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Gatorade/Miralax colonoscopy prep effective, not improved by bisacodyl
Colonoscopy preparation using Gatorade and Miralax was as effective as and better tolerated than Nulytely, but was not improved by the addition of bisacodyl in a recent study.
In a blind, placebo-controlled, randomized trial, researchers administered 306 g Miralax and 64 oz. Gatorade (G/PEG) with or without 10 mg bisacodyl or 1 gallon of Nulytely to 600 participants on the day before colonoscopy. The cohort was evenly divided between the three groups. The Miralax dose was split to include 51 g in 355 ml of a clear liquid at noon and 255 g in Gatorade in the evening. Bowel cleanliness after preparation was evaluated according to the Boston Bowel Preparation Scale (BBPS), and participants also answered questionnaires regarding the tolerability of the preparation technique.
No difference was found between the BBPS scores of patients in the G/PEG and Nulytely groups (P=.19), but those in the two G/PEG groups reported fewer side effects, including nausea (P<.02), vomiting (P<.03), abdominal pain (P<.2) and bloating (P<.002) compared with those taking Nulytely. Patients in the G/PEG groups also indicated that the preparation was more tolerable than did those taking Nulytely, with more participants consuming 100% of the preparation (mean 99.1% ± 4.6 vs. 93.4% ± 12.9), fewer reporting difficulty taking the preparation, and more willing to use the same preparation method in the future (P<.0001 for all three).
Patients in the G/PEG group receiving bisacodyl reported more abdominal cramps than those taking G/PEG with placebo (P<.01), and also tended to not result in a cleaner colon following preparation (BBPS=7.99 ± 1.41 vs. 8.05 ± 1.28, P=.66).
David P. Gerard
“We tried the commonly used formulation of Gatorade/Miralax, with 238 g of Miralax, and it did not work well,” researcher David P. Gerard, MD, told Healio.com. “Our 306 [g] version of Gatorade/Miralax cleanses the colon as well [or better] than Nulytely, and is far better tolerated. Bisacodyl … does not help cleanse the colon better than placebo and causes more side effects. We were able to cleanse the colon adequately in over 96% of patients using a preparation taken the evening before a morning colonoscopy. We are the first group to show such good results with any evening-before preparation.”