Generic
Lactulose
68 brands available in the market
At a glance
Lactulose is a synthetic sugar used in the treatment of constipation and hepatic encephalopathy. It draws water into the intestine through osmosis to soften stool and reduces ammonia absorption.
Description
Lactulose is a hyperosmolar laxative used as an effective treatment for constipation. It is a non-absorbable disaccharide that draws water into the bowel, causing distention through fluid accumulation, thus promoting soft stool and accelerating bowel motion. Lactulose is metabolized in the colon by saccharolytic bacteria, producing low molecular weight organic acids (mainly lactic acid), which lowers the pH of the colon contents, promotes water retention by osmotic effect, and increases peristaltic activity. In hepatic encephalopathy, it reduces absorption of ammonium ions and toxic nitrogenous compounds, resulting in reduced blood ammonia concentrations.
Indications
- Constipation (including chronic constipation)
- Hepatic encephalopathy (liver disease-associated coma and pre-coma)
- Intestinal flora disturbances (e.g., after long-term antibiotic use)
- Increased blood ammonia levels (hyperammonemia)
Therapeutic class
Osmotic Laxative
Pharmacological class
Synthetic Disaccharide
Pharmacology
Lactulose is a synthetic disaccharide metabolized in the colon by saccharolytic bacteria to produce organic acids, which lower colon pH and promote water retention through osmotic effect, increasing peristaltic activity.
Mechanism of action
Draws water into the intestine through osmosis to soften stool and reduces ammonia absorption.
Dosage
Constipation (Adult):
- Initial: 15-30 mL (10-20 g) once daily; may increase to 60 mL (40 g) once daily
- Long-term: 1.5-6 teaspoonfuls daily
- Children (up to 14 years): Initial 3 teaspoonfuls daily; Long-term 1-2 teaspoonfuls
- Infants and toddlers: Initial 1-2 teaspoonfuls daily; Long-term 1 teaspoonful
Portal Systemic Encephalopathy:
- 30-45 mL (20-30 g) q6-8hr; adjusted until 2-3 soft stools/day
- In acute cases: q1-2hr
Administration
- Measure with a measuring cup and take by mouth
- Can be mixed with water or juice
- Shake well before use
- Preferably take at bedtime (takes 6-8 hours to work)
Missed dose
If you miss a dose, skip it and continue with your normal schedule. Do not double the dose.
Side effects
Common Side Effects:
- Flatulence
- Abdominal pain/cramps
- Abdominal distension
- Nausea
- Vomiting
- Diarrhea (with overdose)
Side effects are usually transient and improve with dose reduction.
Precautions & warnings
- Monitor serum electrolytes on long-term therapy
- Caution in diabetic patients (contains sugar)
- Caution in galactose or lactose intolerance
- Do not use with other laxatives
- Do not use if intestinal obstruction is suspected
Contraindications
- Galactosemia
- Intestinal obstruction
- Hypersensitivity to lactulose or its components
Drug interactions
- May prevent release of mesalazine
- Decreased effect with oral neomycin, antacids
- May enhance glycosidic effect of cardiac glycosides (with potassium deficiency)
Food interactions
Alcohol consumption with Lactulose does not cause any harmful side effects.
Use in pregnancy
Use in Pregnancy: Lactulose is generally considered safe during pregnancy (FDA Category B). Animal studies have shown low or no adverse effects to the developing baby.
Pregnancy Category: B — always consult a doctor before taking during pregnancy.
Use in lactation
Use in Lactation: Lactulose is probably safe during breastfeeding. Limited human data suggests no significant risk to the baby.
Pediatric use
Pediatric doses are established (weight-based); effective and safe in children above 4 years of age.
Geriatric use
Use with caution in elderly; no special dose adjustment may be needed.
Renal / hepatic impairment
Renal Impairment: Probably safe in kidney disease; dose adjustment may not be needed.
Hepatic Impairment: Probably safe in liver disease; dose adjustment may not be needed.
Overdose effects
Overdose may cause diarrhea, abdominal cramps, and electrolyte imbalance.
Storage conditions
Store in a dry place away from light and heat; keep out of reach of children.
Chemical structure
C12H22O11