Microsoft word - miralax prep.doc

Colonoscopy is a procedure to examine the colon. A small flexible tube with light and
miniature camera is inserted into your rectum. Medication is given by I. V. to keep you
comfortable during your exam. The risks include but are not limited to pain, bleeding,
infection, medication reactions (irregular heart rhythm or breathing difficulties), bowel
perforation, need for blood transfusion, surgery or repeat colonoscopy, ICU stay and
even rarely death.
Some procedures are scheduled directly. However, if you wish to first have a
consultation with the doctor in the office, to discuss the procedure, sedation, risks and
complications, alternatives etcetera, please notify our office and schedule a clinic visit
instead.
Purchase: (MIRALAX PREP)
Miralax or generic (238 gm) – over the counter, ½ ( half) gallon drinking water,
Bisacodyl 5 mg (generic for dulcolax) 4 tablets.

Preparation
1. You will need to stop aspirin and Anti-inflammatories for seven (7)
days before your exam. These medications include Advil, Alka-Seltzer, Anacin, aleve, BC powder, Bufferin, Ecotrin, Excedrin, Ibuprofen, Feldene, Midol, Motrin, and Naprosyn. Check with your doctor if you have any questions about medications. 2. You will need to stop iron or ferrous sulfate, herbal medications,
metamucil for seven (7) days before your exam.
3. Stop taking Coumadin (Warfarin) for five (5) days before your exam.
Please get an okay from your primary care doctor to stop coumadin for the test (may need lovenox). If you have an artificial heart valve, please notify Dr. Mahajan’s office. 4. Stop taking Plavix (Clopidogrel) for five (5) days before your exam.
Please get an okay from your cardiologist/neurologist. 5. Medications allowed the morning of your procedure with a small sip or
■ Blood Pressure medication.
■ Heart medication.
■ Breathing medication, anxiety, depression medications.
6. Medications to avoid: Insulin or diabetic medication on the morning of
your exam(check with primary physician). FAILURE TO HAVE A
DRIVER WILL RESULT IN CANCELLATION OF EXAM. If colon is not
totally cleaned out, the procedure will have to be repeated.

5 Executive Drive, Suite B-1 | Lafayette, IN 47905 | PH: 765.807.0531 | www.unityhc.com/lg
Take 2 tablets dulcolax (bisacodyl) on _____________ at 9 PM (2 days before procedure) - Pour entire Miralax 238 gm in 1/2 (half) gallon jug of water. Refrigerate it. Clear Liquid Diet ______________
No Solid Food or Milk Products all day
7-Up or Sprite type Chicken Broth or Beef Bouil on (No noodle soups) Clear Gatorade Plain coffee or tea (no cream or milk or Coffemate)
Jel -O (White grape or Lemon), with no fruits in them
Apple or White grape juice
Kool-Aid, popsicles, strained fruit juices (no pulp)
AVOID ALL RED, PURPLE, OR ORANGE COLORING
Start drinking miralax at 5:00 p.m. and complete entire jug in 2
hours. (You may start as early as 10 am). If you develop nausea
and vomiting, please stop drinking miralax prep for 1 hour. Then,
resume the prep to complete it. After completion of miralax, wait 1
hour
. Then take 2 tablets of dulcolax (bisacodyl).
 May have clear liquids after miralax jug is completed. Day of Procedure _____________________________________________

You can have clear liquids only, until 4hours prior to procedure. Take the allowed
medications with sip of water (see other side of this page). You are required to
have a responsible adult to accompany you to and from the hospital. You will not
be allowed to drive home after discharge.
Please register at ________ a.m.
Do not take diabetic meds in the morning.

( ) Unity Surgical Center ( ) St. Elizabeth EAST(ON CREASY)
1411 South Creasy Lane
CALL 423-6443 TO PRE-REGISTER
Take elevator to second floor (go to North Entrance)
Suite # 200) Tel: 765-502-4750
Tel: 765-446-5000

PLEASE CANCEL PROCEDURE 3 DAYS IN ADVANCE (807-0531)TO AVOID
CHARGE of $50
. If any biopsies are taken/blood test done, results will be mailed
in 2 weeks. PLEASE TURN OVER FOR IMPORTANT INFO.

5 Executive Drive, Suite B-1 | Lafayette, IN 47905 | PH: 765.807.0531 | www.unityhc.com/lg

Source: http://www.unityhc.com/sites/default/files/forms/Miralaxprep.pdf

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