laktulos

Lactulose, also known as laktulos in some languages, is a synthetic disaccharide used primarily as a laxative and in the management of hepatic encephalopathy. It consists of the sugars galactose and fructose. In the small intestine it is not absorbed; when it reaches the colon, resident bacteria ferment it to short-chain fatty acids, lowering colonic pH and increasing osmotic pressure. The lower pH converts ammonia (NH3) to ammonium (NH4+), reducing ammonia absorption and helping treat hepatic encephalopathy. As an osmotic laxative, lactulose increases stool water content and accelerates bowel movements.

Indications include chronic constipation and hepatic encephalopathy in patients with liver disease. It may also be used as an adjunct in bowel cleansing in some settings. Dosing is individualized: for constipation, typical starting doses are 15–30 mL per day (or 1–2 tablespoons), given in divided doses or once daily, adjusted to achieve about 2–3 soft stools per day. For hepatic encephalopathy, higher doses are used to produce 2–3 soft stools per day, titrated to clinical and ammonia level targets; the product can be taken orally or via feeding tube and is available as syrup or soluble powder.

Contraindications include intestinal obstruction, acute surgical abdomen, and galactosemia; hypersensitivity to lactulose is also a precaution. Cautions include dehydration, electrolyte disturbances, and diabetes due to the sugar content. Common adverse effects are bloating, gas, cramps, and diarrhea; long-term use may cause electrolyte imbalances and dehydration. Lactulose is generally considered safe during pregnancy; use in lactation should be guided by benefit and monitoring.