Treatment Basics

Lactulose & Hepatic Encephalopathy

Lactulose works by drawing water from your body into your colon, which softens stools and causes you to have more bowel movements. This helps lessen the absorption of toxins in your intestines and flush them out of your system. It also reduces the amount of ammonia in your blood by drawing the ammonia into the colon where it’s removed from the body via bowel movements.

What Should I Discuss with my Doctor Before Taking Lactulose?
How Should I Take Lactulose?
How Long Will I Need to Take Lactulose?
What are the Side Effects of Lactulose?
How Can I Manage the Side Effects of Lactulose?

What Should I Discuss with my Doctor Before Taking Lactulose?

To make sure you can safely take lactulose, tell your doctor:

  • What prescription and nonprescription medications you are taking, especially other laxatives (overuse of laxatives can cause dehydration). Include any products such as vitamins, minerals or other dietary supplements.
  • If you are pregnant, plan to become pregnant, or are breast-feeding.
  • If you have diabetes, as this medication may affect your blood glucose levels. Monitor your blood glucose levels carefully and share the results with your doctor. Your diabetes medication or diet may need to be adjusted.
  • If you need to have any type of intestinal test (like a colonoscopy) or surgery.

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How Should I Take Lactulose?

  • Lactulose comes as a very sweet liquid that you take by mouth.
  • Initial dose is usually 2 tablespoons (30 ml) taken 2-3 times a day. This dose may be increased to 3-4 times a day so that you produce 2-4 soft bowel movements daily. The dosage is based on your medical condition and your response to therapy. Your doctor will tell you exactly how much to take and how often.
  • Measure liquid medicine with a special dose-measuring spoon or cup, not a regular tablespoon. If you do not have a dose-measuring device, ask your pharmacist for one.
  • Some people find it difficult to tolerate the excessively sweet taste of lactulose. To improve the taste, you can mix your dose with one-half glass of water, milk, fruit juice or a soft dessert. To reduce the effects of gas produced by the lactulose, it may be preferable to avoid taking the lactulose at meal time.
  • If for some reason you cannot take lactulose by mouth, it can also be given as an enema. Mix the prescribed dose with 24 ounces of water or normal saline. Administer the solution rectally and keep it inside for 30-60 minutes as directed by your doctor. If you keep the liquid inside less than 30 minutes, repeat the dose unless directed otherwise.
  • If you forget a dose, take the missed dose as soon as you remember it. But, if it’s almost time for your next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for the missed one.
  • Keep the medication in the container it comes in, tightly closed. Store it at room temperature away from excess heat and moisture (not in the bathroom).
  • The liquid may become slightly darker in color, but this is harmless. However, do not use the medicine if it becomes very dark, or if it gets thicker or thinner in texture.

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How Long Will I Need to Take Lactulose?

Lactulose can be used long-term to reduce the risk of having Hepatic Encephalopathy recurrences. If you have cirrhosis and have had an episode of HE, maintenance therapy with lactulose and/or an antibiotic may be recommended. Your doctor will determine exactly how long and how much you need to take.

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What are the Side Effects of Lactulose?

  • Side effects may include:
    • Diarrhea
    • Nausea
    • Gas; feeling bloated
    • Abdominal discomfort
    • Dehydration (severe loss of water/fluids from your body)
  • Tell your doctor if any of these symptoms are severe or do not go away. Dehydration can actually trigger an Hepatic Encephalopathy recurrence.
  • If you have stomach pain, vomiting, muscle cramps, dizziness or weakness, stop taking the lactulose and call your doctor right away.
  • Although uncommon, if you should experience any signs of an allergic reaction like hives, difficulty breathing, swelling of your face, lips, tongue or throat seek emergency medical help.
  • The goal of treatment is to maximize benefits and minimize side effects. Communicating with your doctor is important so that he or she can determine the best dosage for you.

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How Can I Manage the Side Effects of Lactulose?

Diarrhea is a known side effect of lactulose –increased bowel movements are actually why it is effective in treating HE. But bowel movements don’t have to be increased to the point of uncomfortable diarrhea. The number of movements should be around 2-4 soft, controllable bowel movements per day. If you are having more bowel movements, you may be dehydrating yourself, and taking more lactulose than you need. Finding the right dose of the lactulose for yourself is the best way to manage the side effects of the medicine.

For more information about Lactulose side effects, consult your healthcare provider or call 1-800-GO-LIVER today.

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