Lactulose

Indications
 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.
Contraindications
 Galactosaemia, intestinal obstruction. Patients on low galactose diet.
Warnings / Precautions
 Monitor electrolyte imbalance. Lactose intolerance; diabetics.
Adverse Reactions
 Diarrhoea (dose-related), nausea, vomiting, hypokalaemia, bloating and abdominal cramps.
Potentially Fatal: Dehydration and hypernatraemia on aggressive treatment.
Drug Interactions
 May prevent release of mesalazine in the colon. Decreased effect with oral neomycin, antacids.
See Below for More lactulose Drug Interactions
Mechanism of Actions
 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 hr.
Absorption: Not appreciable (oral).
Metabolism: Via colonic flora to lactic acid and acetic acid.
Excretion: Faeces, urine (as unchanged drug).
Administration
 May be taken with or without food. (May be taken w/ meals to reduce GI discomfort. Dilute w/ water, milk, or fruit juice to improve taste.)
Storage Conditions
 Oral: Store at 15-30°C (59-86°F). Rectal: Store at 2-30°C (36-86°F).
ATC Classification
 A06AD11 - lactulose ; Belongs to the class of osmotically acting laxatives.
Storage
 Oral: Store at 15-30°C (59-86°F). Rectal: Store at 2-30°C (36-86°F).
Available As
  • Lactulose 10 gm
  • Lactulose USP 10 gm
  • Lactulose 10 mg
  • Lactulose Solution 10 mg
  • Lactulose 100 mg
  • Lactulose 20% w/w
  • Lactulose 3.325 gm
  • Lactulose 3.325 mg
  • Lactulose USP 3.33 gm
  • Lactulose 3.33 gm
  • Lactulose 3.34 gm
  • Lactulose 3.35 gm
  • Lactulose 3.35 mg
  • Lactulose 450 ml
  • Lactulose 667 mg
  • Lactulose 80 gm

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