Lactulose Drug Study

Generic Name:Lactulose(laktyoo-lose)
Brand Name:Cephulac,
Chronulac ,Movelax,Lilac
Classifications:gastrointestinal agent;
hyperosmotic laxative
Pregnancy Category:C
Availability
10 g/15 mL solution, syrup
Actions
Reduces blood ammonia; appears to involve metabolism of lactose to
organic acids by resident intestinal bacteria.
Therapeutic effects
Acidifies colon contents, which retards diffusion of nonionic ammonia (NH3)
from colon to blood while promoting its migration from blood to colon. In the
acidic colon, NH3 is converted to nonabsorbable ammonium ions (NH4) and
is then expelled in feces by laxative action. Decreased blood ammonia in a
patient with hepatic encephalopathy is marked by improved EEG patterns
and mental state (clearing of confusion, apathy, and irritation). Osmotic
effect of organic acids causes laxative action, which moves water from
plasma to intestines, softens stools, and stimulates peristalsis by pressure
from water content of stool.
Uses
Prevention and treatment of portal-systemic encephalopathy (PSE), including
stages of hepatic precoma and coma, and by prescription for relief of chronic
constipation.

Cautious use
Diabetes mellitus; concomitant use with electrocautery procedures
(proctoscopy, colonoscopy); older adult and debilitated patients; pediatric
use.

Route & dosage

Prevention and Treatment of Portal-Systemic Encephalopathy
adult:PO 3045 mL t.i.d. or q.i.d. adjusted to produce 23 soft stools/d
child/adolescent: PO 4090 mL/d in divided doses adjusted to produce 23
soft stools/d
infant: PO 2.510 mL/d in 34 divided doses adjusted to produce 23 soft
stools/d
Management of Acute Portal-Systemic Encephalopathy
adult: PO 3045 mL q12 h until laxation is achieved, then adjusted to
produce 23 soft stools/d.
Rectal 300 mL diluted with 700 mL water given via rectal balloon catheter,
and retained for 3060 min, may repeat in 46 h if necessary or until patient
can take PO
Chronic Constipation
adult:PO 3060 mL/d prn
child:PO 7.5 mL/d after breakfast
Administration
Oral

Give with fruit juice, water, or milk (if not contraindicated) to

increase palatability. Laxative effect is enhanced by taking with
ample liquids. Avoid meal times.

Rectal

Administer as a retention enema via a rectal balloon catheter. If

solution is evacuated too soon, instillation may be promptly

repeated.
Do not freeze. Avoid prolonged exposure to temperatures above
30C (86F) or to direct light. Normal darkening does not affect
action, but discard solution that is very dark or cloudy.

Adverse effects
GI:Flatulence,borborygmi,belching,abdominal cramps,pain,and distention
(initial dose);diarrhea (excessive dose); nausea, vomiting, colon
accumulation of hydrogen gas; hypernatremia.
Nursing implications

Assessment & Drug Effects

In children if the initial dose causes diarrhea, dosage is reduced

immediately. Discontinue if diarrhea persists.

Promote fluid intake (>=15002000 mL/d) during drug therapy for

constipation; older adults often self-limit liquids. Lactulose-induced

osmotic changes in the bowel support intestinal water loss and
potential hypernatremia. Discuss strategy with physician.
Patient & Family Education

Laxative action is not instituted until drug reaches the colon;

therefore, about 2448 h is needed.

Do not self-medicate with another laxative due to slow onset of drug

action.
Notify physician if diarrhea (i.e., more than 2 or 3 soft stools/d)

persists more than 2448 h. Diarrhea is a sign of overdosage. Dose

adjustment may be indicated.
Do not breast feed while taking this drug without consulting
physician.