Laktulos Levolac (Lactulose, Liquid)

Lactulose is an osmotic laxative used to manage conditions related to bowel motility and ammonia accumulation.

• Constipation: softens stools and promotes regular bowel movements.
• Hepatic encephalopathy: lowers blood ammonia by acidifying colonic contents.
• Prevention of hepatic encephalopathy recurrence: maintains low ammonia levels during long‑term therapy.

• 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, draw water into the lumen, and acidify the contents, thereby softening stools and reducing ammonia absorption.

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

Common Side Effects

• Abdominal bloating: sensation of fullness or swelling in the abdomen.
• Flatulence: increased intestinal gas production.
• Diarrhea: loose, watery stools, especially at higher doses.
• Nausea: feeling of sickness or urge to vomit.
• Abdominal cramping: painful muscle contractions in the gut.
• Thirst: increased desire for fluids.

Serious or Rare Side Effects

• Severe dehydration: excessive fluid loss leading to low blood volume.
• Electrolyte imbalance: abnormal levels of sodium, potassium, or other ions.
• Allergic reaction: rash, itching, swelling, or difficulty breathing.
• Worsening hepatic encephalopathy: rare paradoxical increase in ammonia levels.

When prescribing or dispensing lactulose, consider the following safety measures.

• Dose titration: start with a low dose and adjust based on stool frequency and tolerance.
• Fluid intake: maintain adequate hydration to prevent dehydration.
• Renal impairment: monitor kidney function and adjust therapy if needed.
• Diabetes monitoring: observe blood glucose as lactulose may affect sugar levels.
• Store at room temperature: keep in the original container, protect from moisture and light.

Lactulose can interact with other medicines, requiring attention to avoid reduced efficacy or increased risk.

Major Interactions (Avoid)

• Antibiotics (e.g., rifaximin): may diminish lactulose’s effect on ammonia reduction.
• Antidiarrheals (e.g., loperamide): can counteract the laxative action.
• Mineral oil: may interfere with lactulose’s colonic activity.

Moderate Interactions (Monitor Closely)

• Insulin or oral hypoglycemics: lactulose can influence glucose control.
• Diuretics: combined use may increase risk of electrolyte disturbances.