Lactulose Syrup

Lactulose Syrup – Full Introduction

Lactulose syrup is a synthetic disaccharide laxative primarily used in the treatment of constipation and hepatic encephalopathy. It works by drawing water into the bowel and altering gut flora, making stools softer and easier to pass.

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Drug Class

• Osmotic laxative

• Ammonia-reducing agent (in hepatic encephalopathy)

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Mechanism of Action

Lactulose is not absorbed in the small intestine. When it reaches the colon:

• It is metabolized by colonic bacteria into lactic acid and acetic acid

• These acids lower colonic pH

• Increased osmotic pressure draws water into the colon, softening stool

• In hepatic encephalopathy, acidic environment converts ammonia (NH₃) to ammonium (NH₄⁺), reducing ammonia absorption

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Therapeutic Uses

• Chronic constipation

• Hepatic encephalopathy (reduces blood ammonia levels)

• Constipation in pregnancy and elderly patients

• Post-operative constipation

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Benefits

• Safe for long-term use

• Non-habit forming

• Suitable for children, elderly, and pregnant women

• Improves mental status in hepatic encephalopathy

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Common Side Effects

• Flatulence

• Abdominal bloating

• Abdominal cramps

• Diarrhea (with high doses)

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Serious but Rare Side Effects

• Electrolyte imbalance (with prolonged excessive use)

• Dehydration (secondary to diarrhea)

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Contraindications & Precautions

• Intestinal obstruction

• Galactosemia

• Use with caution in diabetic patients (contains sugars)

• Adjust dose to avoid excessive diarrhea

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Dosage & Administration

• Constipation (adults): 15–30 mL once or twice daily

• Children: Dose adjusted according to age

• Hepatic encephalopathy: Higher divided doses as prescribed

• Can be taken with or without food

• Onset of action: 6–12 hours

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Conclusion

Lactulose syrup is a safe and effective osmotic laxative widely used for constipation and hepatic encephalopathy. Its dual action on bowel movement and ammonia reduction makes it especially valuable in liver disease management.