Lactulose – action, dosage, indications, side effects

Proven content

Lactulose is a non-absorbable sugar used to treat constipation and hepatic encephalopathy. Lactulose is used orally for constipation and orally or rectally for hepatic encephalopathy.

What is lactulose?

Lactulose is used to prevent and treat clinical portal systemic encephalopathy. Its main mechanism of action is to reduce intestinal production and ammonia absorption. It has also gained popularity as a potential therapeutic agent in the treatment of sub-acute clinical encephalopathy. It is also a laxative to treat chronic constipation. Its osmotic effect and influence on intestinal motility are attributed to its therapeutic effectiveness.

Lactulose – action

Lactulose, also known as 1,4 beta galactoside-fructose, is a non-absorbable synthetic disaccharide consisting of galactose and fructose. The mucosa of the human small intestine does not have enzymes to break down lactulose, and therefore the lactulose reaches the large intestine unchanged. In the colon, lactulose is metabolized by colonic bacteria to simple sugars and then to volatile fatty acids, hydrogen and methane.

Lactulose reduces the production and absorption of ammonia in the gut in three ways. First, the metabolism of sugars in the colon produces a laxative effect by increasing gas formation and osmolality within the lumen of the lumen. This laxative effect is also beneficial for constipation.

Lactulose then promotes increased ammonia uptake by colon bacteria, which use trapped ammonia in the colon as a nitrogen source for protein synthesis. Lowering the intestinal pH facilitates this process, which promotes the conversion of ammonia (NH3) produced by intestinal bacteria to ammonium (NH4 +), an ionized form of the molecule, unable to penetrate the biological membrane. Finally, lactulose also reduces intestinal ammonia production. The acidic pH destroys the urease-producing bacteria involved in the production of ammonia. Unabsorbed disaccharide also inhibits the intestinal activity of glutaminase, which blocks the intestinal uptake of glutamine and its metabolism to ammonia.

See also: The five worst bowel diseases

Lactulose – dosage

Lactulose dosages will vary from person to person.

Constipation: The usual adult dose is 15 ml twice a day. The dosage for children will depend on their age. Usually given twice a day.

Liver problems: The usual dose is 30-50 ml three times a day.

Always take lactulose exactly as your doctor or pharmacist has told you. The medicine label will tell you how much lactulose to take, how often to take it, and any special instructions.

How to take lactulose?

Try to spread the doses evenly throughout the day, e.g. if you take them twice a day, take them in the morning and in the evening.

Lactulose should be taken as directed with a glass of water.

Lactulose is sweet and can be mixed with other liquids such as water, milk and fruit juice.

If you forget to take a dose, just take the next dose when needed. Do not take two doses at the same time to make up for a forgotten dose.

When should lactulose take effect?

Lactulose doesn’t work right away. When used for constipation, it may take a day or 2 for the lactulose to soften the stool lumps enough to pass comfortably through the anal opening. However, if after a few days we do not feel that the symptoms are not improving or if they get worse, we should consult a doctor or pharmacist.

Lactulose – side effects

Gas, gas, belching, gurgling / pain in the stomach, nausea, and cramps may occur. If any of these symptoms persist or worsen, tell your doctor or pharmacist immediately. Many people using lactulose do not have serious side effects.

Tell your doctor immediately if you experience any of these unlikely but serious side effects:

1. diarrhea;
2. vomiting;
3. muscle cramps / weakness;
4. irregular heartbeat;
5. mental / mood changes;
6. seizures;
7. severe or persistent stomach / abdominal pain;
8. bloody stools;
9. rectal bleeding.

A very serious allergic reaction to lactulose is unlikely, but you should seek immediate medical attention if you experience one. Symptoms of a serious allergic reaction can include:

1. rash;
2. itching / swelling (especially of the face / tongue / throat);
3. severe dizziness;
4. breathing problems.

This is not a complete list of possible side effects. If you notice other symptoms not listed above, please contact your doctor or pharmacist.

See also: How to recognize an allergic rash? Causes, symptoms and treatment of skin allergies

Lactulose – how to deal with side effects?

Side effects may occur when using lactulose. You can deal with them in simple ways:

1. diarrhea – drink plenty of fluids such as water to avoid dehydration. Signs of dehydration include passing less urine than usual or dark, intensely smelling urine. Reducing the dose of lactulose may also help with diarrhea. Do not take any other medications to treat diarrhea without consulting your pharmacist or doctor.
2. flatulence – lactulose should be taken between meals instead of before or after them; avoid wind-inducing foods such as lentils, peas, beans, and onions. Eating smaller and more frequent meals, eating and drinking slowly, and exercising regularly can also help. Some pharmacy remedies, such as activated carbon tablets or simethicone, can help with the winds.
3. nausea – try taking lactulose with meals or mixing the dose with water or fruit juice.
4. vomiting – drink plenty of fluids such as water to avoid dehydration. Take small, frequent sips. Do not take any other medications to treat vomiting without consulting your pharmacist or doctor.
5. stomach pain – try to rest and relax. Stomach pains can be relieved by eating and drinking slowly and by eating more often and in smaller portions. It may also be helpful to put a hot water bottle on your stomach. If you are in severe pain, talk to your pharmacist or doctor.

While taking lactulose, it’s a good idea to eat a balanced diet that includes high-fiber foods such as whole grain breads and cereals, fruits and vegetables, brown rice, and whole grain pasta. Unless you are used to a high-fiber diet, it’s best to gradually increase the amount of fiber you eat.

It is also recommended to pay attention to physical activity, which will help us keep the digestive system moving (it is recommended to perform regular daily exercises).

While taking lactulose, you may want to include certain foods that contain sorbitol in your diet. Sorbitol is a naturally occurring sugar. It is not digested well and draws water into the intestines, which softens the stool. Fruits (and their juices) with high sorbitol content include apples, apricots, gooseberries, grapes (and raisins), peaches, pears, plums, raspberries, and strawberries.

See also: Conscious eating, or what you don’t know about your diet

Lactulose – precautions

Before taking lactulose, inform your doctor or pharmacist if you are allergic to it; or if you have other allergies. This product may contain inactive ingredients that may cause allergic reactions or other problems. Talk to your pharmacist for more information.

This substance should not be used if you have certain medical conditions. Before using lactulose, it is recommended to consult your doctor or pharmacist if:

1. you are on a low-galactose diet (e.g., a diet with little or no dairy products);
2. some other bowel problem (intestinal obstruction).

Before using lactulose, inform your doctor or pharmacist about your medical history, in particular about:

1. diabetes.

If we have diabetes, lactulose can affect blood sugar levels. It is recommended that you check your blood sugar regularly as directed and share the results with your doctor. Your doctor may need to adjust your diabetes medications, exercise program, or diet.

Older people may be more likely to lose blood minerals (e.g. potassium, sodium) when taking lactulose, especially if they take it for a long time.

You should not take any other laxatives while taking lactulose. Frequent use or abuse of laxatives can severely lose water in the body (dehydration). This is especially true for children or the elderly. Contact your doctor immediately if you experience any of the following symptoms of dehydration:

1. muscle weakness;
2. muscle cramps;
3. dizziness.

Before you have any surgery or other procedures (such as electrocoagulation), tell your doctor or surgeon that you are taking latulose.

Lactulose – interactions with other substances

Lactulose oral solution can interact with other medications, vitamins, or herbs you are taking. An interaction occurs when a substance changes the way a medicine works. This may be harmful or prevent the medicine from working properly.

Remember to inform your doctor about all medications, vitamins or herbs you are taking. To find out how a drug might interact with another drug you are taking, talk to your doctor or pharmacist.

Examples of drugs that may interact with lactulose are listed below.

Drugs that should not be used with lactulose

Do not take these drugs with lactulose. Examples of these drugs include:

Antacids: Do not take antacids with lactulose. Antacids can prevent lactulose from working properly.

Interactions that can make medications less effective

When used with lactulose, these drugs may reduce the effectiveness of lactulose. Examples of these drugs include:

Antibiotics like neomycin: These drugs can stop the breakdown of lactulose in the large intestine. Our doctor will closely monitor us if we take lactulose with an antibiotic.

Before taking lactulose, tell your doctor or pharmacist about all prescription and over-the-counter herbal products, especially:

1. neutralizing agents containing aluminum and / or magnesium;
2. other laxatives.

Lactulose – pregnancy and breastfeeding

The use of lactulose is generally safe during pregnancy and breastfeeding.

Constipation is common at the end of pregnancy and right after the baby is born.

If a woman is pregnant or breastfeeding, it is always better to try to safely treat constipation without taking medication. The doctor or midwife will first instruct the woman to eat more fiber and drink plenty of fluids. She will also be encouraged to do some gentle exercise.

If diet and lifestyle changes do not work, a laxative such as lactulose may be recommended. For more information on how laxatives may affect a pregnant woman and her baby during pregnancy, it is recommended that you consult your doctor.

See also: Childbirth is beautiful, but not necessarily easy