroenterol 2006;20:699-710.
2. Wexner SD, Beck DE, Baron TH, et al. A consensus
document on bowel preparation before colonoscopy:
prepared by a task force from the American Society
of Colon and Rectal Surgeons (ASCRS), the
American Society for Gastrointestinal Endoscopy
(ASGE),
and
the
Society
of
American
Gastrointestinal and Endoscopic Surgeons (SAGES).
Dis Colon Rectum 2006;49:792-809.
3. Food and Drug Administration.
Oral sodium
phosphate (OSP) products for bowel cleansing
(marketed as Visicol and OsmoPrep, and oral
sodium phosphate products available without a
prescription).
December
11,
2008.
http://www.fda.gov/Drugs/DrugSafety/PostmarketDru
gSafetyInformationforPatientsandProviders/ucm1033
54.htm. (Accessed May 10, 2012).
4. Product
information
for
Visicol.
Salix
Pharmaceuticals. Morrisville, NC 27560. March
2009.
5. Product information for OsmoPrep.
Salix
Pharmaceuticals. Morrisville, NC 27560. October
2012.
6. Product information for GoLytely.
Braintree
Laboratories. Braintree, MA 02185. November
2001.
7. Product information for Colyte. Alaven. Marietta, GA
30067. August 2010.
8. Product information for NuLytely.
Braintree
Laboratories. Braintree, MA 02185. March 2008.
9. Product information for TriLyte. Alaven. Marietta,
GA 30067. November 2008.
10. Product information for HalfLytely and Bisacodyl
Tablets Bowel Prep Kit. Braintree Laboratories.
Braintree, MA 02185. July 2010.
11. Product information for MoviPrep.
Salix
Pharmaceuticals. Morrisville, NC 27560. September
2012.
12. Cohen LB. Split dosing of bowel preparations for
colonoscopy: an analysis of its efficacy, safety, and
tolerability. Gastrointest Endosc 2010;72:406-12.
13. Cohen LB, Kastenberg DM, Mount DB, Safdi AV.
Current issues in optimal bowel preparation.
Gastroenterol Hepatol 2009;5(11 Suppl 19):3-11.
14. Cohen LB, Tennyson C. Bowel preparation for
colonoscopy: maximizing efficacy, minimizing risk.
Gastroenterology and Endoscopy News March
2011;1-8.
15. Atreja A, Nepal S, Lashner BA. Making the most of
currently
available
bowel
preparations
for
colonoscopy. Cleve Clin J Med 2010;77:317-26.
16. ASGE Technology Committee, Mamula P, Adler DG,
et al.
Colonoscopy preparation.
Gastrointest
Endosc 2009;69:1201-9.
17. Lichtenstein G. Bowel preparations for colonoscopy:
a review. Am J Health Syst Pharm 2009;66:27-37.
18. Enestvedt BK, Fennerty MB, Zaman A, Eisen GM.
Miralax vs. Golytely: is there a difference in the
adenoma detection rate? Aliment Pharmacol Ther
2011;34:775-82.
19. Hjelkrem M, Stengel J, Liu M, et al. MiraLAX is not
as effective as GoLytely in bowel cleansing before
screening colonoscopies. Clin Gastroenterol Hepatol
2011;9:326-32.
20. Samarasena JB, Muthusamy VR, Jamal MM. Splitdosed MiraLAX/Gatorade is an effective, safe, and
tolerable option for bowel preparation in low-risk
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Cite this document as follows: PL Detail-Document, Comparison of Bowel Preps. Pharmacist’s Letter/Prescriber’s
Letter. June 2012.
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