Suflave is a combination, osmotic prescription laxative that may be used to cleanse the bowel in preparation for colonoscopy in adults. Suflave contains polyethylene glycol 3350, sodium sulfate, potassium chloride, magnesium sulfate, and sodium chloride, and is supplied as a powder that is mixed with a low volume of water before consuming. It tastes like a lemon-lime sports drink.

Colonoscopy is the most common detection method for colorectal cancer and successful screening is dependent upon adequate cleansing of the colon. Many of the available bowel preparation products require the consumption of large volumes of poor-tasting solutions, which can result in low patient compliance. The palatability of Suflave has been shown to improve compliance in clinical trials.

Suflave works by osmosis, drawing water into the bowel, increasing the volume, and reducing the consistency of the stools, making them loose and easily cleared. It is taken as a split-dose regimen over two days.

Suflave was approved on June 15, 2023.

There is a risk of fluid and electrolyte abnormalities with Suflave and you should follow the instructions on the packet exactly as directed, including drinking additional water. Your doctor may conduct laboratory tests before starting Suflave to check your electrolyte levels. Tell your doctor about any medications, supplements, and herbal remedies that you take.

Pre-dose and post-colonoscopy ECGs may be needed for patients at increased risk of heart problems.

Should be used with caution in patients with cardiac arrhythmias, patients who have seizures, and patients with renal impairment or those who are taking concomitant medications that affect renal function. There is a potential for ulcerations in patients with known or suspected inflammatory bowel disease. People at risk for aspiration should be observed during administration.

It is recommended to take two doses of Suflave for complete preparation of the bowel for colonoscopy.

One dose of Suflave is equal to one bottle plus one flavor-enhancing packet.

Day 1, Dose 1: The evening before the colonoscopy

• Open 1 flavor-enhancing packet and pour the contents into 1 of the provided bottles.
• Fill the provided bottle with lukewarm water up to the fill line. After capping the bottle, gently
• shake the bottle until all powder has dissolved. For the best taste, refrigerate the solution for an hour before drinking. Do not freeze. Drink within 24 hours.
• Drink 8 ounces (240mL) of solution every 15 minutes until the bottle is empty.
• Drink an additional 16 ounces (475mL) of water during the evening.
• If nausea, bloating, or abdominal cramping occurs, pause or slow the rate of drinking the solution and drink additional water until the symptoms diminish.

Day 2, Dose 2: Morning of the Colonoscopy (5 to 8 hours before the colonoscopy and no sooner than 4 hours from starting Dose 1)

• Repeat the steps for Day 1 using the other packet and bottle from the Suflave kit.
• Drink an additional 16 ounces (475mL) of water during the morning.
• Stop drinking liquids at least 2 hours before the colonoscopy.
• If nausea, bloating, or abdominal cramping occurs, pause or slow the rate of drinking the solution and drink additional water until the symptoms diminish.

Do not take Suflave if you have:

• A blockage in your bowel (also called a bowel obstruction) or a problem with food moving too slowly through your intestines (also called ileus)
• An opening in the wall of your stomach or intestine (also known as a bowel perforation)
• A very dilated intestine (toxic colitis or toxic megacolon)
• Problems with food and fluid emptying from your stomach (gastric retention)
• An allergy to any active or inactive ingredient in Suflave.

Tell your healthcare provider about all of your medical conditions, including:

• Problems with serious loss of body fluid (dehydration) and changes in blood salts (electrolytes)
• Heart problems
• Stomach or bowel problems including ulcerative colitis
• Problems with swallowing, gastric reflux, or if you inhale food or fluid into your lungs when eating or drinking (aspiration)
• A history of seizures
• If you are withdrawing from drinking alcohol or from taking benzodiazepines
• Low blood salt (sodium) levels
• If you have kidney problems.

It is not known if Suflave will harm an unborn baby. Talk to your healthcare provider if you are pregnant or planning to become pregnant.

It is not known if Suflave passes into breast milk. You and your healthcare provider should decide if you should breastfeed while taking Suflave.

How is Suflave taken?

Suflave is administered as a split-dose regimen over two days.

• The first dose is taken the evening before the colonoscopy, and the second dose is taken the following morning, 5 to 8 hours before the colonoscopy and no sooner than 4 hours after the first dose. One dose of Suflave is equal to one bottle plus one flavor-enhancing packet.
• The first dose of Suflave should be taken 1 day before your colonoscopy.
• That morning, eat a low-residue breakfast. Low-residue foods include white bread, biscuits, muffins (no wheat), cornflakes, eggs, cream of wheat, grits, yogurt, cottage cheese, coffee, tea, juice without pulp, and fruit (no skin or seeds).
• That day and all the next day until 2 hours before your colonoscopy, only drink clear liquids. Stop drinking all fluids at least 2 hours before the colonoscopy. Examples of clear liquids include water, fruit juices (without pulp), lemonade, coffee, tea (no cream or non-dairy creamer), chicken broth, and gelatine desserts (no fruit or topping).
• If you have any nausea, bloating, or feeling like your stomach is upset, after taking your first dose of Suflave, wait to take your second dose until your stomach feels better. Start taking your second dose 5 to 8 hours before the colonoscopy, but no sooner than 4 hours from taking your first dose.
• While taking Suflave do not take any other laxatives, take oral medicines within 1 hour of starting each dose of Suflave, eat solid foods, dairy such as milk, or drink alcohol, and eat or drink anything colored red or purple.

If you miss or are unable to drink the full two doses of Suflave, call your doctor for instructions. Two doses are recommended for the complete preparation of the bowel.

An overdose of Suflave is unlikely to occur because it only contains two doses. If nausea, bloating, or abdominal cramping occurs, pause or slow the rate of drinking the solution and drink additional water until the symptoms diminish.

Do not take other laxatives while taking Suflave. For patients who have trouble swallowing, do not mix Suflave with starch-based thickeners.

Medicines taken by mouth may not be absorbed properly when taken within 1 hour before the start of each dose of Suflave.

While taking Suflave do not take any other laxatives, and do not eat solid foods, dairy such as milk, drink alcohol, or eat or drink anything colored red or purple.

Stop drinking liquids at least 2 hours before the colonoscopy.

Suflave can cause serious side effects, including serious loss of body fluid (dehydration) and changes in blood salts (electrolytes) in your blood. These changes can cause abnormal heartbeats that can cause death, seizures, and kidney problems.

Tell your healthcare provider right away if you have any of the following symptoms: 

• Dizziness
• Headache
• Severe stomach-area (abdominal) pain or rectal bleeding
• Urinating less often than normal
• Vomiting.

Get medical help right away if you have any signs and symptoms of a serious allergic reaction while taking Suflave including difficulty breathing o itching, swelling of the face, lips, tongue, and throat, raised red patches on your skin (hives), or a skin rash.

The most common side effects of Suflave include:

• Abdominal distension
• Abdominal pain
• Headache
• Nausea
• Vomiting.

These are not all the possible side effects of Suflave. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800- FDA-1088.

Tell your doctor about all your other medicines, including prescription and over-the-counter medicines, vitamins, and herbal supplements, especially:

• Medicines to treat a blood salt (electrolyte) imbalance
• Medicines for blood pressure or heart problems
• Medicines for kidney problems
• Medicines for seizures
• Medicines for depression or other mental health problems
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Water pills (diuretics).

Do not take other laxatives while taking Suflave. For patients who have trouble swallowing, do not mix Suflave with starch-based thickeners.

Take the following medicines at least 2 hours before starting each dose of Suflave and not for at least 6 hours after taking each dose:

• Chlorpromazine
• Digoxin
• Fluoroquinolone antibiotics
• Iron
• Penicillamine
• Tetracycline.

Medicines taken by mouth may not be absorbed properly when taken within 1 hour before the start of each dose of Suflave.

This list is not complete. Other drugs may interact with Suflave, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.