Usage
- Lactitol is prescribed for the treatment of chronic idiopathic constipation (CIC) in adults and for the prevention and treatment of hepatic encephalopathy. It is also used off-label for constipation in children.
- Pharmacological classification: Osmotic laxative.
- Lactitol is a non-absorbable sugar alcohol. In the colon, it is fermented by bacteria into short-chain fatty acids, which increase osmotic pressure, drawing water into the colon. This softens the stool and increases stool volume, promoting bowel movements. In hepatic encephalopathy, lactitol lowers colonic pH, reducing ammonia absorption.
Alternate Names
- Lactitol monohydrate
- Importal
- Pizensy
How It Works
- Pharmacodynamics: Lactitol exerts an osmotic effect in the colon, increasing water content and stool volume, stimulating peristalsis, and facilitating bowel movements. In hepatic encephalopathy, it acidifies colonic contents, trapping ammonia and promoting its excretion.
- Pharmacokinetics: Lactitol is minimally absorbed systemically after oral administration. It reaches peak plasma concentration in approximately 3.6 hours. It is metabolized by colonic bacteria. Small amounts are excreted in urine.
- Mode of action: Osmotic effect, increasing intraluminal pressure. For hepatic encephalopathy, it decreases colonic pH, favoring conversion of ammonia (NH3) to ammonium (NH4+), thus reducing its absorption.
- Elimination pathways: Primarily eliminated in feces; minimal renal excretion.
Dosage
Standard Dosage
Adults:
- Chronic Idiopathic Constipation: 20 g orally once a day, preferably with meals. Reduce to 10 g once daily for persistent loose stools.
- Hepatic Encephalopathy (Off-label):
- Prevention: Initial: 0.5 g/kg/day in 2 divided doses; adjust dose to achieve 2 soft stools per day.
- Treatment: 0.5 g/kg/day in 4 divided doses; adjust to achieve 2 to 3 soft stools per day. For minimal hepatic encephalopathy, consider lower doses (0.3 g/kg once daily or 0.5 g/kg/day in 2 divided doses).
Children (off-label):
- Constipation: The mean dosage is 0.25 g/kg/day.
- Ages 1-6 years: 2.5 to 5 g per day.
- Ages 6-12 years: 5 to 10 g per day.
- Ages 12-16 years: 10 to 20 g per day.
- Children 2-6 years: 10 ml per day.
- Children over 6 years: 10-15 ml per day.
- Infants or breastfed babies: 5 ml per day.
- Pediatric safety considerations: Monitor for dehydration, electrolyte imbalances.
Special Cases:
- Elderly Patients: Refer to adult dosing.
- Patients with Renal Impairment: No special dosage adjustments are recommended.
- Patients with Hepatic Dysfunction: No special dosage adjustments are recommended for constipation. For hepatic encephalopathy, dosage adjustments may be necessary based on the severity of the condition.
- Patients with Comorbid Conditions: Individualized dosing is essential.
Clinical Use Cases
Dosage recommendations for specific medical settings like Intubation, Surgical Procedures, Mechanical Ventilation, Intensive Care Unit (ICU) Use, and Emergency Situations have not been specified in the provided information.
Dosage Adjustments
Dose adjustments may be necessary based on individual patient response and tolerability, including considerations for renal/hepatic dysfunction and other relevant factors.
Side Effects
Common Side Effects
- Upper respiratory tract infection
- Flatulence
- Diarrhea
- Abdominal distension
- Increased blood creatinine phosphokinase
- Increased blood pressure
- Nausea
- Vomiting
- Abdominal pain and cramps
- Indigestion
- Anal itching
Rare but Serious Side Effects
- Difficulty breathing or swallowing
- Fever
- Hives, itching, rash
- Reddening of the skin
- Swelling of the eyes, face, or inside of the nose
- Unusual tiredness or weakness
- Severe diarrhea
- Dehydration
- Electrolyte imbalances (hypokalemia, hypernatremia)
Long-Term Effects
- Potential for dependence with prolonged use.
Adverse Drug Reactions (ADR)
- Hypersensitivity reactions (rash, pruritus).
Contraindications
- Known or suspected mechanical gastrointestinal obstruction.
- Galactosemia.
- Appendicitis.
- Acute inflammatory bowel disease (ulcerative colitis, Crohn’s disease)
- Digestive perforation or risk of digestive perforation
- Painful abdominal syndromes of undetermined cause.
- Hypersensitivity to lactitol.
Drug Interactions
Lactitol can reduce the absorption of concomitantly administered oral medications. Administer oral medications at least 2 hours before or after lactitol. Some specific drug interactions include:
- Neomycin
- Digitalis glycosides
- Carbenoxolone
- Amphotericin B
- Corticosteroids
- Thiazide diuretics
Pregnancy and Breastfeeding
- Pregnancy: Insufficient data available to assess risks; use only if potential benefits outweigh potential risks. Animal studies did not reveal evidence of fetal harm.
- Breastfeeding: Unknown if lactitol is present in human milk; minimal systemic absorption suggests low risk to infant, but consider developmental and health benefits of breastfeeding along with the mother’s clinical need for lactitol and any potential adverse effects on the breastfed infant.
Drug Profile Summary
- Mechanism of Action: Osmotic laxative; increases stool water content and volume; acidifies colonic contents in hepatic encephalopathy, reducing ammonia absorption.
- Side Effects: Flatulence, diarrhea, abdominal distension, nausea, and vomiting. Rarely, hypersensitivity reactions.
- Contraindications: Gastrointestinal obstruction, galactosemia.
- Drug Interactions: May reduce the absorption of other oral medications.
- Pregnancy & Breastfeeding: Insufficient data in pregnancy; use with caution. Minimal absorption suggests low risk during breastfeeding.
- Dosage: Constipation: Adults: 20g daily, reduce to 10g if loose stools persist. Hepatic Encephalopathy: 0.5g/kg/day, adjust based on response.
- Monitoring Parameters: Monitor bowel movements, electrolyte levels, and hydration status.
Popular Combinations
No specific popular drug combinations have been identified in the provided information.
Precautions
- Pre-existing gastrointestinal disorders, electrolyte imbalances, and dehydration.
- Pregnant Women: Assess risks and benefits.
- Breastfeeding Mothers: Monitor infant.
- Children & Elderly: Adjust dose accordingly.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Lactitol?
A: For adults with chronic idiopathic constipation, the recommended starting dose is 20 g orally once daily, reduced to 10 g/day if loose stools persist. For hepatic encephalopathy, the starting dose is 0.5 g/kg/day, adjusted based on the individual patient response. Pediatric dosing should be individualized based on weight and age.
Q2: How does Lactitol work?
A: Lactitol is an osmotic laxative, drawing water into the colon to soften stool and promote bowel movements. It also lowers colonic pH, reducing ammonia absorption in hepatic encephalopathy.
Q3: What are the common side effects of Lactitol?
A: Common side effects include flatulence, diarrhea, abdominal distension, nausea, and vomiting.
Q4: Is Lactitol safe during pregnancy and breastfeeding?
A: There is limited data on the use of Lactitol during pregnancy. Consult a doctor before use. While minimal amounts are systemically absorbed, it is unknown if there is a risk to a breastfeeding infant. Discuss the risks and benefits with your doctor.
Q5: What are the contraindications for Lactitol?
A: Lactitol is contraindicated in patients with gastrointestinal obstruction, galactosemia, or hypersensitivity to lactitol.
Q6: How should Lactitol be administered?
A: Lactitol is administered orally, typically once a day, preferably with meals. The powder form should be dissolved in water or other beverages.
Q7: Can Lactitol interact with other medications?
A: Lactitol can potentially reduce the absorption of other oral medications. Administer other oral medications at least two hours before or after lactitol. Consult a doctor about potential drug interactions.
Q8: What should I monitor in patients taking Lactitol?
A: Monitor patients for bowel movement frequency, consistency, and any signs of dehydration or electrolyte imbalances. Also monitor for abdominal discomfort or any adverse effects.
Q9: What is the difference between Lactitol and Lactulose?
A: Both are osmotic laxatives, but Lactitol is generally better tolerated, more palatable, and has a more predictable cathartic activity compared to Lactulose.
Q10: Can Lactitol be used long-term?
A: While Lactitol can be used for extended periods, it is generally recommended for short-term use in chronic constipation. Prolonged use may lead to dependence. For hepatic encephalopathy, long-term use may be necessary. Always consult a doctor before prolonged use.
