Colonoscopy Prep: the more palatable, the more risk

July 21st, 2009. By AbiK

Having a colonoscopy is a weird sort of rite of passage. Once you’ve had one, you can give your colon-checking compatriots that knowing nod when they mention the procedure. Guaranteed after that nod, someone will bring up “prep”—it’s the point of convergence for all colonoscopy conversation. And for good reason: it’s the worst part of the procedure and it’s the only part for which you’re entirely too conscious.

So weren’t we all filled with glee when we learned there was an oral sodium phosphate pill—a pill!—we could take rather then slugging back a 4-liter jug of Golytely? Well, with recent reports, maybe not. 

There are 3 basic options for colonoscopy prep: Golytely (also Colyte, Nulytely), Fleet Phospho-soda EZ Prep, and Oral Sodium Phosphate (Osmo-Prep and Visicol). The problem with them (aside from the fact that you have to take one of them) is that there’s an inverse relationship between their palatability and their associated risks. Here, an overview of the options—not to be construed as medical advice; for that, see your doctor.

Golytely: least palatable, no black box warning

Taste/Feel

A bit chalky, somewhat salty; comes with fruity flavor packets;

Dosage

It’s a mighty big bottle—4 liters typically (over a gallon!); 8 oz. taken every 10 minutes—so figure on roughly 16 servings over 2.6 hours.

Common Side Effects

Bloating, nausea, rectal irritation, stomach fullness or cramps, vomiting.

Potential Serious Adverse Effects

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); chest pain; muscle weakness; persistent or severe nausea and vomiting; severe bloating or abdominal swelling; severe stomach pain; slow or irregular heartbeat; vomiting of blood. Patients with impaired gag reflex, unconscious, or semiconscious patients, and patients prone to regurgitation or aspiration should be observed during administration. 

Fleet Phospho-Soda EZ Prep: more palatable, increased renal risk

Taste/Feel

Salty, but combining with apple juice can help improve the taste.

Dosage

Combine 1.5 oz. solution with 4 oz. of a clear liquid and drink; follow with 8 oz. of water or other clear liquid. Repeated, with at least 5 hours between doses and continuous intake of clear fluids.

Common Side Effects

Diarrhea, gas, nausea, stomach cramps.

Potential Serious Adverse Effects

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); blood in the stools; continued constipation; dizziness; vomiting; weakness. Rarely, serious kidney problems have occurred with the use of this product. Heart failure, kidney disease, or being older than 55 years can increase the risk.

Osmo-Prep: most palatable, black box warning

Taste/Feel

Swallow pills with any clear liquid of your choice.

Dosage

4 tablets every 15 minutes, with 8 oz. of any clear liquid; patient takes either 20 tablets over 1 hour, or 12 tablets over 30 minutes.

Common Side Effects

Nausea, vomiting, stomach/abdominal pain or bloating, dizziness, and headache may occur.

Potential Serious Adverse Effects

Fast/irregular heartbeat, chest pain, fainting, mental mood changes, seizures. Persistent diarrhea or vomiting may result in a serious loss of body water (dehydration) and minerals. Unusual decreased urination, unusual dry mouth/increased thirst, lack of tears, dizziness/lightheadedness, muscle weakness/cramping, or pale/wrinkled skin. Serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Black Box Warning

There have been rare, but serious reports of acute phosphate nephropathy in patients who received oral sodium phosphate products for colon cleansing prior to colonoscopy. Some cases have resulted in permanent impairment of renal function and some patients required long-term dialysis. While some cases have occurred in patients without identifiable risk factors, patients at increased risk of acute phosphate nephropathy may include those with increased age, hypovolemia, increased bowel transit time (such as bowel obstruction), active colitis, or baseline kidney disease, and those using medicines that affect renal perfusion or function (such as diuretics, angiotensin converting enzyme [ACE] inhibitors, angiotensin receptor blockers [ARBs], and possibly nonsteroidal anti-inflammatory drugs [NSAIDs]).

(sources: drugs.com, nulytely.com, tabletprep.com, fleetez-prep.com, mayoclinic.com)

Tags: Colonoscopy, Oral Sodium Phosphate, OSP

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