II. Indications
III. Mechanism
- Lactulose converts Ammonia to unabsorbed Ammonium
- Lactulose is metabolized in the intestinal tract to lactate which acts as an Osmotic Laxative
- Alters bowel flora
IV. Medications
- Lactulose (Chronulac) 70% Solution, 10 g/15 ml
- Lactitol
- As effective as Lactulose with less pain and Flatus
- Pitzalis (1995) Pediatr Med Chir 17(3):223-6 [PubMed]
V. Dosing: Constipation
-
General
- Onset of action within 24-48 hours
- Polyethylene Glycol is typically preferred if available
- May also consider Sorbitol 70% as alternative agent
- Lactulose (Chronulac)
- Adults: 15 to 30 ml orally at bedtime as needed
- Children
- Give 1 to 2 g/kg of 70% Lactulose (10 g/15 ml) once to twice daily up to 3 ml/kg/day (max 60 ml/day)
- May be easier to administer to young children than other Osmotic Laxatives
- May mix with fruit juice, water or milk
VI. Dosing: Hepatic Encephalopathy
-
Hepatic Encephalopathy
- Start 30-45 ml orally every hour until Diarrhea
- Next: 15-30 ml orally three to four times daily with target of 2-3 stools/day
- Hepatic Coma
- Lactulose 300 ml in 700 ml water retention enema every 4 to 6 hours
VII. Pharmacokinetics
- Poorly absorbed (may be used in Renal Failure, unlike most Osmotic Laxatives)
VIII. Adverse Effects
- Abdominal cramping
- Flatus
IX. Efficacy
- First line agent in Hepatic Encephalopathy
- For Constipation, not as effective or well tolerated as Polyethylene Glycol (Miralax)
X. Safety
- Pregnancy Category B
- Unknown safety in Lactation
XI. Resources
XII. References
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
- (2023) Management of Constipation, Presc Lett, #390108
Images: Related links to external sites (from Bing)
Related Studies
| lactulose (on 9/13/2023 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| LACTULOSE 10 GM/15 ML SOLUTION | Generic | $0.01 per ml |
| enulose (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| ENULOSE 10 GM/15 ML SOLUTION | Generic | $0.01 per ml |
Ontology: Lactulose (C0022957)
| Definition (NCI) | A disaccharide (sugar) synthesized from fructose and galactose, Lactulose is used to treat constipation and some liver diseases. Nondigestible in mammals, lactulose passes unabsorbed down to the large intestine where resident bacteria consume it and produce lactic, acetic, and formic acids, which draw fluid into the bowel to soften the stool (laxative effect). Acidification of the colon contents attracts ammonia from the bloodstream, assisting stool excretion; helpful in liver failure when ammonia cannot be detoxified. (NCI04) |
| Definition (MSH) | A synthetic disaccharide used in the treatment of constipation and hepatic encephalopathy. It has also been used in the diagnosis of gastrointestinal disorders. (From Martindale, The Extra Pharmacopoeia, 30th ed, p887) |
| Concepts | Pharmacologic Substance (T121) , Carbohydrate (T118) |
| MSH | D007792 |
| SnomedCT | 111137007, 273945008 |
| LNC | LP61647-1, LP173648-9 |
| English | Lactulose, D-Fructose, 4-O-beta-D-galactopyranosyl-, lactulose, lactulose (medication), laxatives lactulose, LACTULOSE, 4-O-beta-D-Galactopyranosyl-D-fructofuranose, Lactulose [Chemical/Ingredient], Lactulose product, Lactulose (product), Lactulose (substance) |
| Swedish | Laktulos |
| Czech | laktulosa |
| Finnish | Laktuloosi |
| Russian | LAKTULOZA, ЛАКТУЛОЗА |
| Polish | Laktuloza |
| Japanese | ラクツロース, ピアーレ, モニラック, ラグノス |
| Spanish | lactulosa (producto), lactulosa (sustancia), lactulosa, Lactulosa |
| French | Lactulose |
| German | Lactulose |
| Italian | Lattulosio |
| Portuguese | Lactulose |
