Lactaid (Lactase Enzyme) Dosing
The standard dose of Lactaid is 9,000-10,000 FCC units (typically 3 chewable tablets) taken immediately before consuming lactose-containing foods or beverages. 1
Dosing Recommendations
- Take 3 chewable lactase tablets (approximately 9,900 FCC units total) immediately before consuming lactose-containing foods or beverages 1
- The enzyme must be taken with the first bite or sip of dairy products to be effective 1
- A single dose of this strength has been shown to significantly reduce breath hydrogen concentrations and symptoms (abdominal cramping, belching, flatulence, and diarrhea) after lactose challenge 1
When Lactase Supplementation Is Actually Needed
- Only patients consuming more than 280 ml (0.5 pints) of milk or dairy equivalent daily typically require lactase supplementation, as those consuming less generally tolerate this amount even with lactose intolerance 2, 3
- Most adults with lactose intolerance can tolerate 12-15 g of lactose (approximately 1 cup of milk) without symptoms or supplementation 4
Important Clinical Considerations
- Dietary modification should be the primary management approach, not enzyme supplementation 2, 3
- Lactase enzyme supplements may be helpful as an adjunct when dietary avoidance is impractical 5
- The degree of response varies significantly—in one study, 3 out of 24 subjects had minimal benefit from lactase supplementation despite the standard dose 1
- Yogurt and hard cheeses are generally well-tolerated without enzyme supplementation due to lower lactose content or beneficial bacteria 2, 3
Common Pitfalls to Avoid
- Don't prescribe lactase supplementation based solely on patient self-reports of lactose intolerance, as these correlate poorly with objective evidence of lactase deficiency 2, 3
- Rule out secondary causes of lactose intolerance (celiac disease, gastroenteritis, NSAID use, small bowel disease) before assuming primary lactase deficiency 2, 3
- Consider that at least 50% of patients with presumed lactose intolerance actually have broader FODMAP intolerance, which will not respond to lactase supplementation 2
- Medications containing lactose as an excipient typically contain less than 400 mg and rarely cause symptoms, so lactase supplementation for medications is usually unnecessary 2, 6, 7