VA CFU Criteria Formulary Advisor Reference
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MAGNESIUM SULFATE/ POTASSIUM SULFATE/ SODIUM SULFATE SOLN,ORAL

Generic Name
MAGNESIUM SULFATE/ POTASSIUM SULFATE/ SODIUM SULFATE SOLN
Brand Names
SOD SULF-POTASS SULF-MAG SULF, SUPREP
Drug Class
HYPEROSMOTIC LAXATIVES
Formulary Status
PA-F
Copay Tier
2
Last Updated
2025-09-30

Clinical Criteria Summary

Inclusion Criteria

  • Failure unrelated to compliance or other causes, contraindication or intolerance to formulary PEG-3350 bowel prep regimens.

Source Documents

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