The lactulose solution may be administered diluted or undiluted.
The posology should be adjusted according to the individual needs of the patient.
A single dose of lactulose should be swallowed in one and should not be kept in the mouth for an extended period of time.
In case of single daily dose, this should be taken at the same time, e.g. during breakfast. During the therapy with laxatives it is recommended to drink sufficient amounts of fluids (1.5 - 2 liters, equal to 6-8 glasses) during the day.
Dosing in constipation or where a soft stool is considered of medical benefit: Lactulose may be given as a single daily dose or in two divided doses, for lactulose (Duphalac/Duphalac Fruit) in bottles the measuring cup may be used.
After a few days the starting dosage may be adjusted to the maintenance dose based upon treatment response. Several days (2-3 days) of treatment may be needed before treatment effect occurs. See Table 1.
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Dosing in HE (for adults only): For oral administration: Starting dose: 3 to 4 times daily 20-30 g or 30-45 mL.
This dose may be adjusted to the maintenance dose to achieve 2 to 3 soft stools per day.
Pediatric population: The safety and efficacy in children (newborn to 18 years of age) with HE have not been established. No data are available.
Elderly patients and patients with renal or hepatic insufficiency: No special dosage recommendations exist, since systemic exposure to lactulose is negligible.