Microsoft word - colonoscopy-preparation-instructions-2-day-moviprep-aug-2011-1.docx

COLONOSCOPY PREPARATION INSTRUCTIONS – 2 Day Moviprep Patient Name: ______________________________________________ Doctor: _______________________________ Procedure Date: _______________Check-in at ____________a.m./p.m. with procedure to follow one hour later. Facility where procedure is to be performed: Southeast Valley Endoscopy Center 1.) FILL PRESCRIPTION for MoviPrep at your pharmacy.
2.) NO NUTS, SEEDS, POPCORN OR CORN FOR ONE WEEK PRIOR TO COLONOSCOPY.
3.) TWO DAYS BEFORE YOUR PROCEDURE: For the entire day, follow a full liquid diet only –
Smooth ice cream, milk, pudding, vegetable juice, fruit juice/nectar, liquid supplements (Boost, Ensure, Resource,
Sustacal), soup (broth, bouillon, consommé, and strained cream soups – but NO SOLIDS.
4.) FOR THE ENTIRE DAY BEFORE YOUR TEST, FOLLOW A CLEAR LIQUID DIET.
NO SOLID FOODS MAY BE EATEN! We recommend that you drink at least 32 ounces of clear fluids
before beginning the prep. Clear liquids include water, pulp-free juice, tea, coffee, soda, clear
broth, Jell-O , popsicles and Gatorade (no red or purple). Please do not consume milk, milk
products, non-dairy creamer, red or purple products or alcoholic beverages.
5.) NOTHING BY MOUTH 4 HOURS PRIOR TO YOUR CHECK-IN TIME – THIS INCLUDES WATER,
MEDICATIONS, GUM AND MINTS. You may continue to drink clear liquids up to four hours prior
to your check-in time.
6.) WHEN TO DRINK THE LAXATIVE SOLUTION: If you have a check-in time of 9:30 a.m. or earlier:
• At 5:00 p.m. the day before your colonoscopy, empty one Pouch A and one Pouch B into the disposable
container. Add lukewarm water to the top line of the container. Mix to dissolve. You may put MoviPrep in the refrigerator to chill. Within one hour, begin drinking 8 oz of the MoviPrep solution every 15 minutes until the full liter is consumed. Then drink 16oz of the clear liquid of your choice. This is necessary to ensure adequate hydration and an adequate prep. • At 10:00 p.m. the day before your colonoscopy, again empty one Pouch A and one Pouch B into the
disposable container. Add lukewarm water to the top line of the container. Mix to dissolve. You may put MoviPrep in the refrigerator to chill. Within one hour, begin drinking 8 oz of the MoviPrep solution every 15 minutes until the full liter is consumed. Then drink 16oz of the clear liquid of your choice. If you have a check-in time of 10:00 a.m. or later:
• At 7:00 p.m. the day before your colonoscopy, empty one Pouch A and one Pouch B into the disposable
container. Add lukewarm water to the top line of the container. Mix to dissolve. You may put MoviPrep in the refrigerator to chill. Within one hour, begin drinking 8 oz of the MoviPrep solution every 15 minutes until the full liter is consumed. Then drink 16oz of the clear liquid of your choice. This is necessary to ensure adequate hydration and an adequate prep. • On the day of your colonoscopy, at _______a.m. (5 ½ hours before your check-in time) empty one Pouch
A and one Pouch B into the disposable container. Add lukewarm water to the top line of the container. Mix to
dissolve. Begin drinking 8 oz of the MoviPrep solution every 15 minutes until the full liter is consumed. Then
drink 16oz of the clear liquid of your choice. If you wish to chill the MoviPrep you will have to start 6 ½
hours before your check-in time.
REMINDER: Nothing by mouth 4 hours prior to your check-in time. • Failure to follow these instructions could result in your procedure being postponed
or cancelled. This is for your safety and to prevent an increased risk of pulmonary
aspiration due insufficient time to allow stomach contents
to be empty.
* PLEASE READ BACK AND FRONT OF THIS INSTRUCTION SHEET ONE WEEK PRIOR TO YOUR PROCEDURE *
SOUTHEAST VALLEY GASTROENTEROLOGY CONSULTANTS, P.C. CHARLES M. SCHRON MD • G. ALAN BRACHER MD • MANISH G. AMIN MD • SANDEEP C. PATEL MD • YATIN R. PATEL MD TINA M. DVOREN-BAKER NP-C • CHRISTINA F. MORGAN PA-C • MOLLY A. WYANT PA-C
MEDICATION INSTRUCTIONS:

• Stop taking the following medications FIVE (5) DAYS before your procedure, unless directed otherwise by
o Supplements such as iron and vitamin E. Multivitamins may be continued. o Anti-inflammatory medications such as ibuprofen (Advil, Motrin), naproxen (Aleve, Anaprox, Naprosyn), diclofenac (Arthrotec, Voltaren, Cataflam), oxaprozin (Daypro), piroxicam (Feldene), indomethacin (Indocin), ketoprofen, ketorolac, etodolac (Lodine), meloxicam (Mobic), nabumetone (Relafen), salsalate, sulindac. Tylenol is fine to take if you have discomfort. o Medications to thin the blood such as warfarin (Coumadin, Jantoven), clopidogrel (Plavix), ticlopidine (Ticlid), dipyridamole (Persantine, Aggrenox), anagrelide (Agrylin), cilostazol (Pletal), Effient (prasugrel), Xarelto (rivaroxaban) unless specified otherwise. o Pradaxa is generally stopped 1-5 days prior to a procedure, depending on kidney function. Please discuss with the prescribing physcian when this medication should be held prior to your procedure. • DIABETIC MEDICATIONS:
o On the MORNING OF YOUR PREP DAY, take half of your usual diabetic medications.
o On the EVENING OF YOUR PREP DAY, do not take any diabetic medications.
o On the MORNING OF YOUR PROCEDURE DAY, do not take any diabetic medications.
• OTHER HEART MEDICATIONS (such as blood pressure medications) should be taken on the day of your
procedure with a small sip of water. Medications must be taken at least two hours prior to your check-in time to allow the stomach to empty prior to your procedure. • Please bring any INHALERS that you use with you to your procedure.
• ASPIRIN THERAPY: It is okay to continue aspirin 81mg or 325mg daily the week prior to your
If you have questions regarding a medication not listed above, please contact our office at least one week prior to the colonoscopy. * PLEASE READ BACK AND FRONT OF THIS INSTRUCTION SHEET ONE WEEK PRIOR TO YOUR PROCEDURE *

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