Names and pronunciation
(lak′tyoo-lose) Constulose, Enulose, Generlac, Kristalose
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Individual generic drug information
Extracted information for lactulose only.
(lak′tyoo-lose) Constulose, Enulose, Generlac, Kristalose
Source page 749
Func. class.: Laxative; ammonia detoxicant (hyperosmotic)
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Chem. class.: Lactose synthetic derivative
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Do not confuse: lactulose/lactose
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ACTION: Prevents absorption of ammonia in colon by acidifying stool; increases water, softens stool
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USES: Chronic constipation, portal- systemic encephalopathy (PSE) in patients with hepatic disease
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Extracted information for lactulose only.
CONTRAINDICATIONS: Hyper- sensitivity, low-galactose diet Precautions: Pregnancy, breastfeeding, geriatric patients, debilitated patients, diabetes mellitus
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SIDE EFFECTS GI: Nausea, vomiting, anorexia, abdom- inal cramps, diarrhea, flatulence, disten- tion, belching META: Hypernatremia, hypokalemia; hyperglycemia (diabetes) L
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INTERACTIONS • Do not use with other laxatives (hepatic encephalopathy) Decrease: lactulose effects—other oral antiinfectives, antacids Drug/Herb Increase: laxative action—flax, senna Drug/Lab Test Increase: blood glucose (diabetic patients) Decrease: blood ammonia
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Extracted information for lactulose only.
DOSAGE AND ROUTES Chronic constipation • Adult: PO 15-30 mL/day (10-20 g), may increase to 60 mL/day prn • Child: PO 1.5-3 mL/kg/day once or twice daily Hepatic encephalopathy • Adult: PO 30-45 mL (20-30 g) tid or qid until stools soft; RETENTION EN- EMA 300 mL (200 g) diluted • Child: PO (unlabeled) 40-90 mL/ day in 3-4 divided doses • Infant: PO (unlabeled) 2.5-10 mL/ day in divided doses
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Available forms: Oral sol 10 g/15 mL; packets 10, 20 g; rectal sol 10 g/15 mL
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Administer: PO route • With 8 oz fruit juice, water, milk to in- crease palatability of oral form; for rapid effect, give on empty stomach • Increased fluids to 2 L/day; do not give with other laxatives; if diarrhea occurs, reduce dosage • Kristalose: dissolve contents of packet/4 oz water Rectal route • Retention enema (no commercial product) by diluting 300 mL lactu- lose/700 mL of water; administer by rec- tal balloon catheter; retain for >30 min; if retained for <30 min, repeat
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Extracted information for lactulose only.
Assess: • Stool: amount, color, consistency, fre- quency, abdominal pain/distention, bowel sounds prior to use and after use • Cause of constipation; determine whether fluids, bulk, or exercise is miss- ing from lifestyle; use of constipating products • Hepatic encephalopathy: blood am monia level (15-45 mcg/dL or 35-65 umol/L is normal range); may decrease ammonia level by 25%-50%; monitor for clearing of confusion, lethargy, restless ness, irritability if portal-systemic enceph alopathy; monitor sodium in higher doses • Monitor sodium in higher levels • Blood, urine electrolytes if product used often; may cause diarrhea, hypoka- lemia, hyponatremia • I&O ratio to identify fluid loss, replace any loss • Cramping, rectal bleeding, nausea, vomiting; if these symptoms occur, prod uct should be discontinued
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Evaluate: • Therapeutic response: decreased con- stipation, decreased blood ammonia level, clearing of mental state
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • Not to use as a laxative long term, to use as prescribed • To dilute with water or fruit juice to counteract sweet taste • To store in cool environment; not to freeze • To take on an empty stomach for rapid action • To report diarrhea, number, amount, con- sistency of stools; may indicate overdose
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Extracted information for lactulose only.
PHARMACOKINETICS Metabolized in colon, excretion kidneys, unchanged, onset 1-2 days, peak unknown, duration unknown
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Filter the extracted dose blocks for this individual drug.
Chronic constipation
• Adult: PO 15-30 mL/day (10-20 g), may increase to 60 mL/day prn
Candidate age grouping · source page 749
Chronic constipation
• Child: PO 1.5-3 mL/kg/day once or twice daily Hepatic encephalopathy
Candidate age grouping · source page 749
Chronic constipation
• Adult: PO 30-45 mL (20-30 g) tid or qid until stools soft; RETENTION EN- EMA 300 mL (200 g) diluted
Candidate age grouping · source page 749
Chronic constipation
• Child: PO (unlabeled) 40-90 mL/ day in 3-4 divided doses
Candidate age grouping · source page 749
Chronic constipation
• Infant: PO (unlabeled) 2.5-10 mL/ day in divided doses
Candidate age grouping · source page 749