Oral Sulfate Tablets for Bowel Preparation Are Effective and Safe

Douglas K. Rex, MD, MASGE reviewing Di Palma JA, et al. Am J Gastroenterol 2020 Nov 6.

This study compared a new formulation of oral sulfate in tablet form to polyethylene glycol with ascorbate (PEG-EA). Both types of preparation were given in split doses. Patients assigned to the tablet group consumed 12 tablets in the evening and 12 in the morning with 16 ounces of water with each 12-tablet dose, then drank an additional 32 ounces of water with each dose. Overall cleansing success with the oral sulfate tablets (92%) was noninferior to PEG-EA (89%). The rate for excellent preparations was higher with the tablets than with PEG-EA (66% vs 57%; P=.034). Nausea and vomiting were each more common with the tablets than with PEG-EA, though no patients rated vomiting as severe. The fraction of patients rating the preparation as very easy or easy was higher with the tablets than with PEG-EA (65% vs 40%). There were no clinically significant changes in laboratories with either preparation.


Oral sulfate tablets were recently approved for release in the U.S., and the product launch is expected by January 2021. It’s likely that nausea and vomiting can be reduced by spreading the intake of 12 tablets over 15 minutes rather than rapidly ingesting all of the prescribed tablets.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Douglas K. Rex, MD, MASGE

Bio and Disclosures


Di Palma JA, Bhandari R, Cleveland MVB, et al. A safety and efficacy comparison of a new sulfate-based tablet bowel preparation versus a PEG and ascorbate comparator in adult subjects undergoing colonoscopy. Am J Gastroenterol 2020 Nov 6. (Epub ahead of print) (