Two-Day Bowel Preparation With Magnesium Citrate, Dulcolax & Golytely

What is two-day bowel preparation?

Two-day bowel preparation involves taking a variety of laxatives, namely magnesium citrate, Dulcolax^® and Golytely®. They work by softening your poop (stool) so it’s easy to have a bowel movement. The electrolytes in the mixture help prevent dehydration. Together, they clean out your colon (large intestine) to prepare it for a colonoscopy.

Why is bowel prep important?

Bowel prep completely clears your colon of stool. It’s essential because it gives your gastroenterologist the best view of the lining of your colon so they can detect polyps or cancer. For your doctor, a clean colon is like driving on a clear, sunny day. A dirty colon is like driving in a rainstorm.

If you’re a Cleveland Clinic patient, you must follow the instructions for bowel preparation exactly as prescribed or your colonoscopy will be canceled.

How do I use these laxatives for a two-day bowel prep?

At least five days before your colonoscopy, you’ll purchase the following nonprescription laxatives:

• One 10-fluid ounce bottle of magnesium citrate solution
• A package with four Dulcolax tablets containing 5 mg of bisacodyl each (buy the laxative, not the stool softener)

You’ll also need to fill your prescription for Golytely/Nulytely®/Trilyte®/Colyte® well in advance of your scheduled procedure.

Be sure to follow all the instructions exactly so that your colonoscopy doesn’t need to be canceled or repeated.

Key preparation instructions

The following instructions are key to a successful colonoscopy:

• Your bowel must be empty so that your doctor can clearly view your colon. Follow the instructions you get from your gastroenterologist exactly as they’re written.
• Don’t eat any solid food the entire day before your colonoscopy. Drink only clear liquids.

Transportation on the day of your colonoscopy

A responsible driver must be with you when you check in before your colonoscopy. They must stay in the waiting area until you’re discharged. You’re not allowed to leave alone after your colonoscopy. If you don’t have a driver with you to take you home, your exam will be canceled. You aren’t allowed to operate any type of transportation (like a bike, car, scooter, etc.) or leave the facility alone.

Medications

For your safety, certain medications will need to be stopped or adjusted before you can have your procedure. These include:

• Blood thinners: Contact your provider at least two weeks before the procedure about adjusting your medication. Examples of blood thinners include clopidogrel (Plavix^®), warfarin (Coumadin^®), ticlopidine hydrochloride (Ticlid^®), anagrelide (Agrylin^®), rivaroxaban (Xarelto^®), dabigatran (Pradaxa^®), apixaban (Eliquis^®) and prasugrel (Effient^®).
• Insulin and diabetes medication: Always call the provider who orders these medications for instructions on changing the dosage leading up to your colonoscopy. Don’t take your diabetes pills after midnight on the day of your procedure. If you’re taking insulin, like as insulin glargine injection (Lantus^®), insulin lispro (Humalog^®), long-acting insulin like insulin isophane (HumulinN^®, NovolinN^®, ReliOn^®) or 70/30 insulin, take half your normal dose the day before your procedure.
• Weight management medication: If you take medications for weight loss, your dosage may need to be adjusted, or you might need to stop taking them several days to a week before. Contact the doctor who prescribes this medication for further instructions. Weight loss medications that you’ll need to stop include canagliflozin (Invokana^®), dapagliflozin (Farxiga^®, Forxiga^®), dulaglutide (Trulicity^®), empagliflozin (Jardiance^®), ertugliflozin (Steglatro^®), exenatide (Byetta^®, Bydureon^®), liraglutide (Victoza^®, Saxenda^®), lixisenatide (Adylyxin^®), semaglutide (Ozempic^®, Wegovy^®, Rybelsus^®) and tirzepatide (Mounjaro^®, Zepbound^®).
• Iron pills: Stop taking them one week before your colonoscopy.

Medications like aspirin, antibiotics or diuretics should be taken with a sip of water on the day of the exam. If you’re unsure which medications you can continue to take, please get in touch with your healthcare provider.

Three days before your colonoscopy

Stop eating these high-fiber foods three days before your colonoscopy:

• Popcorn
• Beans
• Seeds (flax, sunflower, quinoa)
• Multigrain bread
• Nuts
• Salad/vegetables
• Fresh and dried fruit with skin peel

One day before your colonoscopy

You should only drink clear liquids beginning the day before your colonoscopy. Don’t eat any solid foods.

You can continue to drink clear liquids until three hours before your colonoscopy. The chart shows what you can and can’t drink:

How to take your two-day bowel prep

Read all the instructions before mixing the bowel prep solution.

Two days before your colonoscopy

• 1-5 p.m.: Drink 8 ounces of clear liquids every hour.
• 5:30 p.m.: Drink one 10-fluid ounce bottle of magnesium citrate laxative solution.
• 6-9 p.m.: Continue drinking 8 ounces of clear liquids every hour.
• 9:30 p.m.: Take 4 bisacodyl (Dulcolax) tablets with water by mouth.

One day before your colonoscopy

• You may continue a clear liquid diet throughout the day until 6 p.m.
• In the afternoon, mix the Golytely/Nulytely/Trilyte Colyte bowel preparation solution and refrigerate. You may add the flavor pack — if present — but don’t add ice, sugar or other flavorings to the solution. You’ll drink the solution in two parts.
• At 6 p.m., drink one 8-ounce glass of the solution every 15 minutes until you’ve consumed one-half of the prep solution.
• Six hours before your scheduled procedure, drink the second half of the solution, also in an 8-ounce glass consumed every 15 minutes.
• Continue a clear diet until three hours before your colonoscopy.

Some people’s bowels move slowly, and they may need different instructions. Please see your doctor for personalized bowel prep instructions if you have:

• Medical conditions that need special accommodations
• Had poor bowel prep results or a failed bowel prep in the past
• Had difficulty with anesthesia during a past procedure

What if I have constipation?

You may take extra laxatives in the days leading up to your prep. This should help resolve your constipation before your bowel prep day.

What if I’ve had poor prep results in the past?

Contact your physician as you’ll likely need more bowel prep instructions.

What if I have motility issues from a medical condition?

Certain medical conditions and medications can slow bowel emptying or lead to constipation. Conditions like Parkinson’s, multiple sclerosis (MS) or using a wheelchair can slow down your digestion. Medications like narcotics, gabapentin and anticholinergic medications can also have an impact. Contact your physician and be sure to share your medical history and current medication use, as you’ll likely need extra time and additional laxatives to complete your bowel prep.

What if I can’t drink a large volume of liquid?

Start your prep two to three hours earlier to allow yourself more time to complete the entire prep.

What if I can’t finish my bowel prep?

If you can’t finish your entire bowel prep, you’ll likely need to reschedule your colonoscopy due to poor prep quality.

Do I still have to complete the entire prep if I’ve had bariatric surgery?

Gastric bypass surgery involves your stomach and small bowel. It doesn’t change the length of your colon. You may need to drink smaller amounts of water, more slowly. You’ll need to complete the entire bowel prep, it may just take longer.

What if I’m on dialysis?

Please consult your nephrologist (kidney specialist) prior to scheduling to get instructions that are specific to you. In general, dialysis patients take the Golytely bowel prep and have the procedure on the same day as their dialysis (colonoscopy in A.M., dialysis in P.M.).

How do I know if something is a clear liquid?

If you can pour it in a glass and you can see through it, it’s considered “clear liquid.”

Can I take Uber^®, Lyft^®, taxi or bus home?

An adult must be present with you at check-in for your colonoscopy and remain in the endoscopy area until you’re discharged. You can hire a driver to take you home only if this adult escort is with you at check-in, remains in the endoscopy area until you’re discharged, and takes the hired ride home with you.

Can I “sleep it off” here and drive myself home?

No, you must have an adult with you when you check in. Your responsible adult must remain in the endoscopy center during your procedure and then drive you home. You can’t drive a vehicle for the rest of the day.