Uses of Tulos: - Constipation - Hepatic encephalopathy Constipation, Hepatic encephalopathy Tulos is contraindicated in patients with galactosaemia and intestinal obstruction.

Osmotic purgatives

Lactulose is a synthetic disaccharide. Lactulose is metabolized in the colon by the saccharolytic bacteria, producing low molecular weight organic acids (mainly lactic acid), which lowers the pH of the colon contents, promote the retention of water by an osmotic effect; thus increasing peristaltic activity. Lactulose is minimally absorbed; therefore, the pharmacokinetics of the absorbed material are not relevant to the principal therapeutic action.

How to use Lactulose: Take this medicine in the dose and duration as advised by your doctor. Check the label for directions before use. Measure it with a measuring cup and take it by mouth. Shake well before use. Lactulose may be taken with or without food, but it is better to take it at a fixed time. Adult Dose: Constipation Solution: 15-30 mL (10-20 g) PO once daily; may be increased to 60 mL (40 g) once daily Portal Systemic Encephalopathy Prophylaxis 30-45 mL (20-30 g) PO q6-8hr, adjusted until 2-3 soft stools/day; if acute, may be given q1-2hr until 2-3 soft stools/day Treatment 20-30 g (30-45 mL) PO q1hr to induce rapid defecation; reduced to 20-30 g q6-8hr after defecation achieved; titrated to produce 2-3 soft stools/day Child Dose: Constipation 0.7-2 g/kg/day (1-3 mL/kg/day) PO in divided doses; not to exceed 40 g/day (60 mL/day) Portal Systemic Encephalopathy Prophylaxis Infants: 2.5-10 mL/day (1.7-6.67 g/day) PO in divided doses; titrated to produce 2-3 soft stools/day Children and adolescents: 40-90 mL/day (26.7-60 g/day) PO in divided doses; titrated to produce 2-3 soft stools/day

May prevent release of mesalazine in the colon. Decreased effect with oral neomycin, antacids.

Lactulose is contraindicated in patients with galactosaemia and intestinal obstruction.

Common - Abdominal pain - Nausea - Vomiting - Diarrhea Initial dosing may produce flatulence and intestinal cramps, which are usually transient. Excessive dosage can lead to diarrhoea, dehydration, nusea, vomiting, hypokalemia.

US FDA Pregnancy Category of Lactulose is B. Studies show that Lactulose has no adverse effects. Decisions regarding use during pregnancy and lactation must be made by registered physician.

Precaution: It should be used with caution in patients with lactose intolerance and diabetes. Lactation: Unknown whether drug is distributed into milk; use with caution

There have been no reports of accidental overdosage. In the event of acute overdosage it is expected that diarrhoea and abdominal cramps would be the major symptoms.

Keep in a dry place away from light and heat. Keep out of the reach of children.

Lactulose promotes peristalsis by producing an osmotic effect in the colon with resultant distention. In hepatic encephalopathy, it reduces absorption of ammonium ions and toxic nitrogenous compounds, resulting in reduced blood ammonia concentrations.