Dulphalac

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Indications And Clinical Uses: Relief of constipation, including chronic constipation.

Action And Clinical Pharmacology
Experimental data indicate that lactulose is not significantly absorbed in the small intestine and reaches the colon essentially unchanged. There it is metabolized by bacteria with the formation of low molecular weight acids that acidify the colonic contents. Less than 2% of lactulose is absorbed systemically.

Two mechanisms are believed to be involved in the laxative action of lactulose: 1) Metabolism of lactulose by bacteria results in reduced colonic pH, which stimulates peristalsis and decreases stool transit time. In turn, decreased water reabsorption from the feces further facilitates the passage of soft, well-formed stools. 2) Increased osmotic pressure of fecal material secondary to an increase in colonic organic acids results in accumulation of fluid from surrounding tissues, helping to soften stool mass.

This action takes place gradually, with increased stool volume and frequency normally observed within 24 to 48 hours.

Contra-Indications
Since lactulose crystals contain galactose and lactose, use is contraindicated in patients who require a low galactose diet.

Lactulose is contraindicated in cases of bowel obstruction.

Precautions: General
As with all laxatives, overuse or extended use may cause dependence for bowel function. No laxative should be taken for more than 1 week without the advice of a physician. No laxative should be used in the presence of abdominal pain, nausea, fever, or vomiting, as such symptoms may signal appendicitis or an inflamed bowel.

Lactulose crystals contain galactose and lactose and should be used with caution in diabetics.

Pregnancy: Animal studies have not revealed significant adverse effects. However, lactulose should not be taken by women who are pregnant, or planning to become pregnant, except on the advice of a physician.