II. Mechanism

  1. Converts Ammonia to unabsorbed Ammonium
  2. Produces Diarrhea
  3. Alters bowel flora

IV. Advantages

  1. Poorly absorbed (may be used in Renal Failure)

V. Disadvantages: Constipation

  1. Not as effective or well tolerated as Miralax

VI. Dosages

  1. Constipation
    1. Lactulose (Chronulac)
      1. Consider Sorbitol 70% as alternative agent
      2. Adults: 30 ml PO qhs
      3. Children (10 mg/15 ml) 1-3 cc/kg/day divided qd-bid
        1. Easier to administer to young children
      4. May cause abdominal cramping and flatus
    2. Lactitol
      1. As effective as Lactulose with less pain and flatus
      2. Pitzalis (1995) Pediatr Med Chir 17(3):223-6
  2. Hepatic Encephalopathy
    1. Initial: 30-50 ml PO qh until Diarrhea
    2. Next: 15-30 ml PO tid-qid prn 2-3 stools/day
  3. Hepatic Coma
    1. Lactulose 300 ml in 700 ml water retention enema

Images: Related links to external sites (from Google)

Cost: Medications

LACTULOSE (on 2/10/2012 at Target.com)
LACTULOSE 10 GM/15 ML Syrup #30 for $4.00 ($0.13/unit)
Lactulose Encephalopathy (on 2/9/2012 at DrugStore.com)
Lactulose Encephalopathy 10gm/15ml Solution #473 for $19.98 ($0.04/unit)

Ontology: Lactulose (C0022957)

Definition (MSH) A synthetic disaccharide used in the treatment of constipation and hepatic encephalopathy. It has also been used in the diagnosis of gastrointestinal disorders. (From Martindale, The Extra Pharmacopoeia, 30th ed, p887)
Definition (NCI) A disaccharide (sugar) synthesized from fructose and galactose, Lactulose is used to treat constipation and some liver diseases. Nondigestible in mammals, lactulose passes unabsorbed down to the large intestine where resident bacteria consume it and produce lactic, acetic, and formic acids, which draw fluid into the bowel to soften the stool (laxative effect). Acidification of the colon contents attracts ammonia from the bloodstream, assisting stool excretion; helpful in liver failure when ammonia cannot be detoxified. (NCI04)
Concepts Carbohydrate (T118) , Pharmacologic Substance(T121)
MSH D007792
SnomedCT 111137007, 273945008
English Lactulose, D-Fructose, 4-O-beta-D-galactopyranosyl-, lactulose, lactulose (medication), laxatives lactulose, LACTULOSE, 4-O-beta-D-Galactopyranosyl-D-fructofuranose, Lactulose [Chemical/Ingredient], Lactulose product, Lactulose (product), Lactulose (substance)
Swedish Laktulos
Czech laktulosa
Finnish Laktuloosi
Russian LAKTULOZA, ЛАКТУЛОЗА
Polish Laktuloza
Japanese ラクツロース, ピアーレ, モニラック, ラグノス
Spanish lactulosa (producto), lactulosa (sustancia), lactulosa, Lactulosa
French Lactulose
German Lactulose
Italian Lattulosio
Portuguese Lactulose