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
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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 |