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Lactulose

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Lactulose, Chronulac, Enulose

  • See Also
  1. Laxative
  2. Osmotic Laxative
  3. Constipation
  4. Functional Constipation
  5. Pediatric Constipation
  • Indications
  1. Hepatic Encephalopathy (in Cirrhosis)
  2. Constipation
  • Mechanism
  1. Lactulose converts Ammonia to unabsorbed Ammonium
  2. Lactulose is metabolized in the intestinal tract to lactate which acts as an Osmotic Laxative
  3. Alters bowel flora
  • Medications
  1. Lactulose (Chronulac) 70% Solution, 10 g/15 ml
  2. Lactitol
    1. As effective as Lactulose with less pain and Flatus
    2. Pitzalis (1995) Pediatr Med Chir 17(3):223-6 [PubMed]
  1. General
    1. Onset of action within 24-48 hours
    2. Polyethylene Glycol is typically preferred if available
    3. May also consider Sorbitol 70% as alternative agent
  2. Lactulose (Chronulac)
    1. Adults: 15 to 30 ml orally at bedtime as needed
    2. Children
      1. 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)
      2. May be easier to administer to young children than other Osmotic Laxatives
      3. May mix with fruit juice, water or milk
  1. Hepatic Encephalopathy
    1. Start 30-45 ml orally every hour until Diarrhea
    2. Next: 15-30 ml orally three to four times daily with target of 2-3 stools/day
  2. Hepatic Coma
    1. Lactulose 300 ml in 700 ml water retention enema every 4 to 6 hours
  • Pharmacokinetics
  1. Poorly absorbed (may be used in Renal Failure, unlike most Osmotic Laxatives)
  • Adverse Effects
  1. Abdominal cramping
  2. Flatus
  • Efficacy
  1. First line agent in Hepatic Encephalopathy
  2. For Constipation, not as effective or well tolerated as Polyethylene Glycol (Miralax)
  • Safety
  1. Pregnancy Category B
  2. Unknown safety in Lactation
  • Resources
  1. Lactulose (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=cbf0497c-9c8d-4dfa-bebd-64c589468401
  • References
  1. Hamilton (2020) Tarascon Pocket Pharmacopoeia
  2. (2023) Management of Constipation, Presc Lett, #390108