Microsoft word - revised miralax 8 12 11.doc

DATE: _____________________ TIME: ______________________
PLEASE REPORT TO: _________________________

*Arrive 45 minutes prior to procedure time to register*
PROCEDURE. If you are using public transportation, a responsible
person must accompany you to your home. If these instructions are not followed, your procedure will be
If you have a history of heart disease and take a daily aspirin, you do not need to stop taking it. If however, you
have no history of heart disease and are taking a daily aspirin for preventative purposes, please stop this one week
before your procedure. Be sure to check with our office regarding any of the following: diabetes, valvular heart
disease, bleeding tendencies or anti-coagulation therapy.
ANTI-INFLAMMATORY MEDICATIONS such as Advil, Motrin, Aleve, Naprosyn, and other Ibuprofen
products, as well as IRON PILLS, and METAMUCIL/FIBER SUBSTITUTES should be stopped ONE-
prior to your procedure. (Calcium, Tylenol, Vitamins C & B are OK to continue taking).
Two days prior to your procedure, avoid foods such as fruits, vegetables, skins, roughage, seeds and nuts.

You may have CLEAR LIQUIDS ONLY for one full day before your procedure. (This means NO SOLID FOOD
from the time you wake up in the morning the day before the procedure). Clear liquids include broth, decaf
coffee/tea (no cream, sugar is OK), clear juices (like apple or white grape), all sodas, Jello, Gatorade, Popsicles, and
water. NO RED DYES: Jello, Popsicles, sherbert, and juices must be non-red in color, as red dyes found in foods
can look like blood during the procedure.
AT 3:00PM the day before your procedure take four (4) Dulcolax (Bisacodyl) tablets. These can be purchased at
the pharmacy without a prescription.

AT 5:00PM
the day before your procedure mix the 238 gram bottle of MiraLax powder in a 64oz bottle of
Gatorade. Shake the solution until the MiraLax is dissolved. Drink an 8oz glass of this mixture every 15 minutes
until the solution is gone.
You may continue with clear liquids until 4 hours prior to your scheduled procedure time (for example, if your
procedure is at 12:00pm, you may have clear liquids until 8:00am). After this time, DO NOT HAVE
Do not take any medications the morning of the procedure unless otherwise instructed
by our office.
If you have any questions or difficulties with this preparation, please contact our office at 401-421-8800. Most insurance companies cover this procedure however if you have not checked with your insurance company or if you are unsure of your benefits please check with your carrier regarding coverage.


E:\s\serenoa repens.vp

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