| Recommended Dose and Dosage Regimen | The recommended dose of lactulose for adults and children varies depending on the indication. For the treatment of constipation, the typical initial dose is 15-30 mL (10-20 g) orally once daily, with subsequent adjustments based on response. For hepatic encephalopathy, the initial dose is higher, usually 30-45 mL (20-30 g) orally three to four times daily, with titration to achieve 2-3 soft stools per day. Pediatric dosing may differ based on age and weight. Follow your healthcare provider’s instructions or the product label regarding dosing. |
| Frequency of Administration | The frequency of lactulose administration depends on the indication. For constipation, it is usually given once daily. For hepatic encephalopathy, it may be administered multiple times daily. |
| Route of Administration | Lactulose is administered orally in the form of a liquid solution or syrup. |
| Mechanism of Action (MOA) | Lactulose is a synthetic disaccharide laxative that is not absorbed in the gastrointestinal tract. It undergoes fermentation by colonic bacteria, resulting in the production of short-chain fatty acids and gases (e.g., carbon dioxide, methane). This increases colonic water content, softens stools, and promotes bowel movements. In hepatic encephalopathy, lactulose reduces ammonia absorption from the colon by acidifying the intestinal contents and promoting the conversion of ammonia to ammonium ions, which are excreted in the feces. |
| Pharmacokinetics (PK) | Lactulose is minimally absorbed in the gastrointestinal tract and reaches the colon unchanged. It is metabolized by colonic bacteria to short-chain fatty acids, primarily lactic acid and acetic acid. The unabsorbed lactulose retains water in the colon, softening stools and promoting bowel movements. |
| Pharmacodynamics (PD) | Lactulose exerts its pharmacodynamic effects by increasing colonic water content, softening stools, and promoting bowel movements in constipation. In hepatic encephalopathy, it reduces serum ammonia levels by acidifying the intestinal contents and promoting the conversion of ammonia to non-absorbable ammonium ions, which are excreted in the feces. |
| Pathophysiology | Lactulose is used for the treatment of constipation and hepatic encephalopathy. In constipation, it relieves symptoms by promoting bowel movements and softening stools. In hepatic encephalopathy, it helps reduce serum ammonia levels and improve mental function. |
| Primary Indications | Constipation, hepatic encephalopathy. |
| Contraindications | Contraindications to lactulose use include hypersensitivity to lactulose or its components, galactosemia (due to the presence of galactose in lactulose solution), and intestinal obstruction. Use caution in patients with diabetes, as lactulose may affect blood glucose levels. |
| Purpose of Taking Medication | The purpose of lactulose therapy is to relieve constipation by promoting bowel movements and softening stools. In hepatic encephalopathy, lactulose helps reduce serum ammonia levels and improve mental function by acidifying the intestinal contents and enhancing ammonia excretion. |
| Usage Instructions | Take lactulose orally as directed by your healthcare provider or as indicated on the product label. Measure the liquid solution with a proper measuring device and mix it with water, juice, or other liquids as preferred. Shake the solution well before each use. |
| Precautions and Care | Patients taking lactulose should be advised to increase fluid intake to prevent dehydration and maintain adequate hydration. Use caution in patients with electrolyte imbalances, renal impairment, or heart failure, as excessive fluid retention may occur. Monitor for signs of dehydration or electrolyte disturbances during treatment. |
| Dietary Considerations | Patients taking lactulose for constipation may benefit from a high-fiber diet rich in fruits, vegetables, and whole grains to support bowel regularity. Adequate hydration is essential to prevent dehydration and maintain bowel function. |
| Missed Dose | If a dose of lactulose is missed, take it as soon as remembered, unless it is almost time for the next scheduled dose. Do not double the dose to make up for a missed one. |
| Possible Side Effects | Common side effects of lactulose may include abdominal cramps, bloating, flatulence, and diarrhea. These effects are usually mild and transient. Rarely, severe diarrhea or electrolyte imbalances may occur. |
| Storage and Disposal | Store lactulose solution at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use. Unused or expired medication should be disposed of properly according to local regulations. |
| Overdose or Emergency | In case of lactulose overdose or emergency, seek medical attention immediately. Overdose may lead to severe diarrhea, dehydration, electrolyte imbalances, and gastrointestinal disturbances. Treatment is supportive and may include fluid replacement and electrolyte monitoring. |
| Monitoring and Laboratory Tests | Patients receiving lactulose therapy may require monitoring of bowel function, including frequency and consistency of stools. In hepatic encephalopathy, monitoring of serum ammonia levels and mental status is essential to assess treatment response. |
