Lactulose syrup for children and adults - instructions for use

• October 13, 2018
• Gastroenterology
• Svetlana Morozova

Sometimes a person may have problems with bowel movements. Moreover, the pathology concerns both adults and infants. With constipation, the psychological state is disturbed, the patient becomes irritable. But you don’t need to endure this condition, otherwise general health problems may arise, in particular, disturbances in the digestive system. Modern pharmacology offers a wide range of medications that can gently solve delicate pathologies. One of the most popular and safe is “Lactulose”, the instructions for use of which say that the drug helps to activate the growth of the intestinal’s own beneficial microflora.

Side effects from treatment

Lactulose is usually well tolerated by all patients. Reviews about the treatment are mostly positive, but there are also negative responses. Doctors recommend that if side effects occur, stop using the medicine and choose an analogue. Judging by the reviews, the main complaints of patients during therapy with Lactulose are the following:

• flatulence;
• feeling of nausea;
• decreased appetite;
• vomiting (occurs quite rarely);
• feeling of discomfort:
• aversion to food.

Judging by the reviews, usually the unpleasant phenomena disappear two hours after taking the drug and resume again after using the next dose. If your general health does not suffer and the symptoms of the disease disappear, then this is considered normal.

Reviews from patients and specialists

“Lactulose” has both positive and negative reviews. Recommended responses include:

• gentle and gentle effect on the body;
• quick elimination of the problem of constipation;
• efficiency combined with safety;
• possibility of using even newborn babies in therapy.

As patient reviews show, the drug does not cause negative consequences if used strictly as recommended by a doctor. There are no side effects or they are quite rare and go away on their own.

The authors of negative reviews focus on the weak effect on constipation and the complete lack of effectiveness of the prescribed treatment. Some note that the medication is not suitable, and multiple side effects develop. However, such responses are often found in those who prescribed the medicine themselves or significantly exceeded the recommended dosage.

The variety of responses about this drug speaks in favor of mandatory consultation with a doctor before taking any medication. “Lactulose” can help relieve constipation from intoxication, but it is important to evaluate the existing health problems as a whole.

Where is lactulose syrup used?

Detailed instructions for using lactulose syrup are contained in each package of the medicine. It should be carefully studied to understand how to treat certain ailments.

This drug is effective in treating the following diseases:

• Severe constipation;
• Hemorrhoids caused by difficulty defecating;
• Dysbacteriosis;
• Hepatic coma.

This remedy is actively used in preparation for various examinations of the gastrointestinal tract. If you need to cleanse the intestines without injuring the rectum, a regular enema cannot be used, but lactulose syrup does the job perfectly.

In medicine, non-invasive tests are actively used, the results of which are related to the patient’s use of this drug. In this way, a breath test with lactulose is performed, which allows you to assess the condition of the gastrointestinal tract and the balance of intestinal microflora.

This medicine is safe and does not cause addiction or serious negative consequences. Many doctors consider it most effective for constipation and accompanying hemorrhoids.

Due to swelling of the anus, prolapse of hemorrhoids and severe pain in this area, many patients cannot go to the toilet normally. Feces accumulate in the large intestine, putting pressure on its walls, aggravating the condition.

Taking lactulose syrup improves intestinal motility, dissolves its contents, makes stool soft, so that it comes out easily. This way accelerates the healing of hemorrhoids.

Interaction with other medications

When visiting a doctor, you must inform the specialist about all medications you have recently taken, even those sold in modern pharmacies without a prescription. The active component of Lactulose syrup lowers the pH level in the colon, which can significantly reduce the effect of medications, the release of which directly depends on biological parameters. "Lactulose" has a specific synergistic effect with neomycin during the treatment of diagnosed hepatic encephalopathy. Long-term use of syrup in large doses is fraught with a decrease in the total concentration of potassium in the blood serum, which may result in an increased effect of cardiac glycosides.

Lactulose syrup instructions

The instructions, as well as other information about the drug Lactulose, are printed on the paper that covers the bottle with the drug. The article, in addition to instructions, contains information about analogues, prices and reviews of Lacutlose syrup.

Form, composition, packaging

Lactulose comes in syrup form. The liquid is clear. Yellow color. The active component of the drug is supplemented only with water. In addition, they produce a version of the drug containing galactose and lactose in addition to lactulose itself.

The medicinal syrup is sold in bottles of 1000, 240, 200 or 15 milliliters.

Storage period and conditions

The drug Lactulose can be stored for at least two years in dark and cool rooms. Children are prohibited from accessing the drug.

Pharmacology

Lactulose qualifies as a drug that has a laxative effect that does not require large amounts of fluid intake.

Pharmacokinetics

Since lactulose is not broken down in the digestive tract, it moves on unhindered. Once in the large intestine, the active substance of the drug undergoes metabolism, resulting in the formation of organic low-molecular acids. They, in turn, ensure a decrease in the acidity of the environment with the subsequent removal of slag accumulations from the body, as well as acceleration of the transit of feces.

pharmachologic effect

A laxative that causes a change in the flora of the colon (an increase in the number of lactobacilli), which leads to an increase in acidity in the lumen of the colon and stimulates its peristalsis. Along with this, the volume increases and the stool softens. As a result, a laxative effect develops without directly affecting the mucous membrane and smooth muscles of the colon.

Under the influence of lactulose, ammonia is absorbed in the colon, the formation of nitrogen-containing toxic substances in its proximal section is reduced and, accordingly, their absorption into the vena cava system.

The drug has the ability to inhibit the growth of salmonella in the colon. Does not reduce the absorption of vitamins and is not addictive. Practically not absorbed from the intestines.

Instructions for use

It is usually recommended to give Lactulose to young patients once a day. The entire daily dose of syrup is given at one time, for example, after breakfast. It is recommended to give the product to infants before feeding, so that the baby does not refuse the syrup and regurgitate the drug. A measuring cup is used for dosing, and for the smallest children the medicine can be given from a syringe without a needle.

The duration of use of the medication is determined individually and can range from several weeks to 4 months. For babies in their first year of life, only 5 ml of medication per day is enough. Children 1-7 years old can also be given 5 ml of Lactulose, but it is acceptable to take 10 ml per day. Patients over 7 years old are given 10-15 ml of syrup per dose.

These are the average daily dosages of the medicine, but it is worth starting treatment with lower doses, for example, a 6-month-old baby with constipation can first be given only 1 ml of syrup. The next day, the single dose will be 2 ml and so on. Having determined the effective dosage, the drug is continued to be given in it.

Release forms

The medication can be found in pharmacies in two varieties:

• in the form of a yellow syrup, which can be purchased in bottles of different sizes: 15, 200, 240, 1000 ml;
• in tablets.

Lactulose preparations, regardless of the form of release, have the same active composition. Per 1 ml of syrup and 5 mg tablets there are 0.9 g of lactose and 1.65 g of galactose. This combination helps to quickly eliminate constipation and other digestive problems.

Reception scheme

For constipation, lactulose syrup is used symptomatically. The daily dose is 15-45 ml depending on the severity of the patient's condition. It must be drunk once or divided into two doses. It is advisable to use the medicine in the morning. It starts working within 10-15 minutes.

The patient feels the first urge to go to the toilet. We need to wait until they get stronger. For long-term treatment, it is necessary to take the medicine at the same time of day.

When treating constipation, it is important to ensure sufficient consumption of clean water - 1.5-2 liters per day. Thanks to this, therapy will be more effective

For hepatic coma, precoma, the drug is prescribed 3-4 times a day, 30-45 ml at regular intervals. Thanks to the medicine, toxins and harmful substances are naturally eliminated from the body.

Directions for use and dosage

The manufacturer recommends taking lactulose in the morning immediately before breakfast to start the digestive process and speed up natural bowel movements. Can be mixed with various liquids, such as juice. Prescribed mainly once a day, taking into account the age and health characteristics of the individual patient.

For adults

Lactulose Premium is prescribed to adults in various dosages depending on the type of disease.

So, we offer the following doses of lactulose:

• For constipation - from 15 to 45 ml per day. For severe or chronic constipation, the dose can be increased to 60 ml, but only after the doctor's permission. When the first positive symptoms appear, the dose is gradually reduced to the minimum.
• If liver function is impaired, 30 to 50 ml are prescribed two or three times a day. In this case, the maximum dose should not exceed 190 ml.
• If there are parasites and worms in the intestines, 15 ml is prescribed three times a day. Duration of treatment is up to two weeks. The dose can be increased to 20 ml. Take a week break and repeat the treatment.

For children

The drug contains only natural and safe ingredients, therefore it is allowed almost from the first days of the baby’s life, if there are no contraindications.

So, it is recommended to adhere to the following dosage:

• Lactulose syrup for newborns with constipation is prescribed 10 ml once a day. After the first positive symptoms appear, the dose is reduced to 5 ml per day.
• Children from 1 to 6 years old: 15 ml per day. To consolidate the effect, continue to take 10 ml per day.
• Children from 7 to 14 years old are allowed up to 30 ml per day. After obtaining a positive effect, the dose is reduced to 20 ml per day.

Usually the first positive effect occurs already on the third day after taking the drug. The duration of treatment is determined only by the doctor after making an accurate diagnosis.

During pregnancy and lactation

If there are no contraindications, then lactulose is safely prescribed during pregnancy. There were no recorded negative effects on the fetus. If you are breastfeeding, you should definitely consult your doctor. Lactulose can enter the baby's body through breast milk and cause various side effects, such as diarrhea.

Operating principle

Lactulose is a disaccharide that does not exist in nature, that is, it is obtained synthetically. Its laxative properties have been known for several decades and at the moment this substance is considered one of the most effective and safest agents with a laxative effect. For this reason, it is often added to food products (yogurt, milk, kefir, oatmeal) and even to infant formula.

Once in the small intestine, lactulose is not broken down or absorbed, so it is transported with food masses further into the large intestine, where it is used by bifidobacteria and other beneficial microbes as a substrate for their reproduction. Microorganisms convert this disaccharide into organic acids, which have osmotic activity.

It is thanks to this activity that water is retained in the intestinal lumen, which leads to an increase in the volume of feces and activation of peristalsis. The result of such changes will be stimulation of emptying. In this case, the effect of “Lactulose” appears 1-2 days after use, since it takes some time for the syrup to enter the intestines and be broken down by bacteria.

Lactulose for constipation

Severe constipation occurs in patients for a number of reasons. Often this condition is associated with a serious imbalance of microflora, due to which food is not digested properly. Poor nutrition can also lead to similar consequences. The stool becomes so dense that the intestines cannot push it out.

After taking a single dose of lactulose syrup, it enters unchanged into the small and large intestines, envelops its contents and gradually dissolves.

The feces increase in volume even more, but become softer. It puts pressure on the intestinal walls, irritating them. This starts the process of natural peristalsis. The patient feels a strong urge to go to the toilet and has a full bowel movement.

The advantage of lactulose is that it is not addictive, like other laxatives; the components of the composition do not enter the bloodstream and do not affect the systems and functions of the body.

Side effects

At the beginning of treatment, uncomfortable symptoms of gas formation and bloating in the abdomen may appear, which will disappear within a maximum of two days. In rare cases, the development of nausea and vomiting was observed, and there were also complaints of loss of appetite.

Overdose

An overdose of the drug can lead to diarrhea, which will not last more than two days and will stop on its own. Also, with excessive intake of lactulose, increased side effects were noted.

Drug interactions

When combining lactulose with an antibiotic, the effect of taking a laxative will be reduced.

Enteric-coated tablets, when taken together with lactulose, slow down the release of their active components, since this laxative helps to lower the pH of the intestinal microflora.

Additional instructions

When a patient has complaints of nausea, vomiting and abdominal pain until the diagnosis of his illness is confirmed, the drug should not be used.

The presence of gastrocardiac syndrome in a patient requires caution in the use of laxatives. It is advisable to carry out treatment starting with a small dosage with a gradual increase in order to prevent symptoms of flatulence

Also, caution will not hurt patients who suffer from diabetes mellitus, especially if the colon is affected by the inflammatory process. Long-term use of the drug requires regular monitoring of blood plasma levels: carbon dioxide/potassium/chlorine

Long-term use of the drug requires regular monitoring of blood plasma levels: carbon dioxide/potassium/chlorine.

If diarrhea develops during treatment, the drug should be discontinued.

special instructions

• Should not be used for abdominal pain, nausea, vomiting without verification of the diagnosis.
• Use with caution for gastrocardial syndrome. In such cases, treatment should begin with low doses and increase them gradually to avoid the development of flatulence.
• Use with caution in diabetes mellitus, especially with inflammatory lesions of the colon.
• During long-term treatment (more than 6 months), the levels of potassium, chlorine and carbon dioxide in the blood plasma should be regularly monitored.
• If diarrhea occurs, you should stop taking it.

Lactulose application

The method of using the original drug and its substitutes may differ slightly. That is why you need to carefully read the instructions before use. Reviews from doctors report that it is worth starting with the minimum dosage of the medicine. This will help you avoid the need to use large volumes of Lactulose and its analogues in the future.

The first time the drug is prescribed in a dosage of 15 to 190 milliliters per day. The composition is applied once. It is advisable to carry out the manipulation in the morning, during the first meal. Depending on the symptoms and nature of the pathology, the medication can be used either one-time or according to a schedule. The latter method is selected individually and depends on many factors.

How is the corrective agent “Lactulose” prescribed for children? For babies immediately after birth and up to 6 years of age, the composition is recommended in a dose of 5 to 10 milliliters. For older children, the medication is prescribed at a dose of 10-15 milliliters. The duration of use is determined by the doctor.

Tablet form

The drug is also available in the form of the usual round white pills. The medication can be prescribed to both adults and children. Lactulose tablets should be taken twice a day. To get rid of constipation problems, you need to take four pills with breakfast and four more with dinner.

This form is recommended for children from the age of five. In this case, two pieces are shown - one in the morning and one in the evening. Depending on the age of the patient and the severity of the pathology, the course of treatment can last from two to three weeks.

Lactulose instructions for use

Only a specialist should prescribe this drug for diseases of the gastrointestinal tract. The doctor is able to assess not only the degree of development of the pathology, take into account the general well-being of the patient, but also compare possible risks and compatibility with other medications. The substance can be used not only for medicinal purposes; the medication has proven itself well as prophylaxis and maintenance therapy. It is recommended to take the medicine once a day, preferably in the morning during breakfast. In this case, there are the following recommendations for the dosage of syrup:

• If you are concerned about constipation, then you can consume from 15 to 45 ml of the substance per day. The duration depends on the therapeutic effect, but treatment should last no more than three days. If the problem does not go away, then continue taking it three more times a week, but reducing the daily volume of the drug to 15 ml.
• When diagnosing hepatic encephalopathy, the daily dosage can reach 190 ml of syrup. However, in this case, the entire volume should be divided into several steps. Doctors usually recommend drinking 50 ml of the product three times a day.
• When a patient is diagnosed with salmonellosis, the single dosage of syrup should be 15 ml. The medicine is prescribed three times a day for ten days. This is followed by a seven-day break and the course is repeated.

These recommendations are oriented. The doctor can always make adjustments to the treatment regimen.

Possible replacement

Lactulose is not always effective in treating diseases of the gastrointestinal tract. Analogs that can replace it must have a similar effect. Among the many drugs that are highly effective are:

• "Lactuvit";
• "Depurax";
• "Duphalac";
• "Easy";
• "Normolatkt";
• "Diagnol";
• "Normaze";
• "Medulak";
• "Bioforlax".

Only the attending physician can select a worthy replacement and replace Lactulose in the absence of a therapeutic effect. Analogs are available in various forms. You can choose the drug in the form of a syrup, which is more suitable for children, or in the form of tablets, which are often preferred by adults.

Beneficial features

Lactulose has a wide range of beneficial properties. Instructions for use contain the following information:

• accelerates the removal of toxins from the small and large intestines;
• activates the liver;
• softens stool and helps relieve constipation;
• is an excellent prevention of stool problems;
• promotes the growth of its own bifidobacteria and lactobacilli and their development;
• improves the absorption of minerals and vitamins.

Experts emphasize that the drug “Lactulose” has very low absorption. In the instructions for use you can find information about the absorption of active components, the total of which is no more than 2%. Almost complete breakdown occurs in the large intestine, and metabolism occurs in the liver. Basically, after exposure to the body, the substance leaves unchanged.

Description

To combat constipation, pediatricians recommend using Lactulose syrup. In the instructions for use, the manufacturers described in detail all the properties of this medicine. The drug is based on a component that is a synthetic version of the disaccharide lactose. Such a substance is not found in nature, since it is synthesized in the pharmaceutical industry in order to be used in the future to combat various pathologies. In its original form, lactulose is an ordinary white powder, but for treatment it is used in the form of syrup.

In traditional medicine, Lactulose syrup is used to effectively combat severe constipation, as well as to restore the natural balance of microflora in the intestines. The instructions for use indicate that with the help of this medication you can carry out various diagnostic examinations of the body. A characteristic feature of lactulose is that there are no biological enzymes in the human body that could facilitate the digestion of this component. This means that the substance necessarily enters the intestines, where it begins to actively act.

What is lactulose

Lactulose belongs to the class of prebiotic substances, that is, it:

• is not broken down by digestive enzymes in the upper sections of the gastrointestinal tract (GIT),
• unchanged reaches the lower sections of the gastrointestinal tract (large intestine),
• selectively stimulates the growth and development of protective (beneficial) intestinal microflora bifidobacteria, lactobacilli, etc.

Lactulose consists of one molecule of galactose and one molecule of fructose connected by a b-glycosidic bond. The international non-proprietary name for lactulose is 4-0-?-galactopyranosyl-D-fructose. Gross formula: C 12 H 22 O 11. Molecular weight = 342.3

Lactulose is broken down by enzymes of intestinal microflora (bifidobacteria and lactobacilli) into organic acids: lactic acid, acetic acid, butyric acid, etc.

Medicinal action

The drug helps to increase lactobacilli in the human body.

Many years of practical research have proven that lactulose syrup has a series of health benefits:

1. Acts as a mild laxative. Through biochemical processes, lactulose causes fluid retention in the intestines, increasing the moisture and viscosity of feces and increasing their volume. Under the influence of the active substance, positive changes occur in the composition of the intestinal flora due to the intensification of the proliferation of bifidobacteria and lactobacilli, which break down carbohydrates. This leads to slight acidification of the feces, which stimulates intestinal motility (peristalsis). Compared to other laxatives that stimulate intestinal motility and stimulate chemoreceptors, lactulose syrup does not irritate the mucous membranes and muscle fibers. Therefore, the pharmacological product, when taken for a fairly long time (up to 4 months), does not cause addiction as quickly as other drugs, and does not lead to the appearance of “lazy bowel” syndrome.
2. Eliminates liver poisoning due to encephalopathy. Lactulose today is considered one of the most effective drugs in the treatment of hepatogenic encephalopathy. It lowers the level of ammonia in the blood, which is produced in the intestines as a product of putrefactive bacteria and, when it enters the brain, acts on it as a toxic substance. Lactulose syrup reduces the severity of liver and brain poisoning by toxins and reduces the neuropsychic manifestations of encephalopathy, improving the condition of patients and normalizing brain activity.
3. Has a prebiotic effect on the digestive organs. The therapeutic and preventive qualities of the syrup are explained by the ability of lactulose to reach the large intestine without being treated with enzymes. Here it selectively activates the growth of its own beneficial normal flora (lacto- and bifidobacteria), which has a positive effect on the body.
4. Supports anti-infective protection. The drug suppresses the aggression of many harmful microorganisms, including Shigella, Clostridia, Rotavirus, Yersinia, Salmonella, and various bacteroides. Increases the production of beneficial bacteria that produce enzymes that activate immune functions.
5. Removes poisons, bacterial toxins, enzymes and metabolites harmful to the body (intermediate substances during metabolic processes).
6. Stimulates the production of bile, improves the functioning of the liver and gallbladder.
7. Inhibits the growth and suppresses the activity of Salmonella (causative agent of intestinal infection).
8. Normalizes liver function in cirrhosis. The properties of lactulose to resist the aggression of viruses and pathogenic bacteria and suppress the activity of toxic substances that poison the liver provide an improvement in the condition of patients with cirrhosis of the liver. This occurs due to the activation of the intercellular component of the immune system, which is suppressed in cirrhosis.
9. Improves bone density in osteoporosis. The absorption of calcium in the small intestine increases with the use of lactulose due to improved solubility, without increasing the excretion of calcium in the urine. It helps strengthen bones in people susceptible to osteoporosis, including postmenopausal women. The speed and quality of bone tissue restoration after fractures also improves.
10. Provides protection of beneficial microflora from the effects of antibacterial medications.
11. Suppresses cancer processes. A number of studies prove the anticarcinogenic effect of lactulose, which is explained by the strengthening of protective functions through the activity of bifidobacteria.

The therapeutic effects of the syrup occur without leading to the absorption of minerals and vitamins from the digestive tract. The active substance practically does not enter the bloodstream and has no general effect on the body.

When to take

Lactulose is used for constipation in adults and children, as well as as part of complex therapy for pathologies of the digestive system. Medical indications for use include:

• dysbiosis with obvious signs of dyspepsia;
• malfunctions of the central uneven system due to liver failure;
• constipation of varying severity and the reasons that caused them;
• enteritis caused by increased activity of various pathogenic organisms, including salmonella;
• hyperammonemia;
• in the presence of anal fissures to facilitate defecation and prevent constipation;
• when diagnosing inflammation of hemorrhoids;
• putrefactive dyspepsia syndrome;
• to restore intestinal microflora after a course of radiation and chemotherapy.

The drug has a fairly gentle effect on the body, so it is prescribed even to newborn children, but you should not self-medicate; if problems occur in the digestive system, it is better to consult a doctor.

Choosing a laxative for babies

Constipation in children can occur for a variety of reasons. In addition to artificial feeding and taking antibiotics, such a reaction can be triggered by a change of environment or the process of potty training (psychological factor). You should not try old methods of relieving this condition in a child, for example, bars of soap or the tip of a thermometer lubricated with Vaseline. There are now safer ways to help your baby cope with constipation.

Lactulose-based laxatives have proven themselves to be the best. Studies have shown that the substance has a beneficial effect on the state of microflora not only in children, but also in adults, and does not cause discomfort in the stomach. The drugs improve motility and normalize the consistency of stool. Your doctor will help you choose the right safe remedy.

If children over 1 year of age suffer from constipation, you need to reconsider the diet and introduce more fiber and raw vegetables. Don't forget about the drinking regime. The liquid will soften the stool, which promotes regular bowel movements.

Analogs

The most famous analogue of "Lactulose" can be called the drug "". This is also a sweet syrup, which is sold in bottles of 200, 500 and 1000 ml, as well as in portioned sachets of 15 ml. The concentration of lactulose in this medicine is the same, and the indications for use, possible harm if the dose is exceeded, and side effects of Duphalac and Lactulose are the same.

Other lactulose-based drugs are no less popular, for example, “”, “Goodlak”, “Romphalak” and “Portalak”. All these medicines are also syrups and are used in the same situations as their analogues. In addition, they, like Lactulose, are also prescribed from birth.

There are also combination medications in which lactulose is only one of the components. For example, in the “” composition it is supplemented with hydrolytic lignin, a substance with enterosorbent properties. Such tablets are prescribed to children over one year old for dysbiosis, atopic dermatitis and other problems. They help get rid of bloating, bad breath and other uncomfortable symptoms.

In addition to products that contain lactulose, other medications can relieve constipation in children. These can be glycerin-based suppositories, which are called "". After introduction into the intestine, they cause a reflex activation of motility. In children's dosage, such suppositories are used from three months.

Another laxative drug with a physiological effect that is in demand in childhood is called “”. This powder contains macrogol, and after dilution, the solution can be given to children older than 6 months.

To learn what to do to prevent your child from becoming constipated, watch the following video.

Kefir with lactulose

During clinical examinations, it was revealed that the combined intake of kefir and lactulose increases the number of lactobacilli and bifidobacteria in the human body. If you take this remedy regularly, you may notice several beneficial changes:

• Suppression of pathogenic and conditionally pathogenic microflora.
• Minimize intestinal disorders.
• Eliminate constipation.
• Reduction of atopic dermatitis.
• Increased appetite.

For the purpose of prevention, it is recommended to take kefir containing lactulose for adults and children.

Lactulose for dysbiosis

Dysbacteriosis is a diagnosis that is not found in official medicine, but its manifestations are often found in young and adult patients. Various bacteria actively multiply in our intestines. Most of them are useful.

They form the human immune system and promote proper digestion of food. There is always a small amount of pathogenic microflora in the body; beneficial bacteria suppress it.

When there are fewer beneficial microorganisms than harmful ones, symptoms of dysbiosis appear:

1. Stool disorders;
2. Flatulence;
3. Bloating.

To cope with such symptoms, lactulose syrup is prescribed. This substance is food for beneficial microflora. With its help, it actively multiplies, suppressing pathogenic microorganisms. This is how balance is restored.

Benefits of lactulose

Why is the active substance of the described medicine and its analogues so useful? Lactulose is a unique component. It is not absorbed into the blood and, therefore, cannot affect human health. That is why it is prescribed even to newborn children and expectant mothers.

The drug and its analogues not only regulate the functioning of the digestive tract, but also affect its microflora. Thus, beneficial bacteria are able to bind to lactulose. This environment is favorable for them. The drug helps suppress pathogenic microflora, eliminating the processes of fermentation and decay. Only at the very first stages of correction can the opposite effect be observed.

The medicine is often prescribed to newborn babies who are bottle-fed. For such babies, the medication helps them quickly adapt to a selected diet and avoid digestive problems.

How to replace the composition

Like many other medications, the drug “Lactulose” has analogues. Among them are absolute substitutes that contain the same components. The patient may also prefer relative analogues. These are drugs in which a different active ingredient works, but the effect of correction is the same.

Medicines with an absolute match of the active substance can be distinguished as follows: “Laxilak” or “Livolyuk”, “Lactusan” or “Portolak”. One of the most popular substitutes is the drug Duphalac.

When it comes to relative analogues, the following compositions stand out: “Gutasil” or “Gutalax”, “Senade” or “Mikrolaks”. The most popular substitute for the original drug with a different active ingredient was the medicine “Glycelax” or “Glycerin suppositories”.

Contraindications and side effects of medications

The medicine "Lactulose" (syrup), analogues and absolute substitutes are not prescribed for individual sensitivity to the components. The medicine is also contraindicated for galactosemia.

In some cases, the use of the medication may be accompanied by increased gas formation, abdominal pain, nausea or vomiting. With excessive consumption and non-compliance with the prescribed dosage, there is a possibility of developing diarrhea. However, this symptom goes away on its own already on the second day of canceling the correction. If you develop an allergic reaction of any nature, you should consult a doctor.

Indications for use

Lactulose in syrup or tablets is recommended in the following cases:

• For constipation of various types. This can be either normal or chronic constipation.
• Hepatic encephalopathy and salmonellosis.
• For diseases of the central nervous system.
• In case of food or chemical poisoning.
• For intestinal dysbiosis.
• After long-term drug treatment to restore normal levels of beneficial bacteria in the stomach.
• After surgery, chemotherapy or radiation treatment.
• For complex treatment of hemorrhoids, which are accompanied by anal fissures.

Hydrogen breath test with Lactulose

If you have an allergic reaction to the main component - lactulose, then you may be prescribed a hydrogen breath test. The test is performed in this way, the patient exhales into a special device to collect air.

With such exhalation, experts determine the presence of hydrogen.

After this procedure, the patient is required to drink Lactulose in any form. After this, such samples should be taken after 20 minutes and repeated for about two hours.

With this procedure, 10 breath samples are obtained, transferred to the laboratory and the data is processed. The result of this procedure can be found out within 10 days after delivery.

Before starting the test, special preparation is required:

1. It is not recommended to take antibiotics in two weeks and during them;
2. The day before the examination, the following products should be excluded:

• Nuts;
• Legumes;
• Grain bread.

Smoking is prohibited. After the examination is completed, all prohibitions are lifted.

Use of lactulose in medicine

In the pharmacy chain you can find many drugs containing lactulose. Its use, like any medicine, must be justified by the needs of the body. Use for prevention by a healthy person is also permissible to improve immunity, but in courses, preferably in consultation with a doctor.

Indications

The drug is used to treat diseases of the gastrointestinal tract:

• constipation;
• disorder of the central nervous system due to liver failure (encephalopathy);
• food poisoning accompanied by putrefactive indigestion syndrome in children;
• dysbacteriosis of any etiology (cause);
• for the purpose of preventing dysbiosis and accelerating the restoration of normal flora after intestinal surgery, radiation or chemotherapy;
• for hemorrhoids and anal fissures to prevent constipation.

One of the most common drugs containing lactulose is Duphalac.
The drug is well tolerated by patients, but there are restrictions on its use.

Contraindications

You should not take a drug containing lactulose if you have hereditary intolerance (galactosemia). Also not prescribed for the following conditions:

• intestinal obstruction;
• appendicitis.

Use the drug with caution if adverse reactions occur:

• flatulence;
• bloating;
• nausea;
• vomit;
• diarrhea.

If these symptoms appear, further use of the prebiotic should be discontinued and replaced with other groups of drugs of similar effect.

Treatment and dosage of lactulose

• For constipation, 15 to 60 ml per day is prescribed; after the effect occurs, it is reduced to 10 ml per day according to a special regimen (no more than 3 times a week);
• for hepatic encephalopathy, the daily dose can be 190 ml of syrup;
• treatment of salmonellosis is carried out in two courses of 10 days with a break of 1 week. Take the drug 15 ml three times a day;
• treatment of salmonellosis carriage is a course of taking the drug 20 ml per day for up to 3 weeks.

Use in pediatrics

Taking the drug in childhood should be agreed with the pediatrician and depends on the age of the baby:

The best source of lactulose for a newborn baby is breast milk.

• from 0 to 12 months, treatment begins with 10 ml per day, followed by a decrease to 5;
• from 1 year to 6 years therapeutic dose 15 ml – maintenance 10;
• from 7 to 14 start with 25-30 ml and transfer to 20.

Use during pregnancy

During pregnancy, the dosage of the drug is selected by the doctor. It is not permissible to use products containing lactulose on your own.

Use for weight loss

The use of laxatives for the purpose of losing weight is not permissible. The drug has a cleansing effect when used correctly (however, this does not affect the reduction of fat deposits). Long-term use of laxatives leads to dehydration of the body and the removal of useful substances, including vitamins and minerals, which negatively affects the overall level of health.

Use for the purpose of losing weight can only be as an adjuvant for constipation caused by decreased food intake, for no more than 10-15 days.

Foods rich in lactulose

The following products can be used as a source of lactulose: dairy products, bananas, rye bran, cauliflower and broccoli, corn, beans, asparagus, garlic, onions, dried apricots and black currants.

"Lactulose" in pediatric practice

A fairly popular medicine that relieves constipation is Lactulose syrup for children. The instructions for use say that before offering the medicine to a child, it must be diluted in water, juice or mixture. The daily dosage specifically depends on the age of the baby:

• “Lactulose” for newborns, up to six months of age, is suggested at a rate of 5 ml per day;
• Children from six months to six years - up to 10 ml;
• From seven to fourteen years - if the disease is in an acute stage, then 15 ml per day is suggested; after the condition improves, the dosage is reduced to 10 ml.

The drug can also be used during pregnancy. However, the appointment must be justified by a specialist and the possible risks assessed. The fact is that excessive relaxation of the intestines and its active peristalsis can provoke a miscarriage.

Lactose and lactulose

Lactose and lactulose - what are the differences and similarities between these substances? Lactose, like lactulose, is a milk product, but it is a larger molecule that contains lactulose.

Lactose and lactulose are found in large quantities in milk

Lactose is milk sugar that is broken down in the body under the action of enzymes. With a lack of this enzyme and a large amount of milk entering the body, milk intolerance develops, resulting in diarrhea, bloating and pain in the intestines. In some diseases, an allergic reaction to lactose occurs, but lactulose is well tolerated by such patients.

Lactose gives energy to the body, stimulates the nervous system, and has a beneficial effect on the development of human intestinal microflora. Thanks to lactose, the body absorbs calcium well, improves the functioning of the heart muscle and the elasticity of the vascular wall. It also affects the production of vitamins B and C.

Lactose and lactulose are related substances that guard the human immune system and ensure the normal development of bifidobacteria and lactobacilli.

The lack of these substances leads to disruption of the gastrointestinal tract, promotes the formation of pathogenic microflora, and causes constipation.

Therefore, it is so important to monitor the balance of incoming food, and in case of failures, resort to the help of pharmacological drugs containing these substances

Why the body needs lactulose can be found in the video:

Adverse reactions

Numerous reviews from parents of young children have shown that Lactulose syrup is very effective in normalizing natural bowel movements in children. You can understand how to take this medication if you carefully study the instructions. The main adverse reactions include:

1. Weakness throughout the body.
2. Headache.
3. Allergic reactions.
4. Muscle pain.
5. Dizziness.
6. Heart rhythm disturbance.
7. Nausea.
8. Violation of water and electrolyte balance.

Qualified doctors categorically do not recommend self-medication, since only after a full examination of the body can the most appropriate course of treatment be selected. If at least one adverse reaction occurs, you must interrupt therapy and seek help at the hospital.

Are there any contraindications

If the level of galactose in the plasma increases, this leads to galactosemia. This disease is characterized by delays in physical and mental development. If this diagnosis is made, then Lactulose is a prohibited drug. In addition, there are other absolute contraindications:

• suspicion of appendicitis;
• tendency to allergies to the components of the product;
• intestinal obstruction;
• bleeding from the anus (hemorrhoids are not a contraindication);
• acute inflammatory processes in the abdominal cavity;
• lactase deficiency;
• hypersensitivity to the components of the drug.

Due to the fact that the patient is not always able to assess the degree of his health, Lactulose should only be prescribed by a doctor.

Directions for use and dosage

The doctor selects the dosage and course of treatment individually. The patient’s age, degree and period of the problem, and concomitant diseases are taken into account. It is recommended to take the drug once during breakfast. For a child, you can dissolve it in 100 ml of water or compote. Additional fluid intake during the day is not necessary. In general, the drug is well tolerated if prescribed; in rare cases, adverse reactions occur. If unexpected reactions occur or the expected effect does not occur, you should consult a doctor to adjust the prescription.

Summarizing

You have learned about an effective and efficient composition called Lactulose. Its analogues and substitutes are presented to your attention in the article. Certain formulations become an alternative in treatment when it is not possible to use the original drug. However, before such a replacement you should consult a specialist. After all, incorrect use of the medicine can lead to the development of side effects or worsening of the patient’s condition. Buy drugs and their substitutes only in specialized retail outlets, observe the terms and conditions of storage. Good health to you!

List of lactulose-based drugs

Lactulose is not contraindicated for children, but artificial flavors and additives included in the medicine can cause unwanted reactions in children.

Analogues and prices

Lactulose syrup is available in transparent bottles of 200 ml, 500 ml, 1000 ml. In the pharmacy chain the drug costs an average of 520 rubles. for 500 ml. The list of the most common drug analogues and their average prices can be found in the table.

Despite the similarity of the active substance included in the drugs, the choice of drug for the treatment of intestinal problems should be made only by a pediatrician. The doctor will make a prescription based on the child’s medical history, physical condition and tendency to allergies.

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Contraindications

To treat dysbiosis and constipation in infants, experts recommend using Lactulose syrup. Side effects occur in isolated cases. The deterioration in the health of a small patient may be due to the fact that before starting treatment, the patient’s parents did not study the instructions well. Lactulose syrup is prohibited in the following cases:

1. Galactosemia.
2. Intolerance to the components of the medication.
3. Suspicion of appendicitis, intestinal obstruction.
4. Rectal bleeding.
5. Acute lack of lactase in the body.
6. Glucose-galactose malabsorption.
7. Intolerance to galactose and fructose.

If a child has been diagnosed with diabetes, then the syrup can only be used under the supervision of a qualified physician.

Who should use the tablets?

Tablets "Poslabin lactulose", according to consumer reviews, are one of the most convenient dosage forms of laxative action. It is worth noting that if you have constipation, you should not self-prescribe treatment. Any health problems are a reason to seek help from a doctor.

For whom treatment with the drug is indicated:

• chronic constipation;
• severe liver pathologies with neuropsychic disorders;
• non-generalized form of salmonellosis;
• dysfunction of the digestive system - putrefactive processes, food intoxication.

Important! Lactulose is safe for women during pregnancy and lactation. It can be used to relieve symptoms in babies from 6 weeks. The drug is also prescribed after resection of hemorrhoids.

When diagnosing hepatic encephalopathy, with coma and lack of patient reactions, the dosage may differ significantly. The drug is prescribed 30-50 ml (three times a day). Volumes can be higher and reach 190 ml per day. In this case, lactulose does not always give the expected result and supplementation with Neomycin therapy is required.

You should not experiment with your health. Not all drugs are compatible and can be used for concomitant pathologies.

Lactulose

Lactulose

(lat.
lactulose
) - a laxative drug, prebiotic. Chemical Compound: 4-O-beta-D-Galactopyranosyl-D-fructose. The empirical formula is C12H22O11.

Lactulose - international nonproprietary name

(INN) of the drug. According to the pharmacological index, lactulose belongs to the group “Laxatives”. According to ATC, it belongs to the group “Osmotic laxatives” and has the code A06AD11.

Lactulose is an odorless white crystalline substance, highly soluble in water. It is a product of deep processing of milk and is made from the milk sugar lactose. Lactulose belongs to the class of oligosaccharides, a subclass of disaccharides: its molecule consists of galactose and fructose residues.

Lactulose is a prebiotic

, that is, she:

• is not broken down by digestive enzymes and is not absorbed in the stomach and small intestine and reaches the colon unchanged
• selectively stimulates the growth and development of colon microflora - bifidobacteria, lactobacilli and similar bacteria

Lactulose has an osmotic, laxative effect
, stimulates the proliferation of lactic acid bacteria and colon peristalsis. The microflora of the colon hydrolyzes lactulose to lactic acid (mainly) and partially to formic and acetic acids. At the same time, the osmotic pressure increases and the contents of the intestine are acidified, which leads to the retention of ammonium ions, migration of ammonia from the blood to the intestine and its ionization. Inhibits the formation and absorption of nitrogen-containing toxins in the proximal colon. Reduces the concentration of ammonium ions in the blood by 25–50% and reduces the severity of hepatogenic encephalopathy, improves mental state and normalizes the electrical activity of the brain (Instructions for use).

Lactulose is the only laxative

an effective and safe drug in all age groups, approved for use in
pediatric practice
. The most important feature of lactulose is its prebiotic effect. Prebiotics are partially or completely indigestible food components that selectively stimulate the growth and/or metabolism of one or more groups of microorganisms living in the large intestine, ensuring the normal composition of the intestinal microbiocenosis. From a biochemical point of view, this group of nutrients includes polysaccharides and some oligo- and disaccharides. For microorganisms, they are vital components of their nutrition, sources of energy and plastic material. The most well studied prebiotics are dietary fiber, oligosaccharides, lactose and lactulose. As a result of microbial metabolism of prebiotics in the colon, lactic acid, short-chain fatty acids, carbon dioxide, hydrogen, and water are formed. Carbon dioxide is largely converted into acetate, hydrogen is absorbed and excreted through the lungs, and organic acids are utilized by the macroorganism, and their importance for humans is difficult to overestimate. Lactulose, stimulating the growth of normal intestinal microflora, helps maintain anti-infective protection, in particular against Shigella, Salmonella, Yersinia and rotavirus. When artificially feeding children with a milk formula containing 1.2 g/100 kcal of lactulose with a lactose to protein ratio of 2.5:1, an almost pure culture of bifidobacteria is formed in the intestines, and the acidity of the intestinal contents decreases (Belmer S.V. et al.) .

The dose of lactulose is selected individually, starting with 5 ml once a day. If there is no effect, the dose is gradually increased (by 5 ml every 3-4 days) until the desired effect is obtained. Conventionally, the maximum dose in children under 5 years of age is 30 ml per day, in children 6–12 years of age - 40–50 ml per day, in children over 12 years of age and adults - 60 ml per day. The frequency of administration can be 1–2 (less often 3) times a day. A course of lactulose is prescribed for 1–2 months, and, if necessary, for a longer period. The drug is discontinued gradually under control of stool frequency and consistency (Belmer S.V. et al.).

Lactulose, due to its unique properties, is rightfully considered the gold standard of laxatives. It, like other osmotic drugs, is capable of retaining water in the intestinal lumen, proportional to the number of its molecules. Lactulose is not metabolized or absorbed in the small intestine because brush border enzymes cannot hydrolyze the bond between galactose and fructose molecules, and it reaches the colon virtually unchanged. Here, under the influence of bacterial enzymes, lactulose decomposes to form short-chain fatty acids (lactic, acetic, propionic and butyric). These organic acids may be absorbed or remain in the intestinal lumen. In the latter case, the pH decreases (increased stool acidity). Having pronounced osmotic activity, organic acids stimulate obligate excretion of water throughout the colon, which does not allow the mucous membrane to absorb the products of enzymatic decomposition of lactulose. As a result of the increase in intraluminal pressure caused by water retention and an increase in the volume of chyme, the peristaltic reflex is initiated and coordinated motor activity is stimulated, which leads to an acceleration of intestinal transit. An additional mechanism for stimulating peristalsis is an increase in the volume of intestinal contents due to an increase in the biomass of bifidobacteria and lactobacilli, the growth of which is stimulated by the products of enzymatic hydrolysis of lactulose. This phenomenon develops much later than the main effects, but makes a significant contribution to the development of the general laxative effect. Enzymatic processes lead to the formation of gas (10 g of lactulose - 1 liter of hydrogen and carbon dioxide), most of which is absorbed into the bloodstream and released with exhaled air. In some patients, the remaining gas may cause bloating. Flatulence is practically the only side effect of lactulose. In some patients, it can develop 3-4 days from the start of taking lactulose and, as a rule, goes away on its own. In persistent cases, the dose of lactulose should be reduced to eliminate flatulence. In order to prevent the development of flatulence, a gradual increase in the dose of lactulose from the minimum to the most effective can be recommended. It should also be remembered that exceeding the daily dose of lactulose (more than 100 g) can lead to severe diarrhea. Standard doses of lactulose have a mild laxative effect due to lower, in comparison with other laxatives of this class, osmotic activity and suppression of water reabsorption in the colon (Pasechnikov V.D.).

Unlike most laxative drugs, when taking laxatives with an osmotic effect (lactulose and macrogol), there is no irritation of the chemoreceptors of the mucous membrane and no damage to it, even with prolonged use of the drugs. The high effectiveness of lactulose and macrogol and the absence of serious adverse reactions make these drugs the most preferred laxatives

,
used in the treatment of chronic constipation (Roitberg G.E., Strutynsky A.V. Internal diseases. Digestive system. M.: MEDpress-inform, 2007).
Osmotic laxatives based on lactulose and macrogol are often considered as second-line drugs for the treatment of constipation of any type, which are recommended when non-medicinal methods and dietary fiber are ineffective (Shulpekova Yu.O.).

Due to the ability to bind water, the synthetic disaccharide lactulose, like other osmotic laxatives, increases the weight of stool, softens the consistency and accelerates the movement of chyme through the colon. However, lactulose induces gas formation and bloating

. Moreover, the intestinal microflora adapts to the daily intake of non-absorbable sugars. This circumstance reduces the effectiveness of lactulose during long-term treatment and also forces one to constantly increase its dose to achieve an effect (Makhov V.M., Beresneva L.A.).

short-chain fatty acid imbalance

in the colon: it stimulates the production of acetic acid to the detriment of butyric and propionic acid (Ardatskaya M.D.).

Lactulose is the drug of choice for the treatment of constipation in elderly patients.

30–100 ml/day. Its advantage is that it does not require additional fluid intake, is not addictive, is not absorbed (it can be prescribed for diabetes), does not cause electrolyte disturbances, and is effective for liver diseases (Zvenigorodskaya L.A., Samsonova N.G. .).

Professional medical publications

regarding the effects of
lactulose on the gastrointestinal tract
:

• Belmer S.V., Gasilina T.V., Khavkin A.I., Eiberman A.S. Functional disorders of the digestive system in children. M., RGMU, 2005.–36 p.
• Makhov V.M., Beresneva L.A. Systemic factors in chronic constipation // Attending physician. - 2005. - No. 2.
• Pasechnikov V.D. Functional constipation caused by slow transit of intestinal contents // Farmateka. - 2003. - No. 10. - p. 16–23.
• Sorvacheva T.N., Pashkevich V.V. Functional gastrointestinal disorders in infants: methods of correction. Attending doctor. - 2006, - No. 4, - p. 40-46.
• Zvenigorodskaya L.A., Samsonova N.G. Chronic ischemic disease of the digestive organs: clinical picture, diagnosis, treatment. Consilium-Medicum. —2008. —No. 2. General issues of gastroenterology.
• Babayan M.L. Application of lactulose in pediatric practice // RMZh. Mother and child. Pediatrics. 2011. No. 22. pp. 1380–1383.
• Ardatskaya M.D., Butorova L.I., Grigorieva Yu.V. et al. Clinical and metabolic effectiveness of lactitol in the treatment of chronic constipation (results of the non-interventional prospective observational program “Osmoaid”). Experimental and Clinical Gastroenterology 2018;150(2):149–160.

On the website GastroScan.ru in the “Literature” section there is a subsection “Laxatives”, containing publications for healthcare professionals regarding laxatives and their use.
Indications for use:

• chronic constipation
• hepatic encephalopathy
• salmonellosis, with the exception of generalized forms
• digestive disorders in infants and children under 10 years of age associated with putrefactive processes as a result of food poisoning

Mode of application:

• For adults.
  Adults are usually prescribed 1–3 tablespoons of syrup per day for 3 days as a laxative. Further, as part of maintenance therapy, take 2–5 teaspoons per day. For liver diseases - 2-3 tablespoons 3 times a day
• For children.
  1–3 teaspoons per day.

Interaction with other drugs:
antibiotics (neomycin) and non-absorbable antacids reduce the effect of lactulose. It is recommended not to take lactulose within 2 hours of taking another medicine.

Use of lactulose during pregnancy.

FDA Category of Fetal Risk for Lactulose in Pregnancy: B (Animal studies have not shown any risk of adverse effects of lactulose on the fetus; there have been no adequate studies in pregnant women).

Contraindications:

• hypersensitivity to lactulose
• galactosemia (hereditary disease characterized by the accumulation of galactose in the blood and retardation in physical and mental development)

Side effects.
When you first take lactulose in therapeutic doses, you may experience abdominal pain and flatulence, which usually disappear within two days after the first dose or with subsequent doses. Nausea, vomiting, and lack of appetite are occasionally observed. In case of overdose, diarrhea may occur, which requires complete discontinuation of the drug.

In case of overdose

Possible diarrhea and abdominal pain. In this case, taking the drug should be stopped.

Special instructions:

• lactulose is used with caution in patients with diabetes mellitus (especially in the treatment of hepatic encephalopathy) and with lactose intolerance
• If diarrhea occurs, stop taking lactulose
• for gastrocardial syndrome, doses are increased gradually to avoid flatulence; usually flatulence disappears on its own after 2-3 days of treatment
• It is unacceptable to prescribe lactulose for abdominal pain, nausea and vomiting
• When treated with higher doses for more than 6 months, it is necessary to regularly monitor the level of electrolytes in the serum
• If constipation does not resolve after taking lactulose for several days or constipation appears again after stopping the drug, you should consult a doctor

From the history.
The chemical structure and method of synthesis of lactulose (then called “lactoketose”) were described in 1929 by Montgomery and Hudson. In 1948, the Austrian pediatrician Petueli, figuring out the cause of dysbiosis in children fed artificially, isolated a substance from human milk that activated the growth of protective intestinal microflora (bifidobacteria and lactobacilli) and called it lactulose.

Trade names of medicines

,
in which lactulose is the active ingredient: Duphalac, Lactulose Poly, Lizalak, Normaze, Portlak, Romphalac.
As a prebiotic, lactulose is included in the following prebiotic products

: “Bio-Max” (milk, fermented milk products), baby milk with lactulose “Agusha”, “Ladybug” (fermented milk products), “For Health” (milk, fermented milk products), “Obninsky” (fermented milk products), “ Tallinn" (kefir).

In addition, lactulose is the basis of a number of dietary supplements

and is used in some medications as an excipient (Bifiform and others).

The following drugs containing lactulose are registered in the USA: Constulose, Kristalose, Chronulac, Cephulac, Constilac, Cholac, Duphalac, Evalose, Heptalac, Enulose, Generlac.

By Order of the Government of the Russian Federation of December 30, 2009 No. 2135-r, lactulose (syrup) is included in the List of vital and essential medicines. Back to section

Differences between analogues and drugs of similar action

Generics are often an alternative to expensive medications. They may differ slightly in composition and dosage from the original. Produced as dietary supplements and thereby bypassing a number of clinical trials, generics:

• favorable price,
• are rarely counterfeited, unlike the advertised original.

Most analogues are drugs with similar effects. To be true analogues, drugs must be 100% identical in composition, including the mass fractions of components.

The effect of generics with a similar effect is close to the effect of Duphalac. However, the production of alternatives often uses outdated equipment and raw materials of questionable quality. Because of this, the effectiveness of medicines may be reduced.

The differences between the originals and analogues of similar action are as follows:

1. Composition. The active ingredients of the drugs are the same. However, more expensive medications may additionally contain vitamins or substances that can minimize unpleasant symptoms. The concentration of the active ingredient in generics can be lower than in the original product.
2. Ease of use. As a rule, expensive drugs are produced in different forms. There are syrups, tablets, and solutions to choose from. Budget versions are often of the same form. In the case of laxatives, it is a powder. It is diluted before use, which many find inconvenient.

When planning to purchase an analogue instead of the original drug, you should:

• consult with your doctor, since doctors usually know all the properties of the original and generic,
• choose generics that have been produced for a long time and have proven themselves,
• buy the product in large, trusted pharmacies,
• give preference to medicines produced in countries where there is strict quality control of pharmaceutical products.

The United States, European Union countries, Japan, Canada, and Australia are known for the strictness of their legislation in the field of healthcare.

Description and mechanism of action of the drug

“Lactulose” is a synthetic prebiotic that is obtained through the process of deep processing of whey. It has a crystalline composition and is highly soluble in water. The molecular formula of the substance consists of fructose and galactose connected by a b-glycosidic bond. Lactulose was first isolated by the Austrian scientist Petueli in 1948, who with its help solved the problem of saturating the body of children on artificial nutrition with beneficial bifidobacteria.

Due to its structure, lactulose taken orally enters the large intestine unchanged and in quantity, after which it is broken down into low molecular weight organic acids: lactic, formic and acetic. Metabolic products help reduce pH levels, normalize acidity, stimulate the proliferation of bifidobacteria and lactobacilli, and suppress the development of pathogenic microorganisms.

Under the influence of the drug, fluid accumulates in the intestines, which is necessary to soften the stool. Increasing pressure on the walls of the intestinal tube helps to activate peristalsis and helps the gentle removal of toxins.

In modern pharmacology, “Lactulose” is produced in the form of a syrup of the same name. 100 g of the drug contains 66.7 g of active substance. Taking the drug does not cause discomfort to the newborn, as it does not require additional consumption of a large volume of liquid.

When does the therapeutic effect occur?

An osmotic laxative has a fairly rapid effect. Therefore, doctors often recommend starting with small doses of Lactulose. The syrup, instructions for which are included in each package, begins to act within the first day after administration (usually 6-12 hours). If an infant is undergoing treatment, the therapeutic effect may appear only on the second day.

To improve peristalsis and normalize the bowel movement process, it is mandatory to complete the full course. The drug is non-toxic, has a pleasant taste, is not absorbed into the blood and is not addictive.

Pharmacological group

Lactulose is a laxative that has an osmotic effect. During therapy, intestinal motility is stimulated, and the absorption of phosphates and calcium improves. The drug accelerates the excretion of ammonium ions.

Lactulose, under the influence of intestinal microflora, is broken down into low-molecular organic acids, as a result of which the pH decreases and the osmotic pressure increases, which leads to an increase in the volume of feces. All this leads to stimulation of intestinal motility and a change in stool consistency. With the help of the drug it is possible to restore the physiological rhythm of colon emptying.

In hepatic encephalopathy, precoma and coma, the effect of the drug is associated with the suppression of proteolytic bacteria and an increase in the number of acidophilic bacteria, for example, lactobacilli. Due to the intake of the drug, the contents of the intestine are acidified, and ammonia turns into an ionic form, the amount of nitrogen-containing toxic substances decreases, this is due to the stimulation of bacteria that utilize ammonia for bacterial protein synthesis.

Lactulose is a prebiotic substance. It promotes the growth of beneficial microorganisms, such as bifidobacteria and lactobacilli, and they, in turn, suppress the proliferation of potentially pathogenic bacteria: E. coli and clostridia.

The drug inhibits the growth and reproduction of Shigella and Salmonella, does not interfere with the absorption of vitamins, and is not addictive.

The therapeutic effect of the drug is observed 24-48 hours after taking it (the delay in the laxative effect of the drug is associated with its passage through the digestive tract).

The absorption of the drug is low, up to 3% of the dose taken is excreted by the kidneys. The active component reaches the colon, where it is broken down by microflora. The drug taken in a dosage of 40-75 ml is completely metabolized; in higher doses the drug is partially excreted unchanged in the bile.

Lactulose for weight loss

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Perhaps half of overweight people dream of a miracle diet that will help them lose 5 or even 10 extra pounds in a week. Nutritionists, hearing this, say: “Nonsense! This cannot be! But advertising promises something else. Most drugs that quickly get rid of excess weight work on the principle of a laxative. For this reason, lactulose is sometimes also used inappropriately. By consuming drugs based on this substance, obese people want to achieve a laxative effect and then see weight loss.

But a laxative, even the strongest one, has no effect on fat deposits. And false weight loss occurs only due to loss of moisture. Continuing this “weight loss” for several days, the only result that can be achieved for sure is dehydration and total leaching of nutrients from the body. And even the beneficial properties of lactulose will not save the situation.

But there are options when lactulose can actually be taken for weight loss. More precisely - as an auxiliary tool. When following a diet, especially if there are few foods rich in fiber in the diet, constipation often occurs. This is where lactulose comes to the rescue - it will help quickly remove waste products from the body, cleanse the intestines and take care of the correct microflora. As a result, this will affect your overall well-being, increase your tone and strengthen your immune system. This means you will have the strength to exercise, without which there will definitely be no effective weight loss.

Adverse deviations

Usually doctors focus on possible deviations. According to reviews of Poslabin lactulose, the first therapeutic doses of the drug can provoke abdominal cramps and excessive gas formation. Symptoms make themselves felt after a couple of months and persist thereafter.

Side effects may include:

• headache;
• nausea;
• bouts of vomiting;
• diarrhea;
• lack of appetite.

It is worth noting that such violations are observed in case of non-compliance with the dosage and when contraindications are not taken into account.

How does the medicine work?

The drug "Lactulose", analogs and substitutes for the drug are not able to be absorbed into the blood. This is all due to the fact that a person does not have an enzyme that digests the active substance. The drug works in the intestines. It increases the amount of feces and helps attract water.

As a result of this effect, there is increased pressure on the intestinal walls. The outcome of this algorithm is the appearance of the urge to defecate. It is worth noting that the effect of the drug and its substitutes does not occur instantly. Stool is observed only 6-8 hours after use.

Advantages and disadvantages of drugs with lactulose

Lactulose is suitable for long-term use, is not addictive and can be used not only as a laxative, but also as a prebiotic to treat intestinal dysbiosis or to treat hepatic encephalopathy (due to the reduction of ammonia production).

Over all the years of use of drugs in this group, no data have been obtained on the toxic, teratogenic, or carcinogenic effects of lactulose. The drugs are recognized as safe drugs.

Lactulose is not absorbed in the intestine, and its breakdown does not produce glucose. This is a significant plus for people with high blood sugar levels. Despite the sweet taste, drugs in this group do not increase sugar, and according to some clinical data, lactulose has some hypoglycemic effect.

How do drugs with lactulose “work” in the intestines?

Lactulose is a synthetic disaccharide consisting of galactose and fructose. Once inside the gastrointestinal tract, lactulose passes unchanged into the small intestine without being absorbed into it. And already in the large intestine the following mechanisms begin to take place:

• Increased osmotic pressure in the colon. Lactulose stimulates the proliferation of lactic acid bacteria, which break it down into lactic, formic, acetic acid, and fatty acids. This leads to an increase in osmotic pressure in the intestinal lumen. The consequence of this is the flow of more water into the intestines and an increase in the volume of feces. A larger volume of contents in the intestine creates pressure on the receptors, increasing peristalsis (wave-like contractions) of the intestine and leading to emptying. The osmotic effect is the predominant one among the combined mechanisms of action possessed by lactulose-based drugs.
• Restoration of microflora. Lactulose is a food substrate for beneficial lactic acid bacteria: bifidobacteria and lactobacilli. They feed on it, begin to grow actively, and the biomass of the intestinal microflora increases. This is important for intestinal dysbiosis, when the growth of beneficial bacteria is inhibited or completely absent.
• Acidification of colon contents and reduction of ammonia absorption. In a slightly alkaline environment, putrefactive bacteria actively multiply and release metabolic products harmful to the body: ammonia and ammonium ions. These products have a negative systemic effect on the entire body as a whole. Lactulose, due to its breakdown into fatty acids in the large intestine, changes the pH from slightly alkaline to slightly acidic. Acidification of the environment slows down the growth of putrefactive bacteria and reduces their production of ammonia.

Reception features

The lactulose-based medicine acts gently and slowly, the effect of taking it does not occur immediately, but by the end of the second day from the start of use.

Antibacterial and antacid agents may reduce the effect of lactulose. It is not recommended to drink a laxative within two hours of taking other medications. Concomitant use of drugs may lead to malabsorption.

In adults

• As a laxative, dosage for adults: 15 ml (1 tablespoon) 2 times a day. If the laxative effect does not develop within two days from the date of administration, the dose can be adjusted to 20 ml 2-3 times a day.
• As a corrector of intestinal flora, doses of lactulose are lower: from 5 ml to 10 ml (half or a whole dessert spoon) 1-2 times a day. The course of treatment is 2-4 weeks or more.

In children

• It is recommended to give infants lactulose in a dose of 5 ml (1 teaspoon per day), dividing it into 2 doses;
• children aged 1 to 5 years – 5-10 ml 2 times a day;
• over 6 years old 10-15 ml 1-2 times a day.

The choice of drug and the optimal dose are selected by the doctor, taking into account the patient’s age, the cause of the disease and individual characteristics.

Which medicine to choose

The listed drugs completely or mostly have the same composition, indications, contraindications, actions and side properties.

If the medicine contains any additional substances, including flavorings, the likelihood increases:

• development of allergic reactions in patients,
• occurrence of side effects.

Therefore, if a child or a pregnant woman needs help, it is advisable to choose the original laxative or its true analogues. These contain only the active ingredient and water. In other cases, the use of generics is allowed.

Analogues of Duphalac cannot be called medicines. There were no clinical trials. This means that laxatives are food additives. The products are used to maintain health. In the fight against pathologies, additives are an auxiliary element.

When choosing a laxative, it is worth remembering that in Duphalac, in addition to lactulose, only water is present. Analogs contain other components, including flavorings, that increase the risk of adverse or allergic reactions.

Preventing constipation in babies

The best prevention of difficulties with defecation in babies in the first year of life is natural feeding. Breast milk contains beneficial microorganisms, minerals and vitamins necessary for the growing body. During this period, a woman should eat properly and include as much fermented milk and plant products in her diet as possible. You can also additionally give your baby water in small quantities or children's tea based on chamomile and fennel.

In cases where only artificial feeding is possible, you need to carefully select the milk formula. It is advisable to be guided not by the recommendations of friends, but by the advice of a pediatrician. There is no need to change the formula frequently if the baby’s digestive system has adapted well to a particular product. Artificial babies must drink more fluids to avoid constipation.

Lactulose syrup (this is very important for children!) should be given only if there are severe signs of constipation. If the baby has not had a bowel movement for several days and does not feel discomfort, then it is worth holding off on taking the medicine.

Before giving your baby laxatives, you need to help him in more natural ways. Newborns are often placed on their tummy to better expel gases and start intestinal motility. You can also help with light circular stroking in the navel area and tucking the legs towards the tummy.

Reviews of lactulose syrup

Yana Kristaeva, 28 years old

“Due to frequent constipation, I faced the problem of hemorrhoids. The doctor talked about the relationship between these ailments, so now I carefully monitor the frequency of trips to the toilet. I try to defecate regularly and at the same time. If any difficulties arise, lactulose syrup is always in my medicine cabinet. I drink a single dose and after 10 minutes I rush to the toilet. The medicine has never failed. It is safe and soft. I have no adverse reactions.”

Roman Lisman, 42 years old

“I encountered the problem of constipation while traveling in Southern China. The local food was absolutely not suitable for me, which is why I had difficulties with the toilet. Fortunately, there were doctors with us in the delegation. I was advised to use lactulose syrup. It turned out that this is a very mild but effective laxative. The problem went away by itself, the feeling of heaviness disappeared, and there was no more churning in my stomach. Now I always take this product with me on long trips.”

Anna Romanenko, 39 years old

“I periodically treat myself with Lactulose syrup, and I also give it to my daughter when she becomes constipated. If earlier this problem was a weekly problem, now we have completely forgotten about it. My feeling of bloating and constant churning in my stomach disappeared. This product is absolutely safe, I am not afraid to give it to a 2-year-old child. The baby's taste preferences significantly expanded after starting to take lactulose. If previously feeding my daughter was a problem, now she eats everything and goes to the toilet like clockwork.”

What determines the level of lactulose in the body?

Lactulose is not a substance that the body can synthesize on its own. Therefore, the only source of prebiotics for humans is food and bioactive supplements. If we are not talking about the treatment of advanced chronic diseases, then to maintain a stable level of lactulose, a balanced, proper diet, with the consumption of foods rich in microelements, vitamins and other beneficial substances, is sufficient. In more complex cases, medications containing high concentrations of lactulose come to the rescue. But you shouldn't be afraid of these drugs. They cause virtually no side effects and are allowed even for infants.

Composition and effect of a laxative drug

The drug Lactulose is available in several varieties. The pharmacy offers to buy syrup and tablets. The medicine contains a special substance called lactulose, a white crystalline element. 1 ml of liquid mixture or 5 mg tablet contains 670 mg of lactulose.

A white, water-soluble lactose powder that is produced from milk. Once in the body, the substance does not break down on its own, because there are no special enzymes. It passes unchanged through the organs of the digestive tract.

After the element reaches the large intestine, the process of reproduction of beneficial bifidobacteria and lactic acid microorganisms for the microflora occurs. A natural preparation containing prebiotics has the following properties:

1. Normalization of metabolism by reducing harmful products in feces.
2. Improving the absorption of mineral elements in soft tissues.
3. Strengthening the bone system, which is necessary in childhood, during menopause, and for pregnant and lactating women.
4. Stimulating the liver by cleansing the body of ammonia products (putrefactive substances).
5. Slowing down the synthesis of secondary fatty amino acids, which are involved in the formation of stones in the biliary tract.
6. Prevention of cancer development.

The action of lactulose powder is aimed at treating difficult and infrequent bowel movements. Elderly people are at risk for constipation due to improper functioning of the body, insufficient chewing of food, and low physical activity.

Often, constipation occurs in infancy, when a small tummy begins to master the functioning of the gastrointestinal tract and various foods.

general characteristics

Lactulose is a prebiotic consisting of fructose and galactose molecules. The monosaccharide reaches the large intestine unchanged, where it is broken down into lactic, acetic and butyric acids, providing a breeding ground for lactobacilli and bifidobacteria.

When lactose (disaccharide) is processed in the body, lactulose is formed

If the body does not have enzymes that break down lactose, milk intolerance occurs. Lactulose is well tolerated by everyone and has no negative effects on the body.

Lactulose drug and release form

In medicine, lactulose occupies the niche of laxatives with a mild effect.

Available in the form of tablets or syrup. Suitable for use by newborns, pregnant women and the elderly. It has the appearance of a white crystalline substance, soluble in water without a distinct odor, obtained through deep processing of milk.

Food sources

The list of foods rich in lactulose does not only include dairy products. Although, of course, there are more substances in this category. So, to enrich the body with a useful prebiotic, it is important to pay attention to breast milk, natural yoghurts, cottage cheese, bananas and rye bran. Cauliflower, broccoli, asparagus, corn, beans and even onions or garlic can be used as sources of this beneficial substance. Sweet lovers can replenish their prebiotic reserves from dried apricots and black currants.

Prebiotic requirement

Lactulose can increase the concentration of beneficial bifidobacteria in the body by more than 10 times, and reduce the number of harmful microorganisms by almost a hundred times. But for this you need to consume foods or dietary supplements containing a prebiotic every day. As a result of the experiments, it was determined that 3-4 g of the substance is enough for adults to achieve the effect.

People with:

• chronic constipation;
• disruptions in the functioning of the gastrointestinal tract;
• pathogenic intestinal microflora;
• liver dysfunction;
• high cholesterol;
• improper metabolism.

Diabetes, high acidity in the stomach and low acidity in the intestines are good reasons not to abuse fermented milk products and other foods containing lactulose in high concentrations.

Side effects, overdose and precautions

Lactulose can cause side effects in a child:

• increased gas formation, bloating;
• regurgitation;
• stomach ache;
• decreased appetite;
• nausea, vomiting.

If flatulence occurs, the dose of the drug is reduced for several days to 1 ml. When the body gets used to the medicine, you can give the full dose.

If a child has diarrhea, most likely the recommended dosage of the drug was exceeded. Diarrhea goes away on its own some time after stopping or reducing the dose of the drug. If negative symptoms do not disappear, you should stop treatment and consult a specialist to change the drug. When using Lactulose simultaneously with antibiotics, you need to take into account that it reduces their effectiveness.

Lactulose is contraindicated in case of individual intolerance, rectal bleeding, colostomy, ileostomy, intestinal obstruction and galactosemia, that is, excessive accumulation of galactose in the blood. Also, the drug is not prescribed for suspected inflammation of the appendix. Lactulose is prescribed with caution to people suffering from diabetes and is taken under the mandatory supervision of a physician.

With long-term use - more than 6 months - you should constantly monitor the level of electrolytes in the blood serum. When the diagnosis is unclear, Lactulose cannot be taken; this can only harm the child’s body. If the medicine does not help within a few days, you should definitely consult a doctor (preferably a pediatric surgeon), who will determine the cause of constipation.

Analogs produced in other countries

There are dozens of imported drugs similar to Duphalac. Some funds are issued in the near abroad, others - beyond its borders.

Ukrainian analogues

All analogues produced by Ukrainian companies are allowed for use by pregnant and lactating women and children.

4 Ukrainian analogues of Duphalac are popular on the Russian market:

1. Bioflorax. Created on the basis of lactulose. The drug has a laxative effect and is prescribed for any conditions leading to defecation disorders.
2. Lactuvit. Also contains lactulose. The drug is classified as hypoammonemic. These are capable of changing the structure of feces and improving intestinal motility.
3. Depurax. Recommended for patients with defecation disorders. After using the drug, the physiological process of bowel movements is normalized. Syrup with lactulose is available in packaged form.
4. Normolakt. The composition is as similar as possible to Duphalac. Not only the active substance is identical, but also the additional ones. The syrup helps eliminate constipation and normalize the bowel movement process.

Ukrainian drugs compare favorably in price, costing 90-150 rubles.

Belarusian analogues

There are also generics of Duphalac among Belarusian drugs:

1. Silact. Recommended for patients with stool disorders and hepatic encephalopathy. The drug is available in syrup form.
2. Forject. It is a macrogol laxative. Ethylene glycol polymer replaces lactulose. Forject is used to eliminate systematic constipation in patients over 8 years of age. The medicine is not recommended to be taken during pregnancy and lactation.
3. Castor oil is the cheapest medicine with a laxative effect, but is prohibited for use by children and women during pregnancy. Also, castor oil should not be used for a long time.
4. Picolax. The main purpose is atonic constipation and the need to normalize intestinal motility. The product belongs to the category of laxatives. Release form: oral solution. Contraindications to the use of Picolax are disorders of the digestive system and the first two trimesters of pregnancy.

The cost of Belarusian-made laxatives ranges from 45 to 300 rubles.

Croatian analogues

Not long ago, a new Croatian-made laxative, Portalac, appeared in pharmacies. Answering the question, which is better, Portalac or Duphalac, doctors note:

• the preparations are 100 percent analogues, contain 67 grams of lactulose per 100 milliliters and water,
• being true analogues, and not just drugs with similar effects, Portalac and Duphalac have identical indications and contraindications.

Portalac or Duphalac are chosen based on the cost suitable for the patient. The price of the Croatian drug is in the range of 265-490 rubles. Sometimes the choice is influenced by the availability of one medicine and the absence of another in the pharmacy.

Other analogues

When choosing a laxative medicine, you should pay attention to imported analogues:

1. Legendal. In addition to lactulose and water, it contains citric acid and grapefruit flavoring. The drug is in granules. A solution for oral use is prepared from them. The contents of the package are diluted in water or juice and drunk immediately after meals. As a rule, the effect is observed after 12 hours. Legendal is prescribed not only for defecation disorders, but also for hepatic encephalopathy and the need for surgical intervention on the rectum or colon. It is not recommended to use the medicine for people with lactulose intolerance.
2. Lizalak. This analogue of Duphalac is powdery. You need to prepare a solution. Indications and contraindications are the same as for lactulose or drugs based on it.

You should consult your doctor before using any drug.

Frequently asked questions when using lactulose

Mostly, problems arise for those who decide to give lactulose-based syrup to their child for the first time. In such a situation, it is scary to harm the baby: it seems that the drug is harmless, but the constipation still does not go away. But don't panic if the medicine doesn't work within the first few hours.

The table below contains the most popular questions that new patients usually face. If you haven't found the answer you need, hurry up and contact the experts.

Usually, lactulose for constipation gives results quickly. If it is not there, this is a reason to be wary. Be sure to consult with your doctor, but do not panic ahead of time: lactulose is practically harmless if the patient does not have a hereditary intolerance to this disaccharide.

We recommend that you read the article “Bifidumbacterin for constipation.”