Miralax prep-revised 9-16-1

3601 NE Ralph Powell Rd, Lee’s Summit, MO 64064 5844 NW Barry Rd, Ste. 300, Kansas City, MO 64154 816.836.2200
COLONOSCOPY PREP USING MIRALAX AND GATORADE

PATIENT NAME: _____________________________________ DR. ________________________
You are scheduled for a Colonoscopy on: _____/_____/_____ at ____________________________________
You must arrive by: __________________ for your scheduled procedure at: ___________________________
To ensure that your test is accurate and complete, you must follow these directions. If you have questions,
please call our office at 816-836-2200. Midwest Gastroenterology Center is dedicated to providing you with
quality health care. You matter to us!

Purchase 4 Dulcolax LAXATIVE tablets (no prescription required – generic OK), 64 oz. of Clear, Yellow, or
Green Gatorade (Gatorade G2 if you are a diabetic) and a 238 gm. bottle of Miralax (no prescription required –
generic OK) at your local pharmacy. Follow the instructions below:
THE DAY BEFORE YOUR TEST
THE DAY BEFORE YOUR EXAM YOU WILL BE ON A CLEAR LIQUID DIET ONLY:
AVOID ALL ITEMS WITH RED, ORANGE AND/OR PURPLE FOOD COLORING
Ø In the morning (the day before your procedure) mix the 238 gram bottle of MiraLax into 64 oz. clear liquid you purchased. Be sure that the MiraLax is completely dissolved and refrigerated.
IF YOUR PROCEDURE IS BEFORE 12:00 pm
1. At 3:00 pm, take the 2 Dulcolax tablets by mouth.
2. Between 5:00 and 6:00 pm begin to drink the MiraLax solution. Drink 8 ounces of MiraLax every 15 to 20
minutes for a total of 8 doses. (Complete within 2 hours)
3. At 8:00 pm, take the remaining 2 Dulcolax tablets by mouth.
IF YOUR PROCEDURE IS AFTER 12:00 pm:
1. At 3:00 pm, take the 2 Dulcolax tablets by mouth.
2. Between 5:00 and 6:00 pm begin to drink the MiraLax solution. Drink 8 ounces of MiraLax every 15 to 20
minutes for a total of 4 doses. (Complete within 2 hours).
3. At 6:00 am the morning of your procedure, drink the remaining 32 oz. of Miralax and take the remaining

IF YOU ARE SCHEDULED FOR A MORNING PROCEDURE AND NOT HAVING BOWEL
MOVEMENTS BY 8:00 PM - - CALL OUR OFFICE AND LISTEN TO RECORDING ON
ALTERNATIVES! IF YOU ARE SCHEDULED FOR AN AFTERNOON PROCEDURE AND NOT
HAVING BOWEL MOVEMENTS BY THE MORNING OF THE EXAM - - CALL OUR OFFICE AT 8:00
AM.
SEE REVERSE SIDE
3601 NE Ralph Powell Rd, Lee’s Summit, MO 64064 5844 NW Barry Rd, Ste. 300, Kansas City, MO 64154 816.836.2200
DAY OF YOUR TEST
Ø If your procedure is before 12:00 - Nothing to drink after midnight.
Ø If your test is scheduled late in the day (after 12:00 noon) you may have clear liquids up to 8 hours
before your exam. No gum, mints or candy are allowed 8 hours before your procedure.
Ø If you take a heart, blood pressure, seizure or stomach acid medication routinely -- it is okay to take
this medication early the morning of your procedure with a sip of water. Hold all other medications
until after the procedure unless instructed to do otherwise.
Ø You must arrive for your exam no later than the time listed on the reverse side. Please bring your
insurance card and photo I.D.

Ø If you were mailed any Patient Information Forms please complete them and bring them with you to
your appointment. DO NOT MAIL THEM.
Ø SINCE YOU WILL BE SEDATED YOU MUST HAVE SOMEONE WITH YOU TO DRIVE YOU
Ø Since the sedation will cause temporary forgetfulness you should have someone with you who can
review instructions with you.

PLEASE NOTE:

• Do not take any iron medications for 4 days prior to colonoscopy • Please note you will receive multiple calls and it is important you listen to all carefully. You will get a call to confirm your procedure time, from a pre-op nurse, and if applicable from the pre certification department
of both our office and/or the facility in which you are having the procedure. All calls must be returned.
• If you take blood thinners: Coumadin, Plavix, Reapro, Pradaxa or Aggrenox: o You will need to contact your primary care physician or cardiologist at least 1 week prior to
your procedure to obtain instructions. These medications MAY need to be stopped 4 days prior
if your prescribing physician instructs you to do so. o IF your primary care physician or cardiologist advises you to NOT stop taking your blood thinner,
you must contact our office at least 4 days prior to your scheduled procedure for additional
instructions.
• Drink plenty of clear liquids while doing the prep (at least 8 ounces every hour). • If you are diabetic NO INSULIN OR ORAL MEDICATIONS THE MORNING OF THE PROCEDURE.
TAKE ONLY HALF A DOSE THE DAY BEFORE YOUR PROCEDURE AND NOTHING THE
MORNING OF YOUR PROCEDURE. IF YOU ARE AN INSULIN DEPENDENT DIABETIC WITH
UNSTABLE BLOOD SUGARS NOTIFY YOUR PRIMARY CARE PHYSICIAN FOR
INSTRUCTIONS.
PLEASE CALL US AT 816-836-2200 WITH ANY QUESTIONS

Source: http://www.midwestgastro.com/missbserfiles/MIRALAX%20PREP-revised%209-16-11.pdf