Adult Dosing

Portal-systemic encephalopathy

• 300 mL mixed with 700 mL of water or physiologic saline given as 30-60 minute retention enema, q4-6 hrs
• Give retention enema until the coma stage is reversed and patient is able to take oral medication

Pediatric Dosing

• Safety and effectiveness in pediatric patient have not been established

[Outline]

• Adult Dosing
• Pediatric Dosing

• Prevention and treatment of portal-systemic encephalopathy, including the stages of hepatic pre-coma and coma

• Hypersensitivity to any of the ingredients of the product
• Patients who require a low galactose diet

• N/A

Renal Dose Adjustment

• Renal impairment: Dose adjustments not defined

Hepatic Dose Adjustment

• Hepatic impairment: Dose adjustments not defined

• Patients treated with lactulose solution who may be required to undergo electrocautery procedures during proctoscopy or colonoscopy. Accumulation of H2 gas in significant concentration in the presence of an electrical spark may result in an explosive reaction, hence patients on lactulose therapy undergoing such procedures should have a thorough bowel cleansing with a non-fermentable solution
• As lactulose solution contains galactose and lactose, use cautiously in diabetic patients
• In portal-systemic encephalopathy there is serious underlying liver disease with complications such as electrolyte disturbance, hence in overall management consider other specific therapy to treat liver diseases and electrolyte imbalance
• Administration of lactulose in infants causes hyponatremia and dehydration

Cautions: Use cautiously in

• Diabetes mellitus
• Colorectal electrocautery procedure

Pregnancy Category:B

Breastfeeding: Safety unknown; manufacturer advises caution.

• GI: Flatulence, belching, abdominal discomfort, diarrhea, nausea, vomiting
• METABOLIC: Hypokalemia, hypernatremia (excess dose)

• Gastrointestinal agent; increase osmotic pressure within colon and acidifies colonic contents, resulting in the increase in stool water content and softening of the stool. It also causes migration of ammonia from blood into colon, thereby reducing blood ammonia levels and expelled it through laxative action in the form of ammonium ions
• Poorly absorbed
• Metabolized in colon by bacteria
• Excreted mainly in feces, <3% in urine
• Half-life: 1.7-2 hrs

US Trade Name(s)

• Cholac
• Enulose
• Generlac

US Availability

lactulose (generic)

• Rectal SOLN: 10 g/15 mL

Cholac, Enulose, Generlac

• Rectal SOLN: 10 g/15 mL

Canadian Trade Name(s)

• N/A

Canadian Availability

• N/A

UK Trade Name(s)

• N/A

UK Availability

• N/A

Australian Trade Name(s)

• N/A

Australian Availability

• N/A

[Outline]

Gastrointestinal

Laxatives

Hyperosmotic Agents