Lactulose

Lactulose
Clinical data
Pronunciation	/ˈlæktjʊloʊs/
Trade names	Cholac, Generlac, Consulose, others
Other names	4-O-β-D-Galactosyl-D-fructose
AHFS/Drugs.com	Monograph
MedlinePlus	a682338
Routes of; administration	By mouth
ATC code	A06AD11 (WHO) ;
Legal status
Legal status	UK: General sales list (GSL, OTC); US: ℞-only; In general: Over-the-counter (OTC);
Pharmacokinetic data
Bioavailability	Poorly absorbed
Metabolism	100% in colon by enteric bacteria
Onset of action	8 to 48 hours
Elimination half-life	1.7–2 hours
Excretion	Fecal
Identifiers
	IUPAC name 4-O-β-D-Galactopyranosyl-β-D-fructofuranose; OR; (2S,3R,4S,5R,6R)-2-((2R,3S,4S,5R)-4,5-Dihydroxy-2,5-bis(hydroxymethyl)tetrahydrofuran-3-yloxy)-6-(hydroxymethyl)tetrahydro-2H-pyran-3,4,5-triol;
CAS Number	4618-18-2 ;
PubChem CID	11333;
DrugBank	DB00581 ;
ChemSpider	10856 ;
UNII	9U7D5QH5AE;
KEGG	D00352 ;
ChEBI	CHEBI:6359 ;
ChEMBL	ChEMBL296306 ;
CompTox Dashboard (EPA)	DTXSID5045833 ;
ECHA InfoCard	100.022.752
Chemical and physical data
Formula	C12H22O11
Molar mass	342.297 g·mol−1
3D model (JSmol)	Interactive image;
	SMILES O[C@H]2[C@H](O[C@@H]1O[C@H](CO)[C@H](O)[C@H](O)[C@H]1O)[C@H](O[C@]2(O)CO)CO;
	InChI InChI=1S/C12H22O11/c13-1-4-6(16)7(17)8(18)11(21-4)22-9-5(2-14)23-12(20,3-15)10(9)19/h4-11,13-20H,1-3H2/t4-,5-,6+,7+,8-,9-,10+,11+,12-/m1/s1 ; Key:JCQLYHFGKNRPGE-FCVZTGTOSA-N ;
	(verify)

Lactulose is a non-absorbable sugar used in the treatment of constipation and hepatic encephalopathy.^[3]^[4] It is administered orally for constipation, and either orally or rectally for hepatic encephalopathy.^[3] It generally begins working after 8–12 hours, but may take up to 2 days to improve constipation.^[1]^[2]

Common side effects include abdominal bloating and cramps.^[3] A potential exists for electrolyte problems as a result of the diarrhea it produces.^[3] No evidence of harm to the fetus has been found when used during pregnancy.^[3] It is generally regarded as safe during breastfeeding.^[5] It is classified as an osmotic laxative.^[6]

Lactulose was first made in 1929, and has been used medically since the 1950s.^[7]^[8] Lactulose is made from the milk sugar lactose, which is composed of two simple sugars, galactose and glucose.^[9]^[3] It is on the World Health Organization's List of Essential Medicines.^[10] It is available as a generic medication.^[4] In 2021, it was the 265th most commonly prescribed medication in the United States, with more than 1 million prescriptions.^[11]^[12]

^ ^a ^b Karwacki MW (2006). "Gastrointestinal Symptoms". In Goldman A, Hain R, Liben S (eds.). Oxford textbook of palliative care for children (2nd ed.). Oxford: Oxford University Press. p. 352. ISBN 9780198526537. Archived from the original on 8 September 2017.
^ ^a ^b Hogue VW, McKoy-Beach YB (2006). "Constipation and diarrhea". In Helms RA (ed.). Textbook of therapeutics : drug and disease management (8th ed.). Philadelphia, Pa. [u.a.]: Lippincott Williams & Wilkins. p. 1310. ISBN 9780781757348. Archived from the original on 8 September 2017.
^ ^a ^b ^c ^d ^e ^f "Lactulose". The American Society of Health-System Pharmacists. Archived from the original on 4 September 2017. Retrieved 11 August 2015.
^ ^a ^b Hamilton RJ (2013). "Gastroenterology". Tarascon pocket pharmacopoeia : 2013 classic shirt-pocket edition (27th ed.). Burlington, Ma.: Jones & Bartlett Learning. p. 111. ISBN 9781449665869. Archived from the original on 8 September 2017.
^ Jones W (2013). Breastfeeding and Medication. Routledge. p. 127. ISBN 9781136178153. Archived from the original on 8 September 2017.
^ Papaconstantinou HT (2009). "Operative and Nonoperative Therapy for Chronic Constipation". In Whitlow CB, Beck DE, Margolin DA, Hicks TC (eds.). Improved Outcomes in Colon and Rectal Surgery. New York: Informa Healthcare. p. 366. doi:10.3109/9781420071535-36. ISBN 9781420071535. Archived from the original on 8 September 2017.
^ O'Brien J (2009). "Non-Enzymatic Degradation Pathways of Lactose and Their Significance in Dairy Products". In McSweeney PL, Fox PF (eds.). Advanced dairy chemistry (3rd ed.). New York: Springer-Verlag. p. 236. ISBN 9780387848655. Archived from the original on 8 September 2017.
^ Schumann C (November 2002). "Medical, nutritional and technological properties of lactulose. An update". European Journal of Nutrition. 41 (Suppl 1): I17–I25. doi:10.1007/s00394-002-1103-6. PMID 12420112. S2CID 20487660.
^ Kuntz HD (2008). Hepatology textbook and atlas : history, morphology, biochemistry, diagnostics, clinic, therapy (3rd ed.). Heidelberg: Springer. p. 887. ISBN 9783540768395. Archived from the original on 8 September 2017.
^ World Health Organization (2023). The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023). Geneva: World Health Organization. hdl:10665/371090. WHO/MHP/HPS/EML/2023.02.
^ "The Top 300 of 2021". ClinCalc. Archived from the original on 15 January 2024. Retrieved 14 January 2024.
^ "Lactulose - Drug Usage Statistics". ClinCalc. Retrieved 14 January 2024.

[Gold2006-1] Karwacki MW (2006). "Gastrointestinal Symptoms". In Goldman A, Hain R, Liben S (eds.). Oxford textbook of palliative care for children (2nd ed.). Oxford: Oxford University Press. p. 352. ISBN 9780198526537. Archived from the original on 8 September 2017.

[Helm2006-2] Hogue VW, McKoy-Beach YB (2006). "Constipation and diarrhea". In Helms RA (ed.). Textbook of therapeutics : drug and disease management (8th ed.). Philadelphia, Pa. [u.a.]: Lippincott Williams & Wilkins. p. 1310. ISBN 9780781757348. Archived from the original on 8 September 2017.

[AHFS2015-3] ^ ^a ^b ^c ^d ^e ^f "Lactulose". The American Society of Health-System Pharmacists. Archived from the original on 4 September 2017. Retrieved 11 August 2015.

[Ham2013-4] Hamilton RJ (2013). "Gastroenterology". Tarascon pocket pharmacopoeia : 2013 classic shirt-pocket edition (27th ed.). Burlington, Ma.: Jones & Bartlett Learning. p. 111. ISBN 9781449665869. Archived from the original on 8 September 2017.

[Jones2013-5] Jones W (2013). Breastfeeding and Medication. Routledge. p. 127. ISBN 9781136178153. Archived from the original on 8 September 2017.

[6] Papaconstantinou HT (2009). "Operative and Nonoperative Therapy for Chronic Constipation". In Whitlow CB, Beck DE, Margolin DA, Hicks TC (eds.). Improved Outcomes in Colon and Rectal Surgery. New York: Informa Healthcare. p. 366. doi:10.3109/9781420071535-36. ISBN 9781420071535. Archived from the original on 8 September 2017.

[7] O'Brien J (2009). "Non-Enzymatic Degradation Pathways of Lactose and Their Significance in Dairy Products". In McSweeney PL, Fox PF (eds.). Advanced dairy chemistry (3rd ed.). New York: Springer-Verlag. p. 236. ISBN 9780387848655. Archived from the original on 8 September 2017.

[8] Schumann C (November 2002). "Medical, nutritional and technological properties of lactulose. An update". European Journal of Nutrition. 41 (Suppl 1): I17–I25. doi:10.1007/s00394-002-1103-6. PMID 12420112. S2CID 20487660.

[9] Kuntz HD (2008). Hepatology textbook and atlas : history, morphology, biochemistry, diagnostics, clinic, therapy (3rd ed.). Heidelberg: Springer. p. 887. ISBN 9783540768395. Archived from the original on 8 September 2017.

[WHO23rd-10] World Health Organization (2023). The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023). Geneva: World Health Organization. hdl:10665/371090. WHO/MHP/HPS/EML/2023.02.

[11] "The Top 300 of 2021". ClinCalc. Archived from the original on 15 January 2024. Retrieved 14 January 2024.

[12] "Lactulose - Drug Usage Statistics". ClinCalc. Retrieved 14 January 2024.

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