Laktufarm (Lactulose)

Lactulose is used as an osmotic laxative and ammonia‑lowering agent in several gastrointestinal and hepatic conditions.

• Constipation: softens stool and increases bowel frequency, helping relieve functional constipation in adults.
• Hepatic encephalopathy: lowers intestinal ammonia production, aiding in the treatment and prevention of episodic encephalopathy in patients with liver cirrhosis.
• Chronic liver disease‑related encephalopathy: reduces neurotoxic metabolites, supporting cognitive function in long‑term management of hepatic encephalopathy.

• After oral ingestion, lactulose reaches the colon where resident bacteria hydrolyze it to short‑chain fatty acids such as lactic and acetic acid. These acids lower colonic pH, creating an osmotic gradient that retains water in the lumen, softening feces and stimulating peristalsis. The acidic environment also converts ammonia (NH₃) to ammonium (NH₄⁺), which is poorly absorbed, thereby decreasing systemic ammonia levels.

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

Common Side Effects

• Flatulence: increased intestinal gas production.
• Abdominal cramps: intermittent discomfort.
• Diarrhea: loose stools, especially at higher doses.
• Nausea: mild queasiness.
• Borborygmi: audible intestinal rumbling.

Serious or Rare Side Effects

• Severe dehydration: excessive fluid loss leading to hypotension.
• Electrolyte imbalance: notably low potassium levels.
• Allergic reaction: rash, itching, or swelling.
• Hepatic decompensation: worsening liver function in susceptible patients.

Before initiating lactulose therapy, several safety considerations should be reviewed.

• Renal function: assess kidney status, as dehydration may impair renal clearance.
• Electrolyte monitoring: check serum potassium and sodium, especially in the elderly.
• Diabetes mellitus: consider sugar content, monitor blood glucose.
• Intestinal obstruction: avoid use in patients with known blockage or severe motility disorders.
• Hepatic impairment: adjust dosing and monitor for encephalopathy response.
• Store at room temperature: keep in the original container, protect from moisture and direct sunlight.

Lactulose can influence the absorption or effect of several medicines; interactions should be assessed.

Major Interactions (Avoid)

• Sodium phosphate bowel cleansers: concurrent use may cause severe electrolyte disturbances.
• Strong laxatives (e.g., senna): may lead to excessive diarrhea and dehydration.

Moderate Interactions (Monitor Closely)

• Diuretics: increased risk of hypokalemia; monitor electrolytes.
• Oral hypoglycemic agents: lactulose’s sugar content may affect glucose control.
• Antibiotics (e.g., quinolones): altered gut flora may modify lactulose metabolism.