Dulcolax And Miralax: Safe Together?

Miralax (polyethylene glycol 3350) and Dulcolax Laxative (bisacodyl) are both stimulant and hyperosmotic laxatives. Using these medications together may increase the risk of gastrointestinal side effects such as ulcerations in the colon and ischemic colitis, a potentially life-threatening inflammatory condition caused by reduced blood flow to the colon. However, in certain circumstances, such as when preparing for a colonoscopy, the benefits of taking this combination of drugs may outweigh any risks.

Miralax and Dulcolax bowel prep for colonoscopy

A colonoscopy is a test that allows your doctor to see inside your colon (large intestine) using a colonoscope, a flexible tube with a camera at the end. The images are displayed on a video monitor. During the procedure, your doctor can take a small tissue sample (biopsy) for testing, remove a polyp (tissue growth), and take photos of the inside of your colon.

To ensure your colon is empty for the procedure, you may need to follow a specific bowel preparation regimen. One such regimen involves the use of Miralax and Dulcolax, which work together to clear the bowel of all solid matter. It is important to note that using these medications together may increase the risk of gastrointestinal side effects, such as ulcerations in the colon and ischemic colitis (an inflammatory condition caused by reduced blood flow to the colon). Therefore, it is recommended to consult with your doctor before using this combination.

Three Days Before Your Colonoscopy:

• Follow a low-fiber diet. Avoid foods like popcorn, nuts, fresh fruits, raw vegetables, and products containing whole wheat or bran.
• Stop taking fiber supplements such as Fibercon, Metamucil, and Citrucel.
• Avoid products containing Olestra (a fat substitute found in some fat-free and low-fat foods) for one week.
• Examples of foods you can eat include dairy products, meats, poultry, fish, pasta, white rice, white bread, eggs, mashed potatoes, and cooked carrots or squash.

The Day Before Your Colonoscopy:

• Do not eat any solid foods. Restrict your diet to clear liquids only.
• Drink at least 8 glasses of water throughout the day.
• Between 3 and 5 pm: Take 2 Bisacodyl tablets (Dulcolax).
• Between 2 and 4 pm: Start the Miralax preparation.
• Mix the 8.3 oz of Miralax (14 doses bottle) with 64 oz of Gatorade, Powerade, Pedialyte, or G2 low-sugar Gatorade (NO RED, ORANGE, AND PURPLE LIQUIDS!) in a large pitcher or bowl.
• Drink one 8 oz glass of the solution every 15 minutes until the mixture is gone.
• If you experience nausea or vomiting, rinse your mouth with water. Take a 15-30 minute break and then continue drinking the prep solution.

The Day of Your Colonoscopy:

• You may continue with CLEAR LIQUIDS until midnight before your colonoscopy. After this, you cannot eat or drink anything, including gum, candy, or water.
• Take your regular medications (except as advised previously) with a sip of water.
• If you are insulin-dependent, inform the surgery staff upon check-in.
• Please note that hospital rules dictate that you must have an escort to accompany you home after the procedure.

It is important to follow these instructions carefully and consult your doctor if you have any questions or concerns. Additionally, if you have diabetes or are taking blood thinners, be sure to inform your doctor, as you may need to adjust your medication or dosing.

Potential drug interactions between the two medications

Dulcolax Laxative (bisacodyl) and MiraLAX (polyethylene glycol 3350) are medications that can be used together for a bowel cleansing regimen prior to a colonoscopy. However, it is important to understand the potential drug interactions and risks associated with their combined use.

Using polyethylene glycol 3350 (the active ingredient in MiraLAX) together with bisacodyl (the active ingredient in Dulcolax) may increase the risk of gastrointestinal side effects. These can include ulcerations in the colon and ischemic colitis, an inflammatory condition caused by reduced blood flow to the colon due to narrowed or blocked blood vessels. Ischemic colitis, in particular, can be life-threatening. These side effects are considered relatively rare, but they could be serious if they occur.

Therefore, it is generally recommended to avoid using Dulcolax and MiraLAX together unless specifically advised or prescribed by a doctor. If you have any questions or concerns, it is important to consult your healthcare provider. They may suggest alternatives, dose adjustments, or more frequent monitoring to ensure the safe use of both medications.

It is worth noting that therapeutic duplication can occur when using both Dulcolax and MiraLAX, as they both belong to the 'stimulant and hyperosmotic laxatives' category. The recommended maximum number of medicines in this category to be taken concurrently is usually one. However, in certain circumstances, the benefits of taking this combination of drugs may outweigh the risks. Always consult your healthcare provider before making any changes to your medications or dosage.

Increased risk of gastrointestinal side effects

Using MiraLAX (polyethylene glycol 3350) and Dulcolax Laxative (bisacodyl) together may increase the risk of gastrointestinal side effects. This is because both medications are laxatives, and Dulcolax is a stimulant laxative, which works by irritating the intestines and causing them to contract, while MiraLAX is an osmotic laxative, drawing water into the colon. This combined action can lead to an increased risk of side effects in the gastrointestinal tract.

The concurrent use of these two medications may result in ulcerations in the colon and ischemic colitis, an inflammatory condition caused by reduced blood flow to the colon due to narrowed or blocked blood vessels. These side effects, though rare, can be potentially serious and life-threatening, especially ischemic colitis. Therefore, it is generally not recommended to use these medications together unless specifically advised or prescribed by a doctor.

It is important to consult a doctor if you have any questions or concerns about taking these medications together. Doctors may be able to prescribe alternative treatments that do not interact or may advise on a dose adjustment or more frequent monitoring to safely use both medications. Additionally, it is crucial to inform your doctor about all other medications, vitamins, and herbal supplements you are taking to ensure a comprehensive understanding of your health status.

Furthermore, it is advised to not stop using any medications without first consulting a doctor. In summary, while MiraLAX and Dulcolax can be effective treatments for constipation, their combined use may increase the risk of gastrointestinal side effects, and medical advice should be sought before taking them together.

Instructions for bowel prep before a colonoscopy

Bowel prep for a colonoscopy involves taking laxative medication and restricting your diet to clear your colon of stool. This allows the doctor to clearly see any abnormal areas in your colon during the procedure. If your colon is not completely emptied, the doctor may miss abnormalities, and you may even have to repeat the procedure.

Three days before your colonoscopy:

• Eat only low-fiber foods. Avoid foods such as popcorn, nuts, fresh fruits, raw vegetables, or products containing whole wheat or bran.
• Stop taking any fiber supplements, anti-diarrheal medication, and nutritional supplements that contain fiber.

Two days before your colonoscopy:

Continue eating only low-fiber foods.

One day before your colonoscopy:

• Go on a clear-liquid diet. Do not eat any solid foods. Drink at least 8 glasses of water throughout the day.
• Drink half of a prescription laxative drink to clean out your colon.

The day of your colonoscopy:

• Finish drinking the laxative 4 to 5 hours before you leave home for the procedure.
• Stop drinking any other beverage at least 2 hours before your appointment time.
• Arrange for someone to drive you home after the colonoscopy.

Note: It is important to follow the instructions provided by your doctor for your specific colonoscopy procedure. The above instructions serve as a general guideline, and individual instructions may vary.

Regarding your specific question, it is not recommended to take Dulcolax and MiraLAX together due to potential drug interactions that may increase the risk of gastrointestinal side effects. However, in certain circumstances, a bowel cleansing regimen before a colonoscopy may require the use of both medications. It is important to consult your doctor for personalized advice and instructions.

Precautions for patients with diabetes or those taking blood thinners

It is important to take precautions when using laxatives such as Dulcolax and MiraLAX, particularly for patients with diabetes or those taking blood thinners.

For patients with diabetes, it is imperative to speak with your endocrinologist or primary care doctor before the procedure to discuss the dosing of your insulin or diabetic medications. This is crucial as laxatives can impact your blood sugar levels and insulin requirements.

If you are taking anticoagulants or antiplatelet agents, it is essential to consult your surgeon, primary care doctor, or cardiologist for specific instructions. For anticoagulants, discontinuation may be required at least 5 full days before the procedure. For antiplatelet agents, medications should be stopped one week prior, and no special blood testing is typically needed.

Using MiraLAX (polyethylene glycol 3350) and Dulcolax (bisacodyl) together may increase the risk of gastrointestinal side effects such as ulcerations in the colon and ischemic colitis, a serious inflammatory condition. Therefore, it is recommended to avoid using these medications concurrently unless specifically advised by your doctor.

Before taking any laxatives, inform your doctor about all medications you are using, including vitamins and herbal supplements, to ensure a safe and effective treatment plan.

Frequently asked questions