Lactulose Al (Lactulose)

Lactulose acts on the gastrointestinal tract to relieve bowel stasis and lower ammonia absorption in liver disease.

• Constipation: softens stool and increases bowel movement frequency.
• Hepatic encephalopathy: reduces intestinal ammonia production, improving mental status.
• Prevention of hepatic encephalopathy recurrence: maintains low ammonia levels to avoid relapse.

• Lactulose is a disaccharide that is not absorbed in the small intestine. In the colon it is metabolized by bacteria into short‑chain fatty acids, which increase the osmotic pressure within the lumen, drawing water into the bowel and promoting laxation while also trapping ammonia as ammonium ions, thereby reducing its systemic absorption.

Lactulose may cause several adverse reactions, ranging from mild to serious.

Common Side Effects

• Flatulence: increased gas production in the colon.
• Abdominal cramps: discomfort due to increased intestinal activity.
• Diarrhea: loose stools from excess water in the lumen.
• Nausea: mild upset stomach.
• Bloating: sensation of fullness.
• Thirst: increased fluid loss.

Serious or Rare Side Effects

• Electrolyte imbalance: especially low potassium from prolonged diarrhea.
• Severe dehydration: excessive fluid loss requiring medical attention.
• Allergic reaction: rash, itching, or swelling.
• Rectal bleeding: uncommon but warrants immediate evaluation.

Before prescribing lactulose, consider the following safety measures.

• Renal function assessment: monitor kidney status as dehydration can worsen renal impairment.
• Electrolyte monitoring: check serum potassium and sodium during long‑term use.
• Diabetes caution: lactulose contains carbohydrate that may affect blood glucose.
• Intestinal obstruction avoidance: do not use in patients with known bowel blockage.
• Hepatic impairment dose adjustment: reduce dose if severe liver dysfunction is present.
• Store at ambient temperature: keep in original container, protect from moisture and direct sunlight.

Lactulose can interact with other medicines, altering its efficacy or safety.

Major Interactions (Avoid)

• Antidiarrheal agents (e.g., loperamide): may counteract lactulose’s laxative effect.
• Antibiotics (e.g., rifaximin): can reduce bacterial metabolism of lactulose, diminishing ammonia‑lowering action.

Moderate Interactions (Monitor Closely)

• Mineral supplements (calcium, magnesium): may bind lactulose and decrease its activity.
• Oral hypoglycemic agents: carbohydrate content of lactulose may affect glucose control.
• Proton‑pump inhibitors: may alter gut flora, potentially influencing lactulose metabolism.