Lactulose (Constulose, Enulose, enerlac,

Cholac, Constilac)
GENERIC NAME: lactulose laxative

BRAND NAME: Constulose, Enulose, Generlac, Cholac, Constilac

DISCONTINUED BRAND(S): Acilac, Cephulac, Chronulac, Portalac, Evalose,
Laxilose, Duphalac, Heptalac
DRUG CLASS AND MECHANISM: Lactulose is a man-made sugar that contains
two naturally occurring sugars, galactose and fructose. It is not digested in
the intestine like other sugars so that it reaches the colon where bacteria
digest it and thereby alter the composition of the stool.
Lactulose is used as a laxative to treat constipation. In the colon, lactulose is
broken down by bacteria into products that help to draw water into the colon,
which softens the stool.
Additionally, lactulose is used to treat hepatic encephalopathy, a loss of brain
function and change in mentation that occurs when the liver is unable to
remove toxins from the blood. Bacteria in the colon digest lactulose into
chemicals that bind ammonia that is believed to be the toxin that causes
hepatic encephalopathy. The binding of ammonia prevents ammonia from
moving from the colon into the blood and also draws ammonia from the
blood and into the colon. The bound ammonia then is removed from the
body in the stool.
The FDA approved lactulose in March, 1976.
PRESCRIBED FOR: Lactulose is used to treat constipation and to prevent and
treat hepatic encephalopathy.

SIDE EFFECTS: Common side effects include

passing gas,

belly cramps,

burping,

upset stomach,

nausea, and

vomiting.

Diarrhea may occur if the dose is too high. Serious complications associated
with diarrhea are fluid loss (dehydration), high amounts of sodium in the
blood (hypernatremia), and low amounts of potassium in the blood
(hypokalemia).
SIDE EFFECTS WARNING:
Diarrhea (loose stool) may occur if the dose of lactulose is too high. Problems
associated with diarrhea are fluid and potassium loss in the diarrheal stool
leading to dehydration and low blood levels of potassium (hypokalemia). An
additional side effect is the elevation of blood levels of sodium
(hypernatremia) as a result of the loss of fluid.
Lactulose contains sugars (galactose and lactose) and should be used
cautiously in people with diabetes; however, since lactulose is not digested,
and little of the sugar is absorbed, the effects in people with diabetes usually
are minimal.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes

PREPARATIONS:

Oral or rectal solution: 10 mg/15 ml

Powder for solution (single dose packets): 10 and 20 g.

STORAGE: Lactulose products should be stored at room temperature,

between 15 C and 30 C 59 F and 86 F).
DOSING:
For the treatment of constipation: The usual adult dose is 10 to 20 g of
lactulose daily. The dose may be increased to 40 g daily if necessary. Twentyfour to 48 hours may be required to produce a normal bowel movement.
For the treatment of hepatic encephalopathy: The usual starting dose is 3045 ml (20-30 g of lactulose) by mouth every hour to induce rapid defecation.
After defecation occurs the dose is reduced to 20-30 g 3-4 times per day and
adjusted to produce 2-3 soft stools per day.
DRUG INTERACTIONS:
Antacids increase the colon pH and may interfere with the way lactulose
works. Separating the administration of antacids and lactulose may prevent
this interaction.
Antibiotics kill bacteria including gut bacteria that live in the colon. Colonic
bacteria help to transform lactulose into the active drug that produces the
desired treatment results. Therefore, combining lactulose with some
antibiotics may reduce the effectiveness of lactulose treatment.
PREGNANCY: Lactulose has not been adequately evaluated in pregnant
women. Lactulose may be used during pregnancy if the potential benefits of
treatment outweigh the potential risks to the unborn baby.

NURSING MOTHERS: It is not known whether lactulose is secreted in human

milk or cause harm to the nursing infant.