From the Guidelines
Lactulose is not always effective for constipation, and alternative treatments should be considered if it fails to improve symptoms.
Alternative Treatments
- Polyethylene glycol (PEG): an osmotic laxative that can be used as an alternative to lactulose, with studies showing its efficacy in improving stool consistency and frequency 1.
- Stimulant laxatives: such as bisacodyl, sodium picosulfate, and senna, which can be used to stimulate colonic motility and reduce colonic water absorption 1.
- Intestinal secretagogues: such as lubiprostone, which can stimulate fluid secretion into the intestinal lumen and improve constipation symptoms 1.
- Selective 5-HT agonists: such as prucalopride, which can activate 5-HT4 receptors and increase colonic motility 1.
Considerations
- Dose and administration: the dose of lactulose may need to be increased to 40 g (60 mL or 2-4 packets) daily if needed, but alternative treatments should be considered if symptoms persist 1.
- Side effects: lactulose can cause bloating, flatulence, and abdominal pain, which may limit its use in some patients 1.
- Patient assessment: the Bowel Function Index or Patient Assessment of Constipation Symptoms can be used to assess the severity of constipation symptoms and determine the need for alternative treatments 1.
From the FDA Drug Label
CLINICAL PHARMACOLOGY 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. The laxative action of the metabolites of lactulose then expels the trapped ammonium ion from the colon 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.
If lactulose is ineffective for constipation, alternative treatments should be considered. The FDA drug label does not provide information on what to do if lactulose is ineffective for constipation, but it does describe the mechanism of action of lactulose as a laxative, which may inform the choice of alternative treatments 2.
- No specific guidance is provided in the drug label for managing constipation that does not respond to lactulose.
- Adverse effects of lactulose, such as diarrhea, may be a concern if the dose is increased in an attempt to achieve a laxative effect 2.
From the Research
Alternative Treatments for Constipation
If lactulose is ineffective for constipation, there are alternative treatments available.
- Polyethylene glycol (PEG) is considered a more effective option in many instances, as stated in a literature review 3.
- Other treatments include dietary fiber, medicinal bulk, saline osmotic laxatives, and stimulants like senna or bisacodyl, as discussed in a review of current treatment options for chronic constipation 4.
Considerations for Treatment
When considering alternative treatments, it is essential to assess the patient's condition and medical history to determine the most suitable option.
- Non-pharmacological approaches to managing constipation should be addressed before considering laxative use, as recommended in the literature review 3.
- The choice of laxative depends on various factors, including the patient's condition, medical history, and potential contraindications, as discussed in the review of current treatment options for chronic constipation 4.
Additional Options
Other studies have investigated the effectiveness of different laxatives and treatments for constipation.
- A study comparing powder and liquid lactulose found that more patients preferred the taste, consistency, and portability of powder lactulose, although both forms were equally safe 5.
- An exploratory pilot study found that lactulose may be effective in improving defecation status in patients with Parkinson's disease, although further randomized controlled trials are needed to confirm these results 6.