Conditions and Services Belly and Pelvis Digestive System

What colonoscopy prep solution is best for you?

May 3, 2023

If you’ve had a colonoscopy, you know it’s not all that bad. The actual procedure takes about 15 minutes, and patients are put in a twilight sleep and remember little if anything, about the procedure.

It’s the preparation that most people dislike the most. But several new options for prep solutions are making them more palatable.

The day before a colonoscopy, you are required to avoid solid foods. Late afternoon you will begin drinking a prep solution to thoroughly cleanse the colon before the colonoscopy procedure and then again four to five hours before the procedure. Traditional solutions such as GoLYTELY® and NuLYTELY® include polyethylene glycol (PEG), electrolytes and sodium sulfate. A powder is mixed with water or a clear fluid of your choice and requires you to drink up to 4 liters of fluid over a 12 to 15-hour period.

“People often don’t like these preps because of their salty taste and the large volume of fluid that must be ingested,” says Derrick Eichele, MD, Nebraska Medicine gastroenterologist.

Several alternative solutions use formulas that don’t require large fluid consumption or may not have a salty taste. Two tablet-based formulas, OsmoPrep® and the more recent Sutab®, also received FDA approval in 2021.

“The biggest drawbacks to these alternative solutions are cost and potential side effects,” says Dr. Eichele. “Several preps, including the new tablet Sutab®, may cause potential electrolyte complications that preclude some patients from using these formulas.

The other drawback is that they may not be covered by your insurance, especially the newer preps. Always check with your insurance provider first. They can let you know what preps will be covered and which may require out-of-pocket expenses.

“If the potential risk factors are not an issue and your doctor approves of the product you prefer, my philosophy is that right prep is whichever FDA-approved solution the patient prefers that ensures they follow the prep procedure,” Dr. Eichele says.

Here are the primary colonoscopy preparations on the market and their pros and cons:

Standard PEG-based preps

GaviLyte-C

Contains polyethylene glycol and sodium sulfate, causing a salty taste
Requires ingesting 4 liters of fluid
Covered by most insurance
Cost averages in the $10 to $25 range

GoLYTELY®

Contains polyethylene glycol and sodium sulfate, causing a salty taste
Requires ingesting 4 liters of fluid
Covered by insurance
Cost averages in the $10 to $25 range

GaviLyte-G

Contains sodium sulfate causing a salty taste
Requires ingesting 4 liters of fluid
Covered by insurance
Cost averages in the $10 to $25 range

NuLYTELY, TriLyte®, GaviLyte-N

Does not contain sodium sulfate for a less salty taste
Requires ingesting 4 liters of fluid
Covered by insurance
Cost averages in the $19 to $25 range

Low-volume PEG-based preps

MoviPrep®

May be as effective as 4-liter PEG solutions and better tolerated
Contains sodium ascorbate and ascorbic acid, which have a citrus taste and produce a laxative effect
May be preferred for older adults and those at increased risk of fluid and electrolyte abnormalities
May not be covered by insurance
May cost $100+

Plenvu®

Often preferred for older adults and those at increased risk of fluid and electrolyte abnormalities
Requires consuming 2 liters of fluid
May not be covered by insurance
May cost $100+

MiraLAX®

Requires 2 liters of fluid
More palatable than traditional PEG-plus electrolyte solutions
May be less effective than 4-liter PEG-based preps due to a smaller volume
Covered by insurance

Sodium phosphate-based preps

OsmoPrep®

Requires swallowing 20 tabs with a total of 2 liters of fluid
Reported as effective as PEG-based solutions
Risk for fluid and electrolyte shifts and kidney complications
Should be avoided by patients with heart failure, kidney issues, end-stage liver disease, electrolyte abnormalities or patients age 65 and older
May not be covered by insurance
May cost $240+

Sodium picosulfate-based preps

Clenpiq®

Reported as effective as PEG-based solutions
May cause fluid retention and electrolyte disturbances. Should be avoided in patients with heart failure, kidney issues or risk for electrolyte abnormalities
Only requires drinking 2 liters of fluid
Does not need to be mixed or diluted
May not be covered by insurance
May cost $150+

Sodium sulfate-based preps

Sutab®

Requires ingesting tablets with 3 liters of fluid
As effective as PEG-based solutions
Safety in patients with heart failure, kidney issues or electrolyte abnormalities is unknown
May not be covered by insurance
May cost $150+

Suprep®