Lactulose

Lactulose is a osmotic laxative medicine available in Bangladesh under many brand names. Below are its uses, side effects and precautions — and every brand with its current price.

Lactulose is indicated for:

• Chronic constipation — softening stool and restoring a regular, comfortable bowel habit
• Constipation in pregnancy, children and the elderly — chosen for its gentle action and minimal absorption
• Conditions needing soft stools — such as haemorrhoids (piles), anal fissure, or after ano-rectal surgery
• Hepatic encephalopathy — higher, doctor-titrated doses to lower blood ammonia in advanced liver disease

A registered doctor should confirm the cause of constipation first, particularly if it is new, severe or accompanied by warning symptoms.

Side effects of Lactulose are usually mild and often settle as the gut adjusts:

• Common, especially at the start: bloating, gas (flatulence), abdominal cramps, gurgling
• With higher doses: diarrhoea, nausea, vomiting
• With prolonged excessive dosing: dehydration and electrolyte disturbance (low potassium and sodium)

If diarrhoea develops, the dose is too high — reduce it and consult your doctor. Seek medical advice for persistent vomiting, signs of dehydration such as dizziness and reduced urination, or if constipation does not improve after several days of proper use.

Precautions for Lactulose use:

• Diabetes: standard constipation doses contain little absorbable sugar, but high encephalopathy doses need medical supervision in diabetics
• Lactose intolerance: preparations contain small amounts of related sugars — discuss if you are severely intolerant
• Combine with adequate fluids, fibre-containing food and physical activity for lasting benefit
• New constipation in older adults, blood in stool, weight loss or alternating bowel habit should be investigated before long-term laxative use
• Long-term use is generally considered acceptable when supervised by a doctor — review periodically rather than continuing indefinitely on your own

Lactulose has few important drug interactions:

• Other laxatives: combining them during encephalopathy treatment can mask the stool response doctors use to titrate the dose
• Antacids: may reduce the colonic acidification needed for the ammonia-lowering effect in liver patients
• Antibiotics (e.g. neomycin, rifaximin): alter gut bacteria; doctors account for this in liver disease, where the drugs are sometimes used together deliberately
• Diuretics and corticosteroids: lactulose-induced diarrhoea can add to potassium loss — relevant for heart patients on digoxin

Mention all your medicines to your doctor, particularly if you have liver or heart disease.

Lactulose should not be used in:

• Known hypersensitivity to lactulose or any component of the
• Galactosaemia — a rare inherited disorder of galactose metabolism
• Intestinal obstruction, digestive perforation or risk of perforation, and acute inflammatory bowel emergencies
• Undiagnosed acute abdominal pain — the cause must be established first

Use cautiously in severe lactose intolerance and in patients who cannot tolerate extra fluid shifts. When in doubt, confirm suitability with a registered doctor before starting.

Pregnancy: Lactulose is barely absorbed from the gut, and it is widely regarded as one of the laxatives of choice for constipation in pregnancy when fibre and fluids are not enough. Use the recommended dose, and inform your antenatal doctor that you are taking it.

Lactation: Because absorption into the mother's bloodstream is negligible, no meaningful amount reaches breast milk, and lactulose is generally considered compatible with breastfeeding. As with any medicine in nursing mothers, prefer the lowest effective dose and consult a doctor if constipation persists despite treatment.

Store below 30°C in a dry place away from direct sunlight; do not refrigerate or freeze, as cold can thicken or crystallise the syrup. Keep the bottle tightly closed and use within the period stated on the label after opening. Slight darkening of colour can occur over time. Keep out of the reach and sight of children, and do not use after the expiry date.