LACTULOSE is taken orally and reaches the large bowel without being absorbed into the bloodstream. Here, it is degraded by the normal bacteria found in the bowel, and this changes the pH, making it more acidic. This has two effects, one is to increase the amount of water in the bowel, which makes the stools softer and allows defecation to occur. The other is to remove harmful ammonia from the system and expel it in faeces, preventing the brain from being exposed to it as happens in PSE.
Adults
The usual initial dose is 15 to 30 mL daily. The dose may be increased to 45 mL daily if necessary.
Since lactulose solution relieves constipation by producing a physiological change in the colon, it may take
from 24 to 48 hours before normal defaecation occurs. After three days, the dose may be reduced to 10 to
25 mL daily for maintenance
Children
It is recommended that if lactulose is given to infants and children, this should be done under medical
supervision. The usual initial daily doses (for the first three days) are as follows:
● 7 to 14 years: 15 mL
● 1 to 6 years: 10 mL
● Infants under 1 year: 5 mL
Maintenance daily doses are as follows:
● 7 to 14 years: 10 mL
● 1 to 6 years: 5 to 10 mL
● Infants under 1 year: 3 to 5 mL
As a Prebiotic
Doses of 2g per day have been demonstrated to increase short-chain fatty acid production in vitro. 5g per day has demonstrated a prebiotic effect producing higher counts of Bifidobacterium, Lactobacillus and Anaerostipes with a concomitant rise in branched-chain fatty acids, decrease in branched-chain fatty
acids and, pH and ammonia (in vitro model of human large intestine). In vivo studies have demonstrated a bifidogenic effect at a dose of 10g.
An initial slow dose and a gradual increase is recommended to prevent side effects such as bloating and flatulence.
Composition: 63-70% Lactulose, 15% Galactose , 10% Lactose, 12% Impurities (10% Epilactose, 1% Fructose , 4% 3-Deoxy-glyceropentulose, 1.5% Others)
Other analyses: 30ppm Sulfites, 0.5ppm Lead
Common side effects are distension, flatulence and intestinal cramps occur in 20% of cases, which are usually mild and transient. Excessive dosage can lead to diarrhoea, which can lead to fluid loss and electrolyte imbalance if left untreated.
Uncommon side effects include skin rash, nausea, vomiting, anorexia and increased thirst.
