Symptomatic treatment of constipation and hepatic encephalopathy.
Composition:
5 ml of solution contains 3.335 g of lactulose.
Action:
In the colon, Lactulose is degraded by the bacterial flora to low molecular weight organic acids. These acids cause a decrease in pH in the lumen of the colon, and through osmotic effects - an increase in the volume of content contained in it. These actions stimulate colonic peristalsis and lead to the restoration of normal stool consistency. Constipation subsides and the physiological rhythm of the colon is restored. In the case of hepatic encephalopathy, the effect of the drug was attributed to inhibition of the growth of the bacterial population due to the increase of acidophilic bacteria (eg lactobacilli), conversion of ammonia to ionized form due to acidification of colonic contents, purge due to low pH in the colon, as well as osmotic and change in bacterial nitrogen metabolism by stimulating bacteria to use ammonia for the synthesis of bacterial proteins. In this context, however, it should be remembered that the presence of only hyperammonaemia alone is not sufficient to explain the neuropsychiatric symptoms of hepatic encephalopathy. Ammonia may, however, be a reference compound for other nitrogenous substances. Lactulose is only absorbed to a small extent after oral administration and reaches the colon unchanged, where it is metabolized by the bacterial flora. It is completely metabolised at doses of 40-75 ml; after a higher dose, a certain amount of the drug may be excreted unchanged.
Contraindications:
Hypersensitivity to any of the ingredients. Galactosemia. Organic inflammatory bowel diseases (ulcerative colitis and rectum, Crohn's disease), gastrointestinal obstruction or post-traumatic syndrome, painful abdominal symptoms with an undetermined cause.
Precautions:
Long-term use of the preparation is not recommended otherwise than under medical supervision. A medical consultation is recommended if there is insufficient therapeutic effect after a few days of use. The dose usually used to treat constipation should not be a problem for people with diabetes; the energy value of 30 ml is 116 kJ (28 kcal), and is unlikely to adversely affect the course of diabetes. The dose used to treat hepatic coma or pre-coma is generally much higher and should be taken into account in people with diabetes. The preparation should be administered with caution to patients with lactose intolerance. In children, laxatives should be used in exceptional cases and under the supervision of a physician. It should be taken into account that defecation reflex may occur during treatment. Because lactulose-induced diarrhea can lead to electrolyte imbalance, the drug should be used with caution in patients susceptible to electrolyte disturbances (eg patients with impaired renal or hepatic function, patients receiving diuretic therapy at the same time). Due to the content of lactose, galactose and small amounts of fructose, the preparation should not be used in patients with rare hereditary diseases: galactose or fructose intolerance, Lapp lactase deficiency or poor glucose-galactose absorption.
Pregnancy and lactation:
The use of lactulose during pregnancy and lactation may be considered if deemed necessary. The drug can be used during breastfeeding.
Side effects:
You may experience bloating, abdominal pain, nausea and vomiting. if too high doses are used - diarrhea. In the case of long-term use of high doses (only in the treatment of portal-shaped encephalopathy), the patient may experience electrolyte imbalance due to diarrhea.
Dosage:
Orally. Dosage should be adjusted individually.Constipation. Adults and adolescents (≥ 15 years): starting dose 15-45 ml per day, maintenance dose 10-25 ml per day; children (7-14 years): initial dose 15 ml per day, maintenance dose 10 ml per day; children (1-6 years): initial dose 5-10 ml per day, maintenance dose 5-10 ml per day; infants (under 1 year): initial dose 2.5-5 ml per day, maintenance dose 2.5-5 ml per day. The drug can be used in a single daily dose or in two divided doses using a measuring tape. After a few days, the starting dose can be adjusted to the maintenance dose based on the response you receive.The healing effect may occur after a few days (2-3 days) of treatment.Hepatic encephalopathy (only in adults): starting dose 30-50 ml 3 times a day. This dose can be modified to a maintenance dose to get 2 to 3 soft stools daily. The lactulose solution can be administered diluted or undiluted. For one daily dose, it should be taken at the same time, eg during breakfast. The single dose should be swallowed without too much holding in the mouth.
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