In the colon, lactulose is broken down into organic acids of low molecular weight. These organic acids increase the osmotic pressure and acidify the colonic contents and ensure the formation of a soft stool.
As the pH of the colon content is significantly reduced, formation and absorption of ammonium and other nitrogenous toxic compounds into the portal circulation are markedly reduced. Moreover, blood ammonia is trapped into the colon due to the low pH. On the basis of these mechanisms, blood ammonia is rapidly decreased.
The lowered pH in the colon is an unfavourable environment for the Salmonella bacteria which leads to a reduction or disappearance of these bacteria.
Indications/Uses
Chronic constipation.
Portal hepatic encephalopathy, including the stages of hepatic pre-coma and coma.
Dosage/Direction for Use
Chronic Constipation: Duphalac initiates the return to a normal physiology of the colon. It may take up to 48 hrs before normal defaecation occurs. The total daily dose is taken preferably during breakfast. The dosage for constipation can be varied according to the individual response, but the following dosage scheme serves as a guide (see table).
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Dosage may be reduced if the desired effect is achieved. Portal Hepatic Encephalopathy: Initial Dose: 30-50 mL 3 times daily. Maintenance Dose: To be adjusted to the individual response, diarrhoea must be prevented. Adults: 10-25 mL. Children 7-14 years: 10 mL; 1-6 years: 5-10 mL. Infants: 5 mL. All doses are to be taken daily. Administration: May be taken with meals to reduce gastrointestinal discomfort. For constipation and the production of soft stools, preferably taken once during breakfast.
Contraindications
Since Duphalac also contains galactose and lactose, this should be contraindicated for patients on a galactose-free diet and with galactosemia.
Special Precautions
Duphalac should be used with caution in diabetics. Use in pregnancy: Although studies of Duphalac in laboratory animals have not shown a teratogenic effect, the use of this drug during pregnancy requires that the possible benefits outweigh the possible risks.
Use In Pregnancy & Lactation
Use in pregnancy: Although studies of Duphalac in laboratory animals have not shown a teratogenic effect, the use of this drug during pregnancy requires that the possible benefits outweigh the possible risks.
Adverse Reactions
During the first few days of treatment, meteorism and increased flatulence may occur. These symptoms usually disappear under continued therapy.
Diarrhoea may occur especially when using higher dosages. Dosage then should be adjusted to obtain 2-3 formed stools/day.
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