Lactulose causes a decrease in blood ammonia concentration and reduces the degree of portal-systemic encephalopathy. These actions are considered to be results of the following:
Bacterial degradation of lactulose in the colon acidifies the colonic contents.
This acidification of colonic contents results in the retention of ammonia in the colon as the ammonium ion. Since the colonic contents are then more acid than the blood, ammonia can be expected to migrate from the blood into the colon to form the ammonium ion.
The acid colonic contents convert NH3 to the ammonium ion (NH4)+, trapping it and preventing its absorption.
The laxative action of the metabolites of lactulose then expels the trapped ammonium ion from the colon.
Experimental data indicate that lactulose is poorly absorbed. Lactulose given orally to man and experimental animals resulted in only small amounts reaching the blood. Urinary excretion has been determined to be 3% or less and is essentially complete within 24 hours.
When incubated with extracts of human small intestinal mucosa, lactulose was not hydrolyzed during a 24-hour period and did not inhibit the activity of these extracts on lactose. Lactulose reaches the colon essentially unchanged. There it is metabolized by bacteria with the formation of low molecular weight acids that acidify the colon contents.
Avolac Solution 200 ml
Adults (including elderly): 3 tea spoonful or 15 ml twice daily
Children 5 to 10 years: 2 tea spoonful or 10 ml twice daily
Children under 5 years: 1 tea spoonful or 5 ml twice daily
Babies under 1 year: ½ tea spoonful or 2.5 ml twice daily (paediatric dose should be given after breakfast)
Each dose of Lactulose may, if necessary, be taken with water or fruit juices, usually once a day, preferably in the morning. If a dose is forgotten it should be taken as soon as one remembers up to 8 hours before bedtime. If later, wait for next scheduled dose (don’t double this dose). Don’t take at bedtime. Usual time lapse before drug works is 30 minutes to 3 hours.