Lactulose

Indications

Constipation (Chronic Constipation): In every case of chronic constipation, initial treatment should consist of a diet rich in fiber (vegetables, salads, fruits etc.) a generous amount of liquids and much physical exercise. Lactulose is only to be taken when these measures prove insufficient.

Intestinal flora disturbances:

  • In damaged to intestinal flora (e.g. following long-term antibiotic treatment)
  • gall bladder diseases
  • intestinal diseases ( Colitis, Diverticulosis, Megacolon)

Increased blood ammonia levels (hyper ammoniemia in hepatopathy, portal-systemic encephalopathy).

Pharmacology

Lactulose is a synthetic disaccharide. Lactulose is metabolized in the colon by the saccharolytic bacteria, producing low molecular weight organic acids (mainly lactic acid), which lowers the pH of the colon contents, promote the retention of water by an osmotic effect; thus increasing peristaltic activity. Lactulose is minimally absorbed; therefore, the pharmacokinetics of the absorbed material are not relevant to the principal therapeutic action.

Dosage And Administration

In constipation ( chronic constipation):

  • Adults: Initially 3-6 tea-spoons daily, In long-term therapy 1½-6 tea-spoons daily
  • Children up to 14 years: Initially 3 tea-spoons daily, In long-term therapy 1-2 tea-spoons daily
  • Infants and toddlers: Initially 1-2 tea-spoons daily, In long-term therapy 1 tea-spoon daily

In damaged intestinal flora:

  • Adults: 1-2 tea-spoons daily
  • Children: 1 tea-spoon daily

For reduction of blood ammonia level:

  • Hyper-ammoniemia in hepatopathy: a maximum of 18-30 tea-spoons daily.
  • In portal systemic encephalopathy: hourly doses of 6-9 tea-spoons of Lactulose solution may be used to induce the rapid laxation. When the laxative effect has been achieved, the dose may then be reduced.

Interaction

There is no significant drug interactions with lactulose. The glycosidic effect of cardiac glycosides can be intensified by potassium deficiency in abuse.

Contraindications

Hypersensitivity to either galactose and or lactose; galactose-free diet, gastro-cardial symptom complex, suspected intestinal obstruction.

Side Effects

Occasionally flatulence, cramp and abdominal discomfort can occur at the beginning of treatment; this is rapidly eliminated by reducing the dose. Overdose can result in diarrhoea. In abuse, loss of electrolytes (primarily potassium).

Pregnancy And Lactation

US FDA Pregnancy Category of Lactulose is B. Studies show that Lactulose has no adverse effects. Decisions regarding use during pregnancy and lactation must be made by registered physician.

Precautions And Warnings

Lactulose should be administered with care to patients who are intolerant to lactulose. The dose used in the treatment of (pre) coma hepaticum is usually much higher and may need to be taken into consideration for diabetics.

Overdose Effects

There have been no reports of accidental overdosage. In the event of acute overdosage it is expected that diarrhoea and abdominal cramps would be the major symptoms.

Therapeutic Class

Osmotic purgatives.

Storage Conditions

Keep in a dry place away from light and heat. Keep out of the reach of children.

Available Brand Names

  • Oral Solution (Concentrated) Actilac
    3.35 gm/5 ml (100 ml syrup)
    Healthcare Pharmaceuticals Ltd.
    Unit Price: ৳ 125.00
  • Oral Solution (Concentrated) Actilac
    3.35 gm/5 ml (200 ml syrup)
    Healthcare Pharmaceuticals Ltd.
    Unit Price: ৳ 230.00
  • Oral Solution (Concentrated) Actulose
    3.35 gm/5 ml (100 ml syrup)
    Silva Pharmaceuticals Ltd.
    Unit Price: ৳ 60.22
  • Oral Solution (Concentrated) Actulose
    3.35 gm/5 ml (200 ml syrup)
    Silva Pharmaceuticals Ltd.
    Unit Price: ৳ 120.46
  • Oral Solution (Concentrated) Asilac
    3.35 gm/5 ml (100 ml syrup)
    Asiatic Laboratories Ltd.
    Unit Price: ৳ 120.00
  • Oral Solution (Concentrated) Asilac
    3.35 gm/5 ml (200 ml syrup)
    Asiatic Laboratories Ltd.
    Unit Price: ৳ 230.00
  • Oral Solution (Concentrated) Avola
    3.35 gm/5 ml (200 ml syrup)
    Aristopharma Ltd.
    Unit Price: ৳ 250.00
  • Oral Solution (Concentrated) Avolac
    3.35 gm/5 ml (100 ml syrup)
    Aristopharma Ltd.
    Unit Price: ৳ 140.00
  • Oral Solution (Concentrated) Avolac
    3.35 gm/5 ml (200 ml syrup)
    Aristopharma Ltd.
    Unit Price: ৳ 250.00
  • Oral Solution (Concentrated) Avolac
    3.35 gm/5 ml (100 ml syrup)
    Aristopharma Ltd.
    Unit Price: ৳ 140.00
  • Oral Solution (Concentrated) Avolose
    3.35 gm/5 ml (100 ml syrup)
    Team Pharmaceuticals Ltd.
    Unit Price: ৳ 135.00
  • Oral Solution (Concentrated) Avolose
    3.35 gm/5 ml (200 ml syrup)
    Team Pharmaceuticals Ltd.
    Unit Price: ৳ 245.00
  • Oral Solution (Concentrated) Comfort
    3.35 gm/5 ml
    APC Pharma Ltd.
    Unit Price: ৳ 80.00
  • Oral Solution (Concentrated) Conlax
    3.35 gm/5 ml
    UniMed UniHealth
    Unit Price: ৳ 140.00
  • Oral Solution (Concentrated) Contilos
    3.35 gm/5 ml
    Goodman Pharmaceuticals Ltd.
    Unit Price: ৳ 130.00
  • Oral Solution (Concentrated) D-
    3.35 gm/5 ml (200 ml syrup)
    Drug International Ltd
    Unit Price: ৳ 220.00
  • Oral Solution (Concentrated) D-Lac
    3.35 gm/5 ml (50 ml syrup)
    Drug International Ltd
    Unit Price: ৳ 70.00
  • Oral Solution (Concentrated) D-Lac
    3.35 gm/5 ml (100 ml syrup)
    Drug International Ltd
    Unit Price: ৳ 130.00
  • Oral Solution (Concentrated) Devolac
    3.35 gm/5 ml (100 ml bottle)
    Desh Pharmaceuticals Ltd
    Unit Price: ৳ 100.00
  • Oral Solution (Concentrated) Devolac
    3.35 gm/5 ml (200 ml bottle)
    Desh Pharmaceuticals Ltd
    Unit Price: ৳ 195.00
  • Oral Solution (Concentrated) Dulac
    3.35 gm/5 ml
    Chemist Laboratories Ltd.
    Unit Price: ৳ 150.00
  • Oral Solution (Concentrated) Dulac
    3.35 gm/5 ml
    Chemist Laboratories Ltd.
    Unit Price: ৳ 150.00
  • Oral Solution (Concentrated) E-Lax
    3.35 gm/5 ml
    Edruc Ltd
    Unit Price: ৳ 100.00
  • Oral Solution (Concentrated) Ezylax
    3.35 gm/5 ml
    Orion Pharma Ltd.
    Unit Price: ৳ 140.00
  • Oral Solution (Concentrated) Glovolac
    3.35 gm/5 ml
    Globex Pharmaceuticals Ltd.
    Unit Price: ৳ 120.00
  • Oral Solution (Concentrated) Inolac
    3.35 gm/5 ml
    Incepta Pharmaceuticals Ltd.
    Unit Price: ৳ 120.00
  • Oral Solution (Concentrated) Inolac
    3.35 gm/5 ml
    Incepta Pharmaceuticals Ltd.
    Unit Price: ৳ 120.00
  • Oral Solution (Concentrated) Isolac
    3.35 gm/5 ml
    Concord Pharmaceuticals Ltd.
    Unit Price: ৳ 140.00
  • Oral Solution (Concentrated) Laclose
    3.35 gm/5 ml
    Opsonin Pharma Ltd.
    Unit Price: ৳ 120.37
  • Oral Solution (Concentrated) Lacos
    3.35 gm/5 ml
    Orbit Pharmaceuticals Ltd.
    Unit Price: ৳ 100.00
  • Oral Solution (Concentrated) Lactoben
    3.35 gm/5 ml (100 ml bottle)
    Benham Pharmaceuticals Ltd.
    Unit Price: ৳ 138.00
  • Oral Solution (Concentrated) Lactoben
    3.35 gm/5 ml (200 ml bottle)
    Benham Pharmaceuticals Ltd.
    Unit Price: ৳ 250.00
  • Oral Solution (Concentrated) Lactolax
    3.35 gm/5 ml
    Pharmasia Limited
    Unit Price: ৳ 140.00
  • Oral Solution (Concentrated) Lactomose
    3.35 gm/5 ml
    Monicopharma Ltd.
    Unit Price: ৳ 100.00
  • Oral Solution (Concentrated) Lactu
    3.35 gm/5 ml (100 ml bottle)
    Biopharma Laboratories Ltd.
    Unit Price: ৳ 140.00
  • Oral Solution (Concentrated) Lactu
    3.35 gm/5 ml (200 ml bottle)
    Biopharma Laboratories Ltd.
    Unit Price: ৳ 250.00
  • Oral Solution (Concentrated) Lactulose H
    3.35 gm/5 ml
    Hudson Pharmaceuticals Ltd.
    Unit Price: ৳ 110.00
  • Oral Solution (Concentrated) Lax
    3.35 gm/5 ml
    Medicon Pharmaceuticals Ltd.
    Unit Price: ৳ 120.00
  • Oral Solution (Concentrated) Laxativ
    3.35 gm/5 ml (100 ml bottle)
    Rangs Pharmaceuticals Ltd.
    Unit Price: ৳ 130.00
  • Oral Solution (Concentrated) Laxativ
    3.35 gm/5 ml (200 ml bottle)
    Rangs Pharmaceuticals Ltd.
    Unit Price: ৳ 240.00
  • Oral Solution (Concentrated) Laxativ
    3.35 gm/5 ml (200 ml bottle)
    Rangs Pharmaceuticals Ltd.
    Unit Price: ৳ 240.00
  • Oral Solution (Concentrated) Laxol
    3.35 gm/5 ml
    Navana Pharmaceuticals Ltd.
    Unit Price: ৳ 136.00
  • Oral Solution (Concentrated) Laxolac
    3.35 gm/5 ml
    Globe Pharmaceuticals Ltd.
    Unit Price: ৳ 140.00
  • Oral Solution (Concentrated) Leaxe
    3.35 gm/5 ml (100 ml bottle)
    Alco Pharma Ltd.
    Unit Price: ৳ 140.42
  • Oral Solution (Concentrated) Leaxe
    3.35 gm/5 ml (200 ml bottle)
    Alco Pharma Ltd.
    Unit Price: ৳ 250.75
  • Oral Solution (Concentrated) Leolac
    3.35 gm/5 ml (50 ml bottle)
    Leon Pharmaceuticals Ltd.
    Unit Price: ৳ 65.20
  • Oral Solution (Concentrated) Leolac
    3.35 gm/5 ml (100 ml bottle)
    Leon Pharmaceuticals Ltd.
    Unit Price: ৳ 140.42
  • Oral Solution (Concentrated) Livax
    3.35 gm/5 ml (60 ml bottle)
    Pacific Pharmaceuticals Ltd.
    Unit Price: ৳ 140.00
  • Oral Solution (Concentrated) Livax
    3.35 gm/5 ml (100 ml bottle)
    Pacific Pharmaceuticals Ltd.
    Unit Price: ৳ 250.00
  • Oral Solution (Concentrated) Livoton
    3.35 gm/5 ml (50 ml bottle)
    Kemiko Pharmaceuticals Ltd.
    Unit Price: ৳ 70.21
  • Oral Solution (Concentrated) Livoton
    3.35 gm/5 ml (100 ml bottle)
    Kemiko Pharmaceuticals Ltd.
    Unit Price: ৳ 120.35
  • Oral Solution (Concentrated) Livoton
    3.35 gm/5 ml (200 ml bottle)
    Kemiko Pharmaceuticals Ltd.
    Unit Price: ৳ 230.00
  • Oral Solution (Concentrated) Loctoz
    3.35 gm/5 ml
    Amico Laboratories Ltd.
    Unit Price: ৳ 100.00
  • Oral Solution (Concentrated) Mebolos
    3.35 gm/5 ml (100 ml bottle)
    Millat Pharmaceuticals Ltd.
    Unit Price: ৳ 75.00
  • Oral Solution (Concentrated) Mebolos
    3.35 gm/5 ml (200 ml bottle)
    Millat Pharmaceuticals Ltd.
    Unit Price: ৳ 140.00
  • Oral Solution (Concentrated) Mylac
    3.35 gm/5 ml (100 ml bottle)
    Mystic Pharmaceuticals Ltd.
    Unit Price: ৳ 75.00
  • Oral Solution (Concentrated) Mylac
    3.35 gm/5 ml (200 ml bottle)
    Mystic Pharmaceuticals Ltd.
    Unit Price: ৳ 140.00
  • Oral Solution (Concentrated) Niprolac
    3.35 gm/5 ml (100 ml bottle)
    NIPRO JMI Pharma Ltd.
    Unit Price: ৳ 120.36
  • Oral Solution (Concentrated) Niprolac
    3.35 gm/5 ml (200 ml bottle)
    NIPRO JMI Pharma Ltd.
    Unit Price: ৳ 220.00
  • Oral Solution (Concentrated) Onlac
    3.35 gm/5 ml (100 ml bottle)
    One Pharma Ltd.
    Unit Price: ৳ 140.00
  • Oral Solution (Concentrated) Onlac
    3.35 gm/5 ml (200 ml bottle)
    One Pharma Ltd.
    Unit Price: ৳ 240.00
  • Oral Solution (Concentrated) Oralax
    3.35 gm/5 ml
    Somatec Pharmaceuticals Ltd.
    Unit Price: ৳ 140.00
  • Oral Solution (Concentrated) Osmolax
    3.35 gm/5 ml (100 ml bottle)
    Square Pharmaceuticals Ltd.
    Unit Price: ৳ 140.00
  • Oral Solution (Concentrated) Osmolox
    3.35 gm/5 ml (200 ml bottle)
    Square Pharmaceuticals Ltd.
    Unit Price: ৳ 250.00
  • Oral Solution (Concentrated) P Lac
    3.35 gm/5 ml
    Pharmadesh Laboratories Ltd.
    Unit Price: ৳ 93.12
  • Oral Solution (Concentrated) Polylac
    3.35 gm/5 ml
    Silco Pharmaceutical Ltd.
    Unit Price: ৳ 120.00
  • Oral Solution (Concentrated) Regulose
    3.35 gm/5 ml (100 ml bottle)
    General Pharmaceuticals Ltd.
    Unit Price: ৳ 120.35
  • Oral Solution (Concentrated) Regulose
    3.35 gm/5 ml (200 ml bottle)
    General Pharmaceuticals Ltd.
    Unit Price: ৳ 201.35
  • Oral Solution (Concentrated) Rewat
    3.35 gm/5 ml
    Kumudini Pharma Ltd.
    Unit Price: ৳ 120.00
  • Oral Solution (Concentrated) Serelose
    3.35 gm/5 ml
    Beximco Pharmaceuticals Ltd.
    Unit Price: ৳ 130.00
  • Oral Solution (Concentrated) Sinalac
    3.35 gm/5 ml (60 ml bottle)
    IBN SINA Pharmaceuticals Ltd.
    Unit Price: ৳ 70.00
  • Oral Solution (Concentrated) Sinalac
    3.35 gm/5 ml (100 ml bottle)
    IBN SINA Pharmaceuticals Ltd.
    Unit Price: ৳ 140.00
  • Oral Solution (Concentrated) Sinalac
    3.35 gm/5 ml (200 ml bottle)
    IBN SINA Pharmaceuticals Ltd.
    Unit Price: ৳ 230.00
  • Oral Solution (Concentrated) Sinalac
    3.35 gm/5 ml (450 ml bottle)
    IBN SINA Pharmaceuticals Ltd.
    Unit Price: ৳ 424.00
  • Oral Solution (Concentrated) Sivolac
    3.35 gm/5 ml
    Sharif Pharmaceuticals Ltd.
    Unit Price: ৳ 120.37
  • Oral Solution (Concentrated) Tulac
    3.35 gm/5 ml (50 ml bottle)
    Eskayef Pharmaceuticals Ltd
    Unit Price: ৳ 65.00
  • Oral Solution (Concentrated) Tulac
    3.35 gm/5 ml (100 ml bottle)
    Eskayef Pharmaceuticals Ltd
    Unit Price: ৳ 140.00
  • Oral Solution (Concentrated) Tulac
    3.35 gm/5 ml (200 ml bottle)
    Eskayef Pharmaceuticals Ltd
    Unit Price: ৳ 230.00
  • Oral Solution (Concentrated) Tulos
    3.35 gm/5 ml (100 ml bottle)
    ACME Laboratories
    Unit Price: ৳ 140.00
  • Oral Solution (Concentrated) Tulos
    3.35 gm/5 ml (200 ml bottle)
    ACME Laboratories
    Unit Price: ৳ 230.00
  • Oral Solution (Concentrated) Xylose
    3.35 gm/5 ml
    Delta Pharma Ltd
    Unit Price: ৳ 120.00
  • Oral Solution (Concentrated) Zenilac
    3.35 gm/5 ml
    Zenith Pharmaceuticals Ltd.
    Unit Price: ৳ 120.00