Lactulose The physiological bowel and stool regulator

1. LACTULOSE
The physiological bowel and stool regulator
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2. “It is very tempting to have
a compound available,
which activates
physiological reactions
without producing any
harmful or toxic effects on
the host”
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3. CLASSIFICATION OF LAXATIVESCLASSIFICATION OF LAXATIVES
-L a e vo la c
-D u p h a la c
-L a c to g e r
O S M O T IC A G E N T S
-F ib e ra d
-A g io la x
D IE T A R Y F IB R E S /
B U L K F O R M IN G
-E n e m a s
S T O O L S O F T E N E R
-D u lc o la x
-S e n o k o t
-S k ila x
IR R IT A N T S /
S T IM U L A N T S
-P a ra ffin O il
-A g ro l
L U B R IC A T IN G
A G E N T S
-M ilk o f M a g n e s ia
S A L IN E
L A X A T IV E S
L A X A T IV E S
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4. The Lactose derived
from milk is
converted into
Lactulose (Lactulose)
by means of
isomerization. This
represents another
decisive advancement
in carbohydrate
research at Laevosan
(Fresenius).
LactuloseLactulose
®
Lactulose; An original osmotic laxative from AUSTRIA.
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5. LactuloseLactulose
Martindale,
The Extra Pharmacopoeia,
1993, 30th
Edition, P-887
Lactulose increases bulk formation and
stimulates peristalsis
Lactulose is broken down by colonic bacteria
mainly into lactic acid which exerts a local
osmotic effect in the colon resulting in increased
fecal bulk and stimulation of peristalsis.
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6. LactuloseLactulose
1994
Physicians General Rx, USA,
P II 1297
For the treatment of Chronic Constipation:
In patients with a history of chronic constipation,
lactulose syrup therapy increases the bowel
movements per day and the number of days on
which bowel movements can occur.
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7. LactuloseLactulose
Chemical Structure
Lactulose is a concentrate of
Lactulose. Besides 50% lactulose, the
syrup also contains small quantities of
lactose and galactose.
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8. LactuloseLactulose
Lactulose is a synthetic disaccharide
compound of two monosaccharides
fructose and galactose.
It does not occur naturally. Humans have
no enzymes which can degrade this
sugar. Thus after oral intake Lactulose
passes unchanged through the stomach
and small intestine.
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9. ROLE OFROLE OF LactuloseLactulose
Lactulose traps and bound ammonia in
the colon and excrete rapidly through its
acidic and osmotic actions.
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10. Actions of Lactulose
ACIDIC
•Decreases colonic pH
•Promotes Lactobacillus
Bifidus
•Induction of Eubiosis
•Shorten transit time
OSMOTIC
•Increases stool volume
•Soften the stool
•Facilitate defecation
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11. Effects of Lactulose
1. Eubiosis activator.
Increases Bifidobacteria and Lactobacilli &
inhibits the proliferation of anaerobic Gm-ve
proteolytic (putrefactive) bacteria.
2. Lowering of pH value (acidification of the
intestinal environment).
3. Increase of osmotic pressure in the colon.
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12. Lactulose – Mode of Action
Lactulose reaches the colon unchanged
Breakdown by saccharolytic bacteria into low-molecular acids
(mainly lactic acid)
Acidification of intestinal
Contents (mainly lactic acid)
Increase of the osmotic
pressure
Increase in
absorption of
phosphates
and mineral
salts
Inhibition of
growth of
putrefactive
bacteria
Eubiosis
Conversion of
ammonia into
the non-
absorbable
ammonium ion
Stimulation of
peristalsis
Softer
faeces
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13. LactuloseLactulose in PSEin PSE
 Inhibiting the formation of ammonia in
the gut and its absorption into the blood;
 Promoting the diffusion of ammonia from
the blood into the intestinal lumen;
 Accelerating the excretion of ammonia
with the stools.
In PSE, Lactulose reduces increased blood ammonia levels by:
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14. Lactulose reduces the pH-value in the colon
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15. Main Indications of Lactulose
The Problem
Hepatic Encephalopathy
The Problem
Constipation
The Solution
L A E V O L A C
•Colonic bacteria break down L. mainly
into lactic acids.
•These acids stimulate bowel movement
and set up local osmotic effect.
•Water is drawn into the intestinal lumen.
•Stool volume increases and this further
stimulates peristalsis.
•The soften stool then moves easily
through the bowel.
•Inhibits the formation of ammonia in
the gut and its absorption into the blood.
•Promotes the diffusion of ammonia
from the blood into the intestinal lumen.
•Accelerates the excretion of ammonia
with the stool.
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16. Advantages ofAdvantages of LactuloseLactulose
• Safe and simple oral treatment.
• Restores the natural balance of bacteria in the colon.
• No irritation of the intestine even with long term use.
• Non toxic and non habit-forming.
• Does not develop body tolerance; no need for increase of dose.
• No contraindications.
• Almost no side-effects.
• Liver-diseased patients can have a full diet as reduction of protein
intake is not necessary.
• Also applicable for problem patients:
-Pregnant women -Nursing mothers
-Geriatric patients -Children
-Patients operated recently
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17. Dosage ofDosage of LactuloseLactulose in PSEin PSE
Initial Dose
30-45 ml every 1-2 hours until a desired laxative
effect has been achieved.
Maintenance Dose
30-45 ml three or four times a day.
1 tablespoon = 15ml = 10gm.
1 teaspoon = 5ml = 3.3gm
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18. Lactulose vs Traditional Laxatives
Lactulose Traditional Laxatives
1. Non toxic.
2. Non habit forming.
3. Normalize intestinal flora.
4. Can safely be given in Pregnant,
Cardiac,Diabetic and elderly.
5. Safe even in long term use.
6. Does not cause electrolyte
imbalance.
7. Rare adverse effects like abdominal
pain, bloating, flatulence &
indigestion.
8. Very economical.
1. Hepato toxic.
2. Cause habituation.
3. No effect on intestinal flora.
4. Contraindicated in problematic
patients.
5. Serious side effects in long term
use.
6. May cause electrolyte imbalance.
7. These adverse effects are very
common with traditional laxatives.
8. Less economical.
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