4-O-β-D-Galactopyranosyl-β-D-fructofuranose OR (2S,3R,4S,5R,6R)-2-((2R,3S,4S,5R)-4,5-Dihydroxy-2,5-bis(hydroxymethyl)tetrahydrofuran-3-yloxy)-6-(hydroxymethyl)tetrahydro-2H-pyran-3,4,5-triol
Lactulose is used in the treatment of chronic constipation in patients of all ages as a long-term treatment.[13] The dosage of lactulose for chronic idiopathic constipation is adjusted depending on the constipation severity and desired effect, from a mild stool softener to causing diarrhea. Lactulose is contraindicated in case ofgalactosemia, as most preparations contain the monosaccharide galactose due to its synthesis process.[14][15]
Lactulose is commonly prescribed for children who develop fear of their bowel movements and are withholders. This is because lactulose, when dosed in the proper amount, causes a bowel movement that is impossible to retain for very long. Lactulose is also used for the elderly because of its gentle and consistent results.[medical citation needed]
Lactulose is useful in treatinghyperammonemia (high blood ammonia), which can lead tohepatic encephalopathy. Lactulose helps trap theammonia (NH3) in the colon and bind to it.[16] It does this by using gut flora to acidify the colon, transforming the freely diffusible ammonia intoammonium ions (NH+ 4), which can no longer diffuse back into the blood.[17] It is also useful for preventing hyperammonemia caused as a side effect of administration ofvalproic acid.[18]
Lactulose is used as a test ofsmall intestine bacterial overgrowth (SIBO). Recently, the reliability of it for diagnosing SIBO has been seriously questioned.[19][20][21][22] A large amount of it is given with subsequent testing of molecularhydrogen gas in the breath. The test is positive if an increase in exhaled hydrogen occurs before that which would be expected by normal digestion by the normalgut flora in the colon. An earlier result has been hypothesized to indicate digestion occurring within the small intestine. An alternate explanation for differences in results is the variance in small bowel transit time among tested subjects.[22]
Common side effects of lactulose are abdominal cramping,borborygmus, andflatulence. In normal individuals, overdose is considered uncomfortable, but not life-threatening.[23] Uncommon side effects arenausea andvomiting. In sensitive individuals, such as the elderly or people with reducedkidney function, excess lactulose dosage can result indehydration and electrolyte disturbances such aslow magnesium levels. Ingestion of lactulose does not cause a weight gain because it is not digestible, with no nutritional value. Although lactulose is less likely to causedental caries than sucrose, as a sugar, a potential for this exists, which is relevant when taken by people with a high susceptibility to this condition.[citation needed]
Lactulose is not absorbed in thesmall intestine nor broken down by human enzymes, thus stays in the digestive bolus through most of its course, causing retention of water throughosmosis leading to softer, easier-to-pass stool. It has a secondary laxative effect in the colon, where it isfermented by thegut flora, producingmetabolites which have osmotic powers andperistalsis-stimulating effects (such asacetate), but alsomethane associated withflatulence.[citation needed]
Lactulose is metabolized in thecolon bybacterial flora into short-chain fatty acids, includinglactic acid andacetic acid. These partially dissociate, acidifying the colonic contents (increasing the H+ concentration in the gut).[17] This favors the formation of the nonabsorbableNH+ 4 from NH3, trapping NH3 in the colon and effectively reducing plasma NH3 concentrations. Lactulose is therefore effective in treating hepatic encephalopathy.[24] Specifically, it is effective as secondary prevention of hepatic encephalopathy in people with cirrhosis.[25] Moreover, research showed improved cognitive functions and health-related quality of life in people with cirrhosis with minimal hepatic encephalopathy treated with lactulose.[26]
Lactulose is adisaccharide formed from one molecule each of thesimple sugars (monosaccharides)glucose andgalactose. Lactulose is not normally present in raw milk, but is a product of heat processes:[27] the greater the heat, the greater amount of this substance (from 3.5 mg/L in low-temperaturepasteurized milk to 744 mg/L in in-container sterilized milk).[28]
Lactulose is produced commercially byisomerization oflactose. A variety of reaction conditions and catalysts can be used.[14]
Lactulose is available as ageneric medication.[4] It is available without prescription in most countries, but a prescription is required in the United States,[3] Philippines, and Austria.[citation needed]
In some countries where lactulose may be obtained without a prescription, lactulose is commonly used as afood additive to improve taste and promote intestinal transit.[citation needed]
^abKarwacki MW (2006)."Gastrointestinal Symptoms". In Goldman A, Hain R, Liben S (eds.).Oxford textbook of palliative care for children (2nd ed.). Oxford: Oxford University Press. p. 352.ISBN9780198526537.Archived from the original on 8 September 2017.
^abHogue VW, McKoy-Beach YB (2006)."Constipation and diarrhea". In Helms RA (ed.).Textbook of therapeutics : drug and disease management (8th ed.). Philadelphia, Pa. [u.a.]: Lippincott Williams & Wilkins. p. 1310.ISBN9780781757348.Archived from the original on 8 September 2017.
^abcdefgh"Lactulose". The American Society of Health-System Pharmacists.Archived from the original on 4 September 2017. Retrieved11 August 2015.
^abcHamilton RJ (2013)."Gastroenterology".Tarascon pocket pharmacopoeia : 2013 classic shirt-pocket edition (27th ed.). Burlington, Ma.: Jones & Bartlett Learning. p. 111.ISBN9781449665869.Archived from the original on 8 September 2017.
^World Health Organization (2023).The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023). Geneva: World Health Organization.hdl:10665/371090. WHO/MHP/HPS/EML/2023.02.
^"Lactulose".nih.gov.Archived from the original on 5 September 2015. Retrieved25 August 2015.
^abPanesar PS, Kumari S (1 November 2011). "Lactulose: production, purification and potential applications".Biotechnology Advances.29 (6):940–948.doi:10.1016/j.biotechadv.2011.08.008.PMID21856402.
^abYu D, Cheeseman F, Vanner S (March 2011). "Combined oro-caecal scintigraphy and lactulose hydrogen breath testing demonstrate that breath testing detects oro-caecal transit, not small intestinal bacterial overgrowth in patients with IBS".Gut.60 (3):334–340.doi:10.1136/gut.2009.205476.PMID21112950.S2CID6749287.
Definitions from Wiktionary
Media from Commons
News from Wikinews
Quotations from Wikiquote
Texts from Wikisource
Textbooks from Wikibooks
Resources from Wikiversity
