Generic

Lactulose

Indications

Constipation (Chronic Constipation): In every case of chronic constipation, initial treatment should consist of a diet rich in fiber (vegetables, salads, fruits, etc.) a generous amount of liquids, and much physical exercise. Lactulose is only to be taken when these measures prove insufficient.

Intestinal flora disturbances:

• In damage to intestinal flora (e.g. following long-term antibiotic treatment)
• gall bladder diseases
• intestinal diseases ( Colitis, Diverticulosis, Megacolon)

Increased blood ammonia levels (hyper ammonium in hepatopathy, portal-systemic encephalopathy)

Pharmacology

Lactulose is a disaccharide that has been synthesized. Lactulose is digested in the colon by saccharolytic bacteria, which produces low molecular weight organic acids (mostly lactic acid), which lowers the pH of the colon contents, promotes water retention via an osmotic action, and therefore increases peristaltic activity. Because lactulose is only slightly absorbed, the pharmacokinetics of the absorbed substance has no bearing on the primary therapeutic effect.

Dosage & Administration

In constipation ( chronic constipation):

• Adults: Initially 3-6 teaspoons daily, In long-term therapy 1½-6 tea-spoons daily
• Children up to 14 years: Initially 3 teaspoons daily, In long-term therapy 1-2 tea-spoons daily
• Infants and toddlers: Initially 1-2 teaspoons daily, In long-term therapy 1 tea-spoon daily

In damaged intestinal flora:

• Adults: 1-2 tea-spoons daily
• Children: 1 tea-spoon daily

For reduction of blood ammonia level:

• Hyperammonium in hepatopathy: a maximum of 18-30 teaspoons daily.
• In portal-systemic encephalopathy: hourly doses of 6-9 teaspoons of Lactulose solution may be used to induce rapid laxation. When the laxative effect has been achieved, the dose may then be reduced.

Interaction

With lactulose, there are no major medication interactions. In misuse, potassium deprivation can amplify the glycosidic action of cardiac glycosides.

Contraindications

Galactose and/or lactose hypersensitivity; galactose-free diet; gastro-cardinal symptom complex; possible intestinal obstruction

Side Effects

Flatulence, cramps, and stomach pain may occur at the start of therapy; this is quickly resolved by lowering the dosage. Overdosing might cause diarrhea. Electrolyte loss is a common side effect of drug usage (primarily potassium).

Pregnancy & Lactation

Lactulose is classified as a pregnancy category B by the US Food and Drug Administration. Lactulose has been shown in studies to have no negative effects. A registered physician must make decisions about usage during pregnancy and breastfeeding.

Precautions & Warnings

Patients who are intolerant to lactulose should be given the sugar with caution. The dose used in the treatment of (pre) coma hepatic is generally significantly greater, and diabetics should be aware of this.

Therapeutic Class

Osmotic purgatives

Storage Conditions

Keep in a dry place away from light and heat. Keep out of the reach of children.

Pharmaceutical Name

Healthcare Pharmaceuticals Ltd.