Lactulose information from DrugsUpdate
Lactulose is a synthetic sugar used in the treatment of constipation and hepatic encephalopathy, a complication of liver disease. It is a disaccharide (double-sugar) formed from one molecule each of the simple sugars (monosaccharides) fructose and galactose. The commercial syrup used for treatment of constipation is dyed yellow-orange. It is produced commercially by isomerization of lactose.
Pharmacodynamics
Pharmacokinetics
Lactulose promotes peristalsis by producing an osmotic effect in the colon with resultant distention. In hepatic encephalopathy, it reduces absorption of ammonium ions and toxic nitrogenous compounds, resulting in reduced blood ammonia concentrations. Onset 48 hours.
Absorption Not appreciable (oral).
Metabolism Via colonic flora to lactic acid and acetic acid.
Excretion Faeces, urine (as unchanged drug).
Lactulose Indications / Lactulose Uses
Information Not Available
Lactulose Adverse Reactions / Lactulose Side Effects
Diarrhoea (dose-related), nausea, vomiting, hypokalaemia, bloating and abdominal cramps. Potentially Fatal: Dehydration and hypernatraemia on aggressive treatment.
Precautions
Since Lactulose solution contains galactose (less than 1.6 g/15 mL) and lactose (less than 1.2 g/15 mL), it should be used with caution in diabetics.
Special Precautions
Monitor electrolyte imbalance. Lactose intolerance; diabetics.
Other Drug Interactions
May prevent release of mesalazine in the colon. Decreased effect with oral neomycin, antacids.
Other Interactions
Information Not Available
Dosage
Oral Constipation Adult: Initially, 10-20 g (15-30 ml) daily as a single dose or in 2 divided doses; gradually adjust according to patient's response. Max dose: 45 ml (or up to 40 g of the reconstituted oral powder formulation)/day. Child: As 3.35 mg/5 ml solution: 1 mth to 1 yr: 2.5 ml; 1-5 yr: 5 ml; 5-10 yr: 10 ml; 10-18 yr: 15 ml. All doses to be given bid. Oral Hepatic encephalopathy Adult: 60-100 g (90-150 ml) daily in 3 divided doses; adjust to produce 2 or 3 soft stools each day. Rectal Hepatic encephalopathy Adult: Mix 200 g (300 ml) with 700 ml water or 0.9% sodium chloride as a retention enema. Retain enema for 30-60 minutes; repeat every 4-6 hr until oral medication can be administered.
Food(before/after)
May be taken with or without food. (May be taken w/ meals to reduce GI discomfort.)
List of Contraindications
Lactulose and Pregnancy
Category B: Either animal-reproduction studies have not demonstrated a foetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the 1st trimester (and there is no evidence of a risk in later trimesters).
Lactulose and Lactation
Undetermined.
Lactulose and Children
Safety and efficacy not established. Administer with caution. Infants receiving lactulose may develop hyponatremia and dehydration.
Lactulose and Geriatic
With long-term therapy (more than 6 mo) at increased risk of dehydration and electrolyte imbalance.
Lactulose and Other Contraindications
Galactosaemia, intestinal obstruction. Patients on low galactose diet.
Storage
Oral Store at 15-30℃ (59-86°F). Rectal: Store at 2-30℃ (36-86°F).
Lab interference
Oral Store at 15-30℃ (59-86°F). Rectal: Store at 2-30℃ (36-86°F).
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