Lactulin oral solution contains Lactulose; a non-absorbable sugar used in the treating hepatic encephalopathy and constipation.

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Lactulose is a synthetic disaccharide osmotic laxative available in Kenya as; Duphalac, Lactulac, Lactulin, Osmolax or Lacx used in the treatment of constipation and in hepatic encephalopathy. Lactulose is broken down by colonic bacteria mainly into lactic acid. This exerts a local osmotic effect in the colon resulting in increased faecal bulk and stimulation of peristalsis. It may take up to 48 hours before an effect is obtained. When larger doses are given for hepatic encephalopathy the pH in the colon is reduced significantly and the absorption of ammonium ions and other toxic nitrogenous compounds is decreased, leading to a fall in blood-ammonia concentration and an improvement in mental function.

Lactulose is usually given as a solution containing approximately 3.35 g of lactulose per 5mL together with other sugars such as galactose and lactose; an oral powder formulation is also available in Kenya. In the treatment of constipation, the usual initial dose is 10 to 20 g (15 to 30mL) given daily by mouth in a single dose or in 2 divided doses; doses up to 40 g (60mL) daily have been given. The dose is gradually adjusted according to the patient’s needs. Children aged 5 to 10 years may be given initial doses of 10 mL twice daily; 1 to 5 years, 5 mL twice daily; under 1 year, 2.5 mL twice daily.

In hepatic encephalopathy, 60 to 100 g (90 to 150mL) is given daily by mouth in 3 divided doses. The dose is subsequently adjusted to produce 2 or 3 soft stools each day. Lactulose solution 300mL mixed with 700mL of water or sodium chloride 0.9% has been used as a retention enema; the enema is retained for 30 to 60 minutes, repeated every 4 to 6 hours until the patient is able to take oral medication.


Lactulose should not be given to patients with galactosaemia or intestinal obstruction. It should not be used in patients on a low galactose diet and care should be taken in patients with lactose intolerance or in diabetic patients because of the presence of some free galactose and lactose.

Adverse Effects and Side Effects

Lactulose may cause abdominal discomfort associated with flatulence or cramps. Nausea and vomiting have occasionally been reported after high doses. Some consider the taste to be unpleasant. Prolonged use or excessive dosage may result in diarrhoea with excessive loss of water and electrolytes, particularly potassium. Hypernatraemia has been reported.


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