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 intestinal flora (e.g., following long-term antibiotic treatment)
• Gall bladder diseases
• Intestinal diseases (Colitis, Diverticulosis, Megacolon)
• Increased blood ammonia levels (hyperammonemia in hepatopathy, portal-systemic encephalopathy)

Lactulose is a hyperosmolar laxative which is used as an effective treatment approach for constipation. It is a non-absorbable disaccharide which draws water into the bowel, causes distention through fluid accumulation, thus promotes soft stool and accelerates bowel motion.

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 and promotes 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.

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.

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

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

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 diarrhea. With abuse, loss of electrolytes (primarily potassium) may occur.

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 a registered physician.

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.

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

Osmotic purgatives

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