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C:\documents and settings\cdrexel\desktop\lakesidewebpc\pdf\colonoscopic-prep.prn.pdf

Suri Karthikeyan, M.D.
Gastroentorology & Hepatology
Suri Karthikeyan, M.D., M.R.C.P., F.R.C.P. (c) INSTRUCTIONS FOR COLONOSCOPIC PREP WITH MIRALAX AND CLEAR LIQUIDS
READ CAREFULLY–DO NOT EXCEED RECOMMENDED DOSAGE AS SERIOUS SIDE EFFECTS MAY OCCUR.

Name: _____________________________
You have been scheduled for the above examination. Please report to:
Lakeside Memorial Hospital - Central Registration – Rear of Building
PLEASE REVIEW ALL INSTRUCTIONS UPON RECEIPT!
(1) 255 gm bottle of MiraLax
(2)
4 Ducoluz tablets
(3)
64oz. or (2) 32oz. of Clear Liquids such as Sprite, Ginger Ale, 7-Up, White Grape juice (White grape juice works best)
Note: Individual responses to laxatives do vary. This prep may cause multiple bowel movements. It often works within 30
minutes, but may take as long as 3 hours after beginning to drink the MiraLax or Clear Liquid mixture. Please remain within reach
of toilet facilities.
----PLEASE TURN OVER-----
In order to assure optimal colonoscopic examination, the following guidelines are recommended

1)
Take no Aspirin or Aspirin-containing products for five (5) days before the procedure. Acetaminophen (Tylenol, Panadol or Datril) can be used. Do not take arthritis medications like Ibuprofen (Advil, Motrin, Naprosyn, Feldene or Nuprin) for three to five (3-5) days before the procedure. Take no extra dietary fiber, including Metamucil, Citrucel or similar products one (1) week before the procedure. Stop all iron medications or vitamins containing iron one (1) week before the procedure. Note: Please discontinue use of
CARAFATE or any antacids 24-48 hours prior to your procedure.
Do not eat nuts, raisins, fruit containing seeds, foods containing seeds (sesame, poppy, etc.) or uncooked vegetables three (3) days before the procedure. You can take your regular medications on the morning of the examination, except Insulin. Please check with us prior to taking any
Insulin or other antidiabetic medications on the morning of the examination.
DAY BEFORE EXAMINATION
Begin a clear liquid diet one (1) day before the procedure. . No food is allowed. Clear liquids include water, 7-Up, colas, apple juice,
Jello (no red or purple allowed) and broth. Do not drink any red or purple liquids. You may have coffee or tea, but no milk.
DRINK AS MUCH LIQUID AS YOU CAN TOLERATE.
At 3:00 p.m. mix the 255 gm bottle MiraLax in 64 oz. clear liquids of your choice. Shake the solution until the MiraLax is dissolved. Drink an 8 oz. glass of the solution every 10-15 minutes until the solution is gone. Continue drinking clear fluids until bedtime. DAY OF EXAMINATION
Drink only clear liquids thereafter until examination is completed. You should plan on 2-3 hours, including recovery time, for this test. Transportation arrangements must be made for someone to pick you up at the Central Registration area – Rear of Building and
accompany you home. No exceptions can be made.
You must arrange for a neighbor, friend or family member to stay with you after your arrival home, since sedation effects can last well into the evening.
*NOTE TO PATIENT: Depending on the type of insurance coverage you have, you may be required to pay two co-pays for an
outpatient procedure. One for the doctor and another for the hospital. Please call your insurance to verify your co-payment
obligations. Thank You.

Source: http://www.lakesidehealth.org/pdf/colonoscopic-prep.pdf

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