Laevolac (Lactulose)

Laevolac (lactulose) acts as an osmotic laxative and ammonia‑lowering agent, addressing conditions related to bowel motility and hepatic ammonia accumulation.

• Constipation: softens stool and increases bowel movements, providing relief from infrequent or difficult defecation.
• Hepatic encephalopathy: reduces blood ammonia levels, helping to prevent or improve neuropsychiatric symptoms in patients with liver disease.
• Hyperammonemia in liver disease: lowers systemic ammonia, supporting metabolic control in chronic liver conditions.

• Lactulose is a synthetic disaccharide that reaches the colon unchanged, where bacterial enzymes hydrolyze it to short‑chain fatty acids such as lactic and acetic acid. The resulting acidification lowers colonic pH, converting ammonia (NH3) to ammonium (NH4+), which is trapped in the lumen and excreted. The osmotic effect of the unabsorbed sugars also draws water into the bowel, softening stool and stimulating peristalsis.

Lactulose may cause gastrointestinal and metabolic reactions, ranging from mild to serious.

Common Side Effects

• Flatulence: increased intestinal gas.
• Abdominal cramps: intermittent stomach pain.
• Diarrhea: loose stools, especially at higher doses.

Serious or Rare Side Effects

• Electrolyte imbalance: notably low potassium.
• Severe dehydration: from excessive fluid loss.
• Allergic reaction: rash, itching, or swelling.

When prescribing Laevolac, clinicians should consider several safety measures to minimise risks.

• Assess renal function: impaired kidneys may reduce lactulose clearance.
• Monitor electrolytes: especially potassium, during prolonged therapy.
• Use caution in diabetics: lactulose contains sugars that may affect glucose control.
• Avoid in galactosemia: patients lack the ability to metabolise certain sugars.
• Adjust dose in hepatic failure: severe liver dysfunction may require careful titration.
• Store at room temperature: keep below 25°C in the original container, protect from moisture.

Lactulose can influence the activity of other medicines, requiring attention to potential interactions.

Major Interactions (Avoid)

• Antidiarrheal agents (e.g., loperamide): may counteract lactulose’s laxative effect.
• Broad‑spectrum antibiotics: can alter colonic flora, reducing lactulose metabolism.
• Oral phosphate binders: may bind lactulose, decreasing its efficacy.

Moderate Interactions (Monitor Closely)

• Metformin: combined use may increase gastrointestinal discomfort.
• Sucralfate: may decrease lactulose absorption if taken simultaneously.
• Iron supplements: can reduce lactulose’s osmotic activity when co‑administered.