sodium sulfate / potassium sulfate / magnesium sulfate
Suprep is a combination bowel prep kit used to clean out your colon before a colonoscopy. It works by causing diarrhea, which helps clear your intestines so that your gastroenterologist can see inside your colon more clearly. The medication is a berry-flavored liquid taken in two doses that must be prepared according to the instructions. You take the first dose on the night before your procedure and the second dose on the morning of your procedure. Common side effects include bloating, stomach pain, and nausea.
What is Suprep?
What is Suprep used for?
Colon cleansing before a colonoscopy
How Suprep works
Suprep is an osmotic laxative that contains sodium sulfate, potassium sulfate, and magnesium sulfate. These salts aren't easily absorbed by your body, so they pull water into your intestines, causing bowel movements that help empty your colon before a procedure.
Drug Facts
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What are the side effects of Suprep?
Common Side Effects
- Overall discomfort (54%)
- Bloating (40%)
- Stomach pain (36%)
- Nausea (36%)
- Vomiting (8%)
- Nausea
- Stomach pain
- Bloating
- Vomiting
Other Side Effects
- Electrolyte imbalances
Serious Side Effects
- Severe dehydration: vomiting, dizziness, tiredness, headache, urinating less, dry mouth
- Heart rhythm problems: weakness, dizziness, fainting, chest pain, trouble breathing
- Kidney problems: urinating less, swelling, tiredness, nausea, vomiting
- Seizures
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Dehydration—increased thirst, dry mouth, feeling faint or lightheaded, headache, dark yellow or brown urine
- Fast or irregular heartbeat
- Kidney injury—decrease in the amount of urine, swelling of the ankles, hands, or feet
- Seizures
- Sudden or severe stomach pain, bloody diarrhea, fever, nausea, vomiting
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
Pros and cons of Suprep
Pros
Works quickly, within an hour or so
Requires less liquid to drink compared to other bowel prep products
Berry-flavored for taste
Brand-name medication is approved for adults and children 12 years and older
Cons
Commonly causes nausea and vomiting
Might not be safe for people with kidney problems
Raises the risk of a gout attack in people with gout
Can interact with medications taken by mouth if taken close to your prep time
Pharmacist tips for Suprep
Follow all instructions carefully about what to eat or drink in the days before taking Suprep. If you're unsure, ask your care team.
The day before your colonoscopy, drink only clear liquids. Avoid alcohol, milk, or anything that's red or purple. Safe options include water, apple or orange juice (no pulp), coffee or tea (without creamer), chicken broth, and gelatin desserts without fruit or toppings.
Drink both doses of Suprep for a complete bowel prep. If you skip the second dose, your colon might not be fully cleaned, which could affect your colonoscopy results.
Stay near a restroom after taking Suprep since it will cause frequent bowel movements.
Call your prescriber right away if you have severe vomiting or signs of dehydration like dizziness, tiredness, or headaches after taking Suprep. Dehydration can cause electrolyte imbalances, which can lead to serious side effects like heart rhythm problems or seizures.
Tell your prescriber about any medications you take. In general, take other medications at least 1 hour before taking Suprep. But some medications like tetracycline antibiotics, fluoroquinolone antibiotics, and iron supplements should be taken at least 2 hours before or 6 hours after taking Suprep.
Tips on how to prepare your Suprep dose
Each Suprep kit contains two doses, each in a separate bottle. You'll need to add cool water to each dose before drinking. Don't drink the medication directly from the bottle.
Taking the first dose: On the evening before your procedure, pour one bottle of Suprep into the provided mixing container. Add cool water to the 16-oz line (or 12-oz line for children) and mix. Drink the entire mixture. Then, refill the container with water to the 16-oz line and drink twice more over the next hour.
Taking the second dose: On the morning of your procedure, repeat the same steps as dose 1. Make sure you drink the final container of water at least 2 hours before your procedure.
Frequently asked questions about Suprep
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What are the risks and warnings for Suprep?
Suprep can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Severe dehydration and electrolyte imbalance
Risk factors: Severe vomiting | Taking other medications that can lead to dehydration or electrolyte imbalance | Gout
Drink plenty of fluids before, during, and after taking Suprep to stay hydrated. If you experience severe vomiting or signs of dehydration after taking it, your prescriber might check your lab tests to monitor your electrolytes, kidney function, and hydration levels. Electrolyte imbalances can cause serious problems, including irregular heartbeats, seizures, and kidney issues.
Suprep can also temporarily raise uric acid levels, which might trigger a gout flare-up. If you have gout or other uric acid-related conditions, talk to your prescriber before using this medication.
Heart rhythm problems
Risk factors: History of heart rhythm problems | Recent heart attack | Unstable chest pain | Congestive heart failure | Cardiomyopathy
There have been rare cases of serious heart rhythm problems (arrhythmias) linked to osmotic laxatives like Suprep used for bowel prep. Your prescriber might check your heart with an electrocardiogram (ECG) before and after your colonoscopy if you are at higher risk for heart problems.
Seizures
Risk factors: History of seizures | Benzodiazepine withdrawal | Alcohol withdrawal | Low sodium levels | Taking other medications that raise your risk for seizures
Some people have had seizures or fainted after taking Suprep, even if they never had seizures before. These cases were linked to electrolyte imbalances, like low sodium, potassium, calcium, or magnesium levels.
If you have a history of seizures or are at higher risk, your prescriber might need to monitor you closely. This includes people taking certain antidepressants, those withdrawing from alcohol or benzodiazepines, or those with low sodium levels. Let your prescriber know about any seizure history or medications you take before using Suprep.
Kidney problems
Risk factors: History of kidney problems | Taking other medications that can harm the kidneys
If you have kidney problems or take medications that can harm the kidneys — such as diuretics, ACE inhibitors, angiotensin receptor blockers, or NSAIDs — talk to your prescriber before taking Suprep. These medications raise your risk for kidney injury. It’s important to drink plenty of fluids while taking Suprep to stay hydrated. Your prescriber might check your kidney function with lab tests before and after your colonoscopy to make sure your kidneys are working properly.
Colon problems
Risk factors: Inflammatory bowel disease (IBD) | Taking stimulant laxatives at the same time | Severe ulcerative colitis
Suprep and other osmotic laxatives might cause small ulcers in the colon. In rare cases, some people have developed a serious condition called ischemic colitis, which reduces blood flow to the colon and might require hospital treatment. Taking Suprep with stimulant laxatives can raise these risks, so talk to your prescriber before using any additional laxatives.
Serious choking
Risk factors: Trouble swallowing | Poor gag reflex
If you have trouble swallowing or a poor gag reflex, you might be at risk of choking or inhaling (aspirating) Suprep. Let your prescriber know if you have any of these problems before starting this medication.
Suprep dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 2 bottles of oral solution | 1 kit | $122.73 | $122.73 |
Typical dosing for Suprep
Adults: Take two 6-oz doses of Suprep for a complete two-day regimen.
Dose 1 - Evening before your colonoscopy
Drink a mixture of one 6-oz bottle of Suprep and cool water added up to the 16-oz line in the provided mixing container.
Over the next hour, drink two more 16-oz containers of water.
Dose 2 - Morning of your colonoscopy
Drink a mixture of one 6-oz bottle of Suprep and cool water added up to the 16-oz line in the provided mixing container.
Over the next hour, drink two more 16-oz containers of water.
Children 12 years and older: Take two 4.5-oz doses of Suprep for a complete two-day regimen.
Dose 1 - Evening before your colonoscopy
Drink a mixture of one 4.5-oz bottle of Suprep and cool water added up to the 16-oz line in the provided mixing container.
Over the next hour, drink two more 12-oz containers of water.
Dose 2 - Morning of your colonoscopy
Drink a mixture of one 4.5-oz bottle of Suprep and cool water added up to the 16-oz line in the provided mixing container.
Over the next hour, drink two more 12-oz containers of water.
Suprep contraindications
Blockage in the gut (obstruction)
Hole in the bowel (perforation)
Severe colon swelling (toxic megacolon)
Stomach not emptying properly (gastric retention)
What are alternatives to Suprep?
Cleansing the colon to prepare for colonoscopy
Cleansing the colon to prepare for colonoscopy
Cleansing the colon to prepare for barium enema x-ray examination (Golytely, Colyte, Gavilyte-C, and certain generic preps only)
Suprep images
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References
Best studies we foundASGE Standards of Practice Committee, et al. (2015). Bowel preparation before colonoscopy. Gastrointestinal Endoscopy.
Braintree Laboratories, Inc. (2020). SUPREP BOWEL PREP- sodium sulfate, potassium sulfate, magnesium sulfate solution, concentrate. DailyMed.
Lehrer, J.K., et al. (2024). Gastrointestinal perforation. MedlinePlus.
Skomorochow, E., et al. (2023). Toxic Megacolon. StatPearls
Sun, C. LF., et al. (2022). Low-Volume Bowel Preparation Is Associated With Reduced Time to Colonoscopy in Hospitalized Patients: A Propensity-Matched Analysis. Clinical and Translational Gastroenterology.
Takashima, K., et al. (2021). Castor oil as booster for colon capsule endoscopy preparation reduction: A prospective pilot study and patient questionnaire. World Journal of Gastrointestinal Pharmacology and Therapeutics.
Taro Pharmaceuticals, U.S.A., inc. (2024). SODIUM SULFATE, POTASSIUM SULFATE, AND MAGNESIUM SULFATE BOWEL PREP KIT- sodium sulfate anhydrous, potassium sulfate, and magnesium sulfate solution. DailyMed.
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