Lactulose Crescent (Lactulose)

Lactulose is an osmotic laxative that acts on the gastrointestinal tract and on ammonia metabolism in liver disease.

• Constipation: softens stool and promotes bowel movements in patients with functional or chronic constipation.
• Hepatic encephalopathy: lowers blood ammonia concentrations, helping to improve mental status in patients with liver‑related encephalopathy.
• Prevention of hepatic encephalopathy recurrence: used chronically to maintain low ammonia levels and reduce the risk of episodic encephalopathy.

• Lactulose remains largely unabsorbed in the small intestine; when it reaches the colon it draws water into the lumen by increasing osmotic pressure, which softens feces. Colonic bacteria ferment lactulose to short‑chain fatty acids, acidifying the colonic contents and converting ammonia to ammonium, thereby facilitating its excretion and reducing systemic ammonia levels.

Lactulose may cause a range of adverse reactions, most of which are related to its laxative action.

Common Side Effects

• Flatulence: increased intestinal gas production.
• Abdominal cramping: mild to moderate discomfort.
• Diarrhoea: loose stools, especially at higher doses.
• Nausea: occasional feeling of queasiness.
• Bloating: sensation of fullness in the abdomen.

Serious or Rare Side Effects

• Electrolyte imbalance: especially low potassium with prolonged diarrhoea.
• Severe dehydration: marked fluid loss requiring medical attention.
• Allergic reaction: rash, itching, or swelling.
• Hyperosmolar coma: extremely rare, associated with massive overdose.

Before using Lactulose, consider the following safety measures.

• Renal impairment: monitor kidney function as dehydration can worsen renal status.
• Diabetes mellitus: watch for changes in blood glucose due to carbohydrate content.
• Pediatric use: dose adjustment may be required for children.
• Pregnancy and lactation: use only if clearly needed after risk‑benefit assessment.
• Concomitant laxatives: avoid simultaneous use to prevent excessive diarrhoea.
• Store at ambient temperature: keep below 25 °C, retain in original container, protect from moisture and direct sunlight.

Lactulose can influence the absorption or effect of other medicines.

Major Interactions (Avoid)

• Antacids containing magnesium: may increase laxative effect and cause electrolyte disturbances.
• Oral antibiotics: altered gut flora can reduce lactulose fermentation, diminishing efficacy.

Moderate Interactions (Monitor Closely)

• Diabetic medications: carbohydrate content may affect glucose control.
• Digoxin: electrolyte shifts from diarrhoea can predispose to toxicity.
• Other osmotic laxatives: combined use may lead to severe diarrhoea and dehydration.