Lactulose Greenwood (Lactulose)

Lactulose acts as an osmotic laxative and ammonia‑lowering agent in the gastrointestinal tract.

• Constipation: softens stool and promotes regular bowel movements.
• Hepatic encephalopathy: reduces intestinal ammonia absorption, improving neurological function in liver disease.
• Prevention of constipation in patients with chronic liver disease: helps maintain bowel regularity to support ammonia control.

• Lactulose is a synthetic disaccharide that is not absorbed in the small intestine. In the colon it is metabolized by bacterial flora into short‑chain fatty acids, which increase osmotic pressure and draw water into the lumen, softening stool. The resulting acidification of colonic contents converts ammonia to ammonium, decreasing its absorption and lowering systemic ammonia levels.

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

Common Side Effects

• Flatulence: increased gas production in the colon.
• Diarrhea: loose stools due to osmotic effect.
• Abdominal cramping: discomfort from increased intestinal activity.
• Nausea: mild stomach upset.
• Bloating: sensation of fullness.

Serious or Rare Side Effects

• Severe dehydration: excessive fluid loss from prolonged diarrhea.
• Electrolyte imbalance: abnormal potassium or sodium levels.
• Hypernatremia: elevated blood sodium from fluid shifts.
• Allergic reaction: rash, itching, or swelling.
• Hepatic encephalopathy worsening: paradoxical increase in ammonia in rare cases.

Before using Lactulose, consider the following safety measures.

• Renal impairment: monitor fluid and electrolyte status closely.
• Diabetes mellitus: assess blood glucose as lactulose may affect sugar levels.
• Pediatric use: adjust dosing carefully under medical supervision.
• Pregnancy: use only if clearly needed after risk‑benefit evaluation.
• Lactose intolerance: consider alternative laxatives if intolerance is severe.
• Store at ambient temperature: keep below 25°C in the original container, protect from moisture and direct sunlight.

Lactulose can interact with other medicines, affecting their absorption or efficacy.

Major Interactions (Avoid)

• Antacids containing magnesium or aluminum: may reduce lactulose effectiveness.
• Antibiotics (e.g., rifaximin): can alter gut flora, potentially diminishing lactulose’s ammonia‑lowering action.

Moderate Interactions (Monitor Closely)

• Diabetic medications: monitor blood glucose as lactulose may affect glycemic control.
• Diuretics: watch for signs of dehydration and electrolyte disturbances.
• Other laxatives: combined use may cause severe diarrhea and electrolyte loss.