syrup 10ml

7 cents

  • Constipation

  • Hepatic encephalopathy

PO:
Duphalac 10g/15ml
Store at room temperature


ADULT DOSE

PO:
Constipation
10-20ml 12-24 hourly.
Hepatic Coma
Hourly doses of 30-45 ml of lactulose may be used to induce the rapid laxation in the initial phase of the therapy of portal-systemic encephalopathy. When the laxative effect has been achieved, the dose of lactulose may then be reduced to the recommended daily dose of 30-45ml 3-4 times daily. Continuous long-term therapy is indicated to lessen the severity and prevent the recurrence of portal-systemic encephalopathy. The dose for this purpose is the same as the recommended daily dose.

PAEDIATRIC DOSE

PO:
Constipation
0.5mg/kg 12-24 hourly
Hepatic coma
1mg/kg hourly until bowel cleared then 1mg/kg 6-8 hourly

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY
Dose as in normal renal function

Lactulose is a synthetic disaccharide in solution form for oral administration. It is a colonic acidifier that promotes laxation. Lactulose causes a decrease in blood ammonia concentration and reduces the degree of portal systemic encephalopathy. These actions are considered to be results of the following: Bacterial degradation of lactulose in the colon acidifies the colonic contents. This acidification of colonic contents results in the retention of ammonia in the colon as the ammonium ion. Since the colonic contents are then more acid than the blood, ammonia can be expected to migrate from the blood into the colon to form the ammonium ion. The acid colonic contents convert NH3 to the ammonium ion (NH4)+, trapping it and preventing its absorption. The laxative action of the metabolites of lactulose then expels the trapped ammonium ion from the colon.

CONTRAINDICATIONS:

  • Mechanical bowel obstruction

  • Since lactulose contains galactose, it is contraindicated in patients who require a low galactose diet.


WARNINGS
Infants receiving lactulose may develop hyponatraemia and dehydration.

PRECAUTIONS
General
See WARNINGS and CONTRAINDICATIONS

Laboratory Tests:
No tests in addition to routine ICU tests are required

Drug/Laboratory Test Interactions:
None known

Other laxatives should not be used, especially during the initial phase of therapy for portal-systemic encephalopathy, because the loose stools resulting from their use may falsely suggest that adequate Lactulose dosage has been achieved.

Gastrointestinal:
Diarrhoea, nausea and vomiting, gaseous distention with flatulence or belching, abdominal discomfort
Metabolic:
Dehydration, hypokalaemia, hypernatraemia

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