Lattulac Eps (Lactulose)

• Lactulose is employed in the treatment of gastrointestinal and hepatic disorders where reduction of intestinal ammonia and promotion of bowel movements are therapeutic goals.
• Constipation: relieves stool hardness, increases frequency of bowel movements and eases passage of feces.
• Hepatic encephalopathy: lowers blood ammonia concentrations, helping to improve mental status and prevent neurological deterioration.

• Lactulose is a synthetic disaccharide that is not absorbed in the small intestine. In the colon it is metabolised by bacterial flora to short‑chain fatty acids, which increase the osmotic pressure within the lumen, drawing water into the bowel and acidifying colonic contents. The resulting environment traps ammonia as ammonium ions, reducing its absorption into the portal circulation and thereby lowering systemic ammonia levels.

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

Common Side Effects

• Abdominal cramping or pain
• Flatulence and bloating
• Diarrhoea or loose stools
• Nausea or mild vomiting
• Increased thirst
• Transient electrolyte imbalance (e.g., mild hyponatraemia)

Serious or Rare Side Effects

• Severe dehydration requiring medical attention
• Marked electrolyte disturbances (e.g., severe hyponatraemia, hypokalaemia)
• Allergic reactions such as rash, itching or angioedema
• Hepatic decompensation in patients with advanced liver disease

• When using Lattulac Eps, clinicians should consider several safety measures to minimise risk.
• Assess renal function: adjust use in patients with impaired kidney clearance.
• Monitor electrolyte levels: watch for sodium and potassium changes during therapy.
• Use caution in diabetes: lactulose may affect blood glucose control.
• Avoid in intestinal obstruction: risk of perforation or worsening blockage.
• Adjust dose in severe hepatic impairment: monitor ammonia and clinical response.
• Store at room temperature: keep in original container, protect from moisture and direct sunlight.

Lactulose can interact with other medicines, altering its efficacy or increasing adverse effects.

Major Interactions (Avoid)

• Antidiarrhoeal agents (e.g., loperamide): may counteract lactulose's laxative action.
• Mineral oil: can reduce lactulose's effectiveness by coating the intestinal mucosa.
• Certain antibiotics (e.g., broad‑spectrum): may disrupt colonic flora needed for lactulose metabolism.

Moderate Interactions (Monitor Closely)

• Insulin or oral hypoglycaemic drugs: lactulose may enhance hypoglycaemia; monitor blood glucose.
• Other laxatives or osmotic agents: additive effect may cause excessive fluid loss.
• Phosphate binders: may interfere with lactulose’s ability to acidify colonic contents.