Generic Name: Lactulose

Brand Name: Duphalac

Classifications: Laxative, Ammonia reduction agent
Mechanism of Action: The drug passes unchanged into the colon where bacteria break it down to organic acids that
increase the osmotic pressure in the colon and slightly acidify the colonic contents, resulting in an increase in stool
water content, stool softening, laxative action, and migration of blood ammonia into the colon contents with
subsequent trapping and expulsion in the feces.
Indications: Treatment of constipation, Prevention and treatment of portal-systemic encephalopathy
Contraindications: allergy to lactulose, low-galactose diet, Use cautiously with diabetes and lactation. Pregnancy
Category C.
Adverse Drug Reactions: GI: Transient flatulence, distension, intestinal cramps, belching, diarrhea, nausea;
Hematologic: Acid---base imbalances
Dosage: 30---45 ml tid or qid. Adjust dosage every day or two to produce 2---3 soft stools/day. 30---45 ml/h may be
used if necessary. Return to standard dose as soon as possible.
Nursing Responsibilities:
1. Assess for Allergy to lactulose, low-galactose diet, diabetes, lactation.
2. Do not freeze laxative form. Extremely dark or cloudy syrup may be unsafe; do not use.
3. Give laxative syrup orally with fruit juice, water or milk to increase palatability.
4. Monitor for adverse drug effects. Report diarrhea, severe belching, abdominal fullness.
5. Do not administer other laxatives while using lactulose.
6. Monitor serum ammonia levels.
7. The following side effects may occur: abdominal fullness, flatulence, belching.
8. Assure ready access to bathroom; bowel movements will be increased to 2-3 per day.