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PT Name:
Acct. #
Glycolax Preparation for Colonoscopy
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The Day Before the Colonoscopy
Drink clear liquids only
o Clear liquids include fat free broth, apple juice, Gatorade®, black coffee or tea
with or without sugar, ginger ale, white cranberry juice, Jello, ice popsicles and
water.
 Do not drink fluids that are red or purple.
 It is important to drink as much fluid as possible throughout the day.
At 5PM take 4 Dulcolax (Bisacodyl) Tablets, 5mgs. each, by mouth with a glass of water.
o These are available over the counter at your pharmacy.
At 7PM mix all of the 240g to 255g bottles of Glycolax with a 64oz. bottle of Gatorade®
in a pitcher and stir very well until the Glycolax is dissolved.
o Glycolax is obtained from your pharmacy using the prescription provided.
 You may substitute 2 quarts of Crystal Light® Lemonade for the
Gatorade®.
Drink an 8 oz. glass of this solution every 10-15 minutes until the solution is gone.
o Some patients have found it helpful to drink the solution through a straw and chill
the solution.
o It usually takes about an hour before you begin to have the diarrhea effect.
 You may experience some bloating or cramping with this prep. This
usually gradually improves once the diarrhea begins.
o Occasionally patients will develop nausea and vomiting. If this happens, take a
break for an hour and then resume drinking the solution more slowly.
o The diarrhea effect will generally continue for about 2 hours after you finish the
solution.
You may have additional clear liquids until midnight.
The Day of the Colonoscopy
Nothing by mouth including gum or candy after midnight. Remember that until that time
you may ONLY have clear liquids which are not red or purple. Failure to follow these
instructions may result in your procedure being cancelled. If you are unable to finish the
preparation, call the office at 267-620-1100.
PHYSICIAN ADDENDUM:
Physician initials __________
Information sheet given _____________ (employee initials)
Patient chooses to call and schedule procedure at a later time ____________ (employee initials)
Patient initials __________________
(Glycolax prep – day before-03/07)