Lactulac

escription

Lactulose Solution is a laxative used in Pakistan to treat chronic constipation and manage hepatic encephalopathy, a liver disease complication causing confusion or coma. Made from lactose, it softens stools and promotes bowel movements, helping those with sluggish digestion often seen in urban Karachi or rural Punjab due to low-fiber diets. Available in bottles (e.g., 120ml, 240ml), priced around Rs. 150-300, prescription-optional but often doctor-recommended, and distributed through DRAP-registered pharmacies.

How It Functions

Lactulose, a synthetic disaccharide, is fermented by gut bacteria into short-chain fatty acids, increasing water absorption in the colon to soften stools and stimulate peristalsis. In hepatic encephalopathy, it lowers blood ammonia by trapping it in the gut for excretion. Chemically, it’s 4-O-β-D-galactopyranosyl-D-fructofuranose. Effects begin in 24-48 hours for constipation, with ammonia reduction in days for encephalopathy.

Dosage Information

Adults: For constipation, 15-30ml daily (1-2 tablespoons), taken orally with water, adjustable to 15-60ml based on response; for hepatic encephalopathy, 30-45ml 3-4 times daily. Children: Constipation, 0.7-2ml/kg/day (max 40ml); encephalopathy, consult pediatrician. Use a marked syringe or spoon for accuracy. Take at the same time daily, with or without food. Consult physician for duration (typically short-term for constipation, longer for encephalopathy) or if no effect in 48 hours.

Side Effects

• Very Common (>1 in 10): Gas, bloating, stomach cramping.
• Common (up to 1 in 10): Diarrhea, nausea, vomiting.
• Rare: Allergic reactions (rash, itching, hives, swelling of face/lips/tongue).

Drug Interactions

Lactulose may interact with:

• Antacids: Reduces efficacy; space 2 hours apart.
• Neomycin: Decreases lactulose’s effect in encephalopathy.
• Other laxatives: Risks excessive diarrhea.

Indications

Approved for:

• Chronic constipation.
• Treatment or prevention of hepatic encephalopathy or coma in liver disease.

When Not to Use

Avoid in:

• Hypersensitivity to lactulose or other sugars.
• Galactose-free diet requirement (e.g., galactosemia).
• Bowel obstruction or acute abdominal pain.
• Scheduled surgery without physician clearance.

Precautions

• Monitor for excessive diarrhea; stop if severe or bloody.
• Use cautiously in diabetes; contains small amounts of galactose and lactose.
• Ensure 2-3 liters daily fluid intake, especially in Pakistan’s hot climate or fasting.
• Avoid in pregnancy/breastfeeding unless essential; consult physician.
• Buy from DRAP-registered pharmacies; check holograms to avoid counterfeits.
• Discard if solution darkens excessively.

Warnings

• Allergic reactions: Stop if rash, swelling, or breathing difficulty occurs; seek urgent care.
• Overuse: Prolonged use without supervision may cause electrolyte imbalance.
• Hepatic encephalopathy: Monitor ammonia levels; adjust dose to avoid diarrhea.
• Pregnancy: Limited data; use only if benefits outweigh risks.
• Bowel obstruction: Avoid until ruled out by physician.

Additional Notes

• Pregnancy Category: Consult physician; category B, use if needed.
• Breastfeeding: Minimal absorption; consult physician, monitor infant.
• Availability: Common in urban and rural pharmacies; generics like Duphalac available.
• Stability: Stable at 15-30°C; do not freeze; discard after expiration or if overly dark.
• Reporting: Log batch for side effects; report to DRAP for quality control.

Doctor Review

Dr. Naeem Akhtar, a gastroenterologist in Lahore, notes Lactulose’s gentle action for constipation and encephalopathy, ideal for Pakistan’s low-fiber diet population. DRAP data supports its safety, but Dr. Akhtar advises fluid intake and monitoring for diarrhea to prevent dehydration.

Disclaimer

This is general product information, not a prescription or medical advice. Consult your doctor or pharmacist for personal guidance.