Lactulose Aiwa (Lactulose)

Lactulose acts on the gastrointestinal tract and ammonia metabolism, providing therapeutic benefit in specific conditions.

• Constipation: softens stool and promotes regular bowel movements.
• Hepatic encephalopathy: lowers intestinal ammonia absorption, improving neurological status.
• Prevention of hepatic encephalopathy recurrence: helps maintain low ammonia levels to reduce future episodes.

• Lactulose is a synthetic disaccharide that is not absorbed in the small intestine. In the colon it is metabolized by bacterial enzymes into lactic acid and acetic acid, lowering colonic pH and creating an osmotic gradient that draws water into the lumen, facilitating stool passage. The acidic environment also converts ammonia (NH3) to ammonium (NH4+), reducing its absorption and systemic levels, which benefits patients with hepatic encephalopathy.

Lactulose may cause a range of adverse reactions, most of which are mild and transient.

Common Side Effects

• Abdominal bloating: sensation of fullness or swelling.
• Flatulence: increased intestinal gas.
• Diarrhea: loose, watery stools.
• Nausea: feeling of sickness.
• Stomach cramps: intermittent abdominal pain.
• Thirst: increased desire for fluids.

Serious or Rare Side Effects

• Severe electrolyte imbalance: abnormal sodium or potassium levels.
• Dehydration: excessive fluid loss leading to weakness.
• Allergic reaction: rash, itching, or swelling.
• Worsening hepatic encephalopathy: rare paradoxical increase in ammonia.

Before using Lactulose, consider the following safety measures.

• Renal impairment: adjust dose and monitor kidney function.
• Electrolyte monitoring: check serum electrolytes during prolonged therapy.
• Diabetes: observe blood glucose as lactulose may affect glycemic control.
• Discontinuation: avoid abrupt stopping without medical advice.
• Store at room temperature: keep in the original container, protect from moisture.

Lactulose can interact with other medicines, affecting efficacy or safety.

Major Interactions (Avoid)

• Antidiarrheals (e.g., loperamide): may reduce lactulose effectiveness.
• Mineral oil: can impair absorption of lactulose.
• Magnesium‑containing laxatives: increase risk of electrolyte disturbances.

Moderate Interactions (Monitor Closely)

• Oral antibiotics: lactulose may alter gut flora and affect antibiotic activity.
• Potassium supplements: monitor serum potassium levels.
• Blood glucose monitoring devices: lactulose may interfere with some readings in diabetic patients.