Drug Index

Mechanism :

Lactulose is poorly absorbed from the gastrointestinal tract and no enzyme capable of hydrolysis of this disaccharide is present in human gastrointestinal tissue. As a result, oral doses of lactulose reach the colon virtually unchanged. In the colon, lactulose is broken down primarily to lactic acid by the action of colonic bacteria, which results in an increase in osmotic pressure and slight acidification of the colonic contents. This in turn causes an increase in stool water content and softens the stool.

Indication :

  • Constipation
  • Hepatic encephalopathy

Contraindications :

Contraindicated in patients who require a low galactose diet viz. Galactosemia, and in gastrointestinal obstruction.

Dosing :

0.7-2 g/kg/day (corresponds to 1-3 ml/kg/day) orally in divided doses;
40 g/day.
Hepatic Encephalopathy:
For infants:
Use 2.5-10 ml/day (corresponds to 1.7-6.67 g/day) orally in divided doses and adjusted to ensure passing 2-3 soft stools per day.
For children and adolescents:
Use 40-90 ml (corresponds to 26.7-60 g/day) orally in divided doses adjusted to produce 2-3 soft stools per day.

Adverse Effect :

Adverse reactions seen initially are nausea and vomiting, flatulence and intestinal cramps, which are usually transient. Excessive dosage can lead to diarrhea with potential complications such as loss of fluids, hypokalemia, and hypernatremia.

Interaction :

Nonabsorbable Antacids: May inhibit the desired lactulose-induced drop in colonic pH. Therefore, a possible lack of desired effect of treatment should be taken into consideration before such drugs are given concomitantly with lactulose.

Renal Dose :

Dose in Renal Impairment GFR (mL/min)
20-50Dose as in normal renal function
10-20Dose as in normal renal function
<10Dose as in normal renal function

Dose in Patients undergoing Renal Replacement Therapies
CAPDNot dialysed. Dose as in normal renal function
HDNot dialysed. Dose as in normal renal function
HDF/High fluxNot dialysed. Dose as in normal renal function
CAV/VVHDNot dialysed. Dose as in normal renal function

Hepatic Dose :

No dose adjustments are recommended.
09/26/2020 21:00:15 Lactulose
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