Description
Lactulose Pharmacodynamics
It has a hyperosmotic laxative effect, stimulates intestinal peristalsis, improves absorption of phosphates and calcium salts, promotes excretion of ammonium ions.
Lactulose is broken down by the intestinal flora of the large intestine into low-molecular organic acids, which leads to a decrease in pH and an increase in osmotic pressure and, consequently, an increase in the volume of intestinal contents. These effects stimulate intestinal peristalsis and affect the consistency of the stool. The physiological rhythm of emptying the large intestine is restored.
In hepatic encephalopathy and hepatic (pre)coma, the effect is due to suppression of proteolytic bacteria by increasing the number of acidophilic bacteria (such as lactobacilli); transition of ammonia into an ionic form by acidifying the contents of the colon; emptying of the colon due to lower pH in the colon and osmotic effect; and reduction of nitrogenous toxins by stimulating bacteria that recycle ammonia for bacterial protein synthesis.
Lactulose as a prebiotic enhances the growth of beneficial bacteria such as bifidobacteria and lactobacilli, which in turn helps to suppress the growth of potentially pathogenic bacteria such as Clostridium and E.coli and provides a more favorable balance of intestinal flora.
It has the ability to inhibit the growth and reproduction of Salmonella and Shigella. Does not reduce the absorption of vitamins and is not addictive.
Action occurs 24 to 48 hours after intake (delayed effect is due to the passage of the drug through the gastrointestinal tract).
Indications
– Constipation: regulation of the physiological rhythm of emptying the colon;
– Stool softening for medical purposes (hemorrhoids; post-operative period of surgical interventions on the colon or anus);
– Liver encephalopathy: treatment and prevention of hepatic coma and precoma.
Contraindications
– Hypersensitivity to any component of the drug;
– Galactosemia;
– Galactose and/or fructose intolerance, lactase deficiency, glucose-galactose malabsorption;
– Intestinal obstruction;
– Rectal bleeding;
– Colo-, ileostoma;
– Suspicion of appendicitis.
With caution:
Diabetes mellitus.
Pregnancy and lactation:
If necessary, lactulose may be prescribed during pregnancy and lactation.
Dosage and administration.
- The drug is intended to be taken orally, during or after meals.
Lactulose may be prescribed as a single daily dose or this dose may be divided into two doses using a measuring cup. - All doses should be adjusted individually. If a single daily dose is prescribed, it should be taken at the same time, such as during breakfast.
- For constipation:
– children under 1 year of age: 5 ml/day;
-Children from 1 to 6 years of age: 5 to 10 ml/day;
-Children 7 to 14 years of age: 15 ml/day;
-Children over 14 years of age and adults: 15-45 ml/day during the first three days, then 10-30 ml/day. Laxative effect of the drug develops during the first two days of administration. Treatment duration is from 4 weeks to 3-4 months. - In hepatic coma, precoma, encephalopathy:
The initial dose is 30-45 ml 3 times a day. Then the dose is adjusted so that soft stools are 2-3 times a day. Treatment can last up to 3 months or more.
In hepatic coma, precoma and hepatic encephalopathy: orally by 30-50 ml 3 times a day, the daily dose may be 90-190 ml; then in individually adjusted maintenance dose (providing fecal pH of 5-5.5) 2-3 times a day. - In the postoperative period:
Adults – 10-30 ml 3 times a day, children over 1 year – 5-10 ml 2-3 times a day, up to 1 year – 5 ml 2-3 times a day. The drug is administered 18-24 hours after surgery for 3-5 days.
