What are alternative bowel prep options to Golytely (polyethylene glycol)?

Alternative Bowel Preparation Options to GoLYTELY (Polyethylene Glycol)

Several effective alternatives to GoLYTELY (4L PEG-ELS) exist for bowel preparation, with low-volume PEG formulations being equally effective in healthy non-constipated individuals while offering better tolerability and patient compliance. 1

FDA-Approved Alternative Options

Low-Volume PEG-Based Preparations

• MoviPrep (2L PEG-ELS with ascorbate and sodium sulfate) 1

  • Contains supplemental ascorbate and sodium sulfate
  • Administered as split-dose for optimal effectiveness

• SUPREP (Oral Sulfate Solution - OSS) 1

  • FDA-approved for split-dose administration only
  • Clinical trials show comparable cleansing efficacy to PEG-ELS (98.4% vs 89.6%)
  • Lower volume improves patient tolerance

• Prepopik (Sodium picosulfate/magnesium citrate) 1

  • Recently introduced to US market
  • Most effective when administered as split-dose
  • Similar cleansing efficacy to PEG-ELS

• SUCLEAR (Combination of PEG-ELS and OSS) 1

Prescription Tablet Option

• Osmo-Prep (Sodium phosphate tablets) 1
  • Note: Contains boxed warning about risk of acute phosphate nephropathy
  • Should be avoided in patients with renal insufficiency

Evidence-Based Administration Methods

Split-Dose Administration

• Split-dose regimens (taking half the preparation the evening before and half the morning of the procedure) significantly improve bowel cleanliness compared to single-dose administration
• Studies show 4.38 times higher odds of adequate cleansing with split dosing 1

Low-Volume PEG with Adjuncts

• 2L PEG + Bisacodyl combination 2

  • Equally effective as 4L PEG-ELS
  • Higher patient compliance (93% vs 66% completed full preparation)
  • Significantly better patient comfort scores

• MiraLAX (PEG-3350) + Gatorade + Bisacodyl 3

  • 238g MiraLAX in 64 oz Gatorade plus four 5mg bisacodyl tablets
  • Achieved excellent/good bowel cleansing in 93.3% vs 89.3% with GoLYTELY
  • Better patient acceptance in community setting

Patient-Specific Considerations

Special Populations

• For patients with renal insufficiency, congestive heart failure, or advanced liver disease:

  • PEG-ELS preparations are preferred due to their iso-osmotic properties 1
  • Avoid sodium phosphate preparations due to risk of electrolyte disturbances

• For pediatric patients:

  • PEG-3350 at 1.5g/kg/day for 4 days before procedure 1
  • Clear liquid diet on the final day
  • May be combined with enemas in older children

Palatability Considerations

• Lactulose may be considered in resource-limited settings 4
  • Comparable bowel cleansing to PEG (BBPS score 6.25 vs 6.35)
  • 90% of patients found it more palatable than PEG
  • Minimal electrolyte disturbances

Common Pitfalls and Solutions

1. Inadequate preparation despite compliance

   • Consider large-volume enemas before sedation
   • Through-the-scope enema technique during colonoscopy
   • Rescheduling for next-day colonoscopy reduces risk of repeat failure 1

2. Poor tolerance of preparation volume

   • Switch to split-dose regimen
   • Consider low-volume PEG plus adjunctive medications
   • Use taste enhancers when permitted

3. Constipation management

   • For opioid-induced constipation, use stimulant laxatives with or without stool softeners 1
   • PEG with water twice daily is effective for maintenance

Remember that regardless of the preparation chosen, the quality of bowel cleansing directly impacts the ability to detect lesions and determines appropriate screening/surveillance intervals. The goal is to achieve a preparation that allows detection of lesions >5mm throughout the colon 1.