Lactulose
Lactulose (Chronulac, Duphalac)
Lactulose
( LAK-tyou-lohs)
Pregnancy Category: B Acilac Cephulac Cholac Chronulac Constilac Constulose Duphalac Gen-Lac Enulose Evalose Heptalac Lactulax Laxilose PMS Lactulose (Rx)

Classification: Ammonia detoxicant, laxative

Action/Kinetics: A disaccharide containing both lactose and galactose; causes a decrease in the blood concentration of ammonia in clients suffering from portal-systemic encephalopathy. Due to bacteria-induced degradation of lactulose in the colon, resulting in an acid medium. Ammonia will then migrate from the blood to the colon to form ammonium ion, which is trapped and cannot be absorbed. A laxative action due to increased osmotic pressure from lactic, formic, and acetic acids then expels the trapped ammonium. The decrease in blood ammonia concentration improves the mental state, EEG tracing, and diet protein tolerance of clients. The increased osmotic pressure also results in a laxative effect, which may take up to 24 hr. Partly absorbed from the GI tract. Onset: 24-48 hr.

Uses: Prevention and treatment of portal-systemic encephalopathy, including hepatic and prehepatic coma (Cephylac, Cholac, Enulose, Evalose, Heptalac are used). Chronic constipation (Chronulac, Constilac, Duphalac are used).

Contraindications: Clients on galactose-restricted diets.

Special Concerns: Safe use during lactation and in children has not been established. Infants who have been given lactulose have developed hyponatremia and dehydration. Use with caution in presence of diabetes mellitus.

Side Effects: GI: N&V, diarrhea, cramps, flatulence, gaseous distention, belching.

Drug Interactions: Antacids / May inhibit the drop in pH of the colon required for lactulose activity Neomycin / May cause lactulose degradation R/T neomycin-induced in elimination of certain bacteria in the colon

How Supplied: Oral Solution: 10g/15 mL ; Syrup: 10 g/15 mL

Dosage
?Syrup, Oral Solution Encephalopathy.
Adults, initial: 30-45 mL (20-30 g) t.i.d.-q.i.d.; adjust q 2-3 days to obtain two or three soft stools daily. Long-term therapy may be required in portal-systemic encephalopathy; infants: 2.5-10 mL/day (1.6-6.6 g/day) in divided doses; older children and adolescents: 40-90 mL/day (26.6-60 g/day) in divided doses.
During acute episodes of constipation.
30-45 mL (20-30 g) q 1-2 hr to induce rapid initial laxation.
Chronic constipation.
Adults and children: 15-30 mL/day (10-20 g/day) as a single dose after breakfast (up to 60 mL/day may be required).