Dutiful Relief: Duphalac for Gentle Constipation Management
Duphalac (lactulose) is a first-line osmotic laxative prescribed for the effective and predictable treatment of chronic and occasional constipation. Its mechanism of action is distinct and physiological, working by drawing water into the bowel to soften stools and stimulate natural peristalsis. As a non-absorbable disaccharide, it offers a favorable safety profile, making it suitable for long-term management across diverse patient demographics, including the elderly, children, and pregnant women under medical guidance. Its secondary use in hepatic encephalopathy for reducing blood ammonia levels further underscores its therapeutic versatility and established efficacy in clinical practice.
Features
- Active Pharmaceutical Ingredient: Lactulose (a synthetic disaccharide derivative of lactose).
- Pharmacotherapeutic Group: Osmotic laxative, Ammonia detoxicant (A06AD11).
- Available Formulations: Oral solution and syrup, typically at a concentration of 3.35-3.75 g/5ml.
- Mechanism of Action: Functions as an osmotic agent, drawing water into the colon lumen; fermented by colonic bacteria into low molecular weight acids.
- Prescription Status: Available both as a prescription and over-the-counter (OTC) medication, depending on regional regulations.
- Onset of Action: Full effect typically observed within 24-48 hours, though initial bowel movement may occur sooner.
Benefits
- Provides predictable and reliable relief from constipation by softening stools and promoting comfortable, natural bowel movements.
- Supports the restoration and maintenance of healthy colonic flora by acting as a prebiotic, promoting the growth of beneficial bacteria like Bifidobacteria and Lactobacilli.
- Offers a high degree of safety for long-term use without causing tolerance or dependency, unlike stimulant laxatives.
- Suitable for a wide range of patients, including infants, children, the elderly, and pregnant or breastfeeding women (under medical supervision).
- Serves a dual therapeutic purpose by effectively managing hepatic encephalopathy through the reduction of blood ammonia levels.
- Works in a physiological manner, mimicking the body’s natural processes for bowel regulation.
Common use
Duphalac is primarily indicated for the treatment of constipation, whether chronic or occasional. It is employed in situations where dietary and lifestyle modifications have proven insufficient. Its action is particularly valued in patient populations where gentle and predictable bowel regulation is paramount, such as in post-operative care, for patients with hemorrhoids or anal fissures exacerbated by hard stools, and in the elderly where bowel motility is often reduced. A significant secondary indication is the treatment and prevention of portal-systemic encephalopathy (hepatic encephalopathy), a serious complication of liver disease. In this context, Duphalac acidifies colonic contents, converting ammonia (NH3) to ammonium (NH4+), which is then trapped in the colon and excreted, thereby reducing systemic ammonia absorption.
Dosage and direction
Dosage must be individualized based on the patient’s age, condition, and response. It is crucial to administer the correct dose using the measuring cup or spoon provided to ensure accuracy.
- Adults and Adolescents (for constipation): The usual starting dose is 15-30 ml (approximately 10-20g of lactulose) daily. The dose may be increased to 60 ml per day if necessary. The daily dose can be taken as a single administration or divided into two doses (e.g., morning and evening). The dosage should be adjusted to produce 2-3 soft stools per day.
- Children (for constipation): For infants and children, the dose is weight-dependent. A common guideline is 2.5-10 ml per day. Medical advice is essential for determining the appropriate pediatric dosage.
- Hepatic Encephalopathy: The dosage is significantly higher and must be strictly supervised by a physician. The initial dose is typically 30-50 ml, three to four times daily. The dose is then adjusted to produce 2-3 soft stools per day.
- Administration: Duphalac can be taken undiluted or diluted with water, juice, or milk. It is best taken at the same time(s) each day to establish a routine. Adequate fluid intake (6-8 glasses of water per day) is essential for optimal efficacy.
Precautions
- A diagnostic evaluation should be considered to rule out underlying pathological conditions in patients with chronic, unresolved constipation before initiating long-term therapy.
- Use with caution in patients with diabetes mellitus, as the syrup contains galactose and lactose; although minimal amounts are absorbed, monitoring may be advised.
- Electrolyte levels may need monitoring during prolonged therapy, especially in debilitated patients.
- If abdominal pain, nausea, or vomiting occurs or worsens, discontinue use and consult a physician.
- Patients with rare hereditary problems of fructose or galactose intolerance should not take this medicine.
- While generally safe, use during pregnancy and lactation should be discussed with a healthcare provider.
Contraindications
Duphalac is contraindicated in patients with:
- Known hypersensitivity to lactulose or any of the excipients in the formulation.
- Galactosaemia, a rare genetic metabolic disorder.
- Conditions where a reduction in gut motility is dangerous, such as intestinal obstruction, acute inflammatory bowel disease (e.g., Crohn’s disease, ulcerative colitis) of the large intestine, or undiagnosed abdominal pain.
- Appendicitis or symptoms suggesting appendicitis.
Possible side effect
Duphalac is generally well-tolerated. Side effects are typically dose-related and often transient, subsiding as treatment continues or with dose adjustment.
- Very Common (>1/10): Flatulence and abdominal distension, especially at the beginning of treatment.
- Common (1/10 to 1/100): Abdominal discomfort, cramping, nausea, belching, and vomiting.
- Uncommon (1/100 to 1/1000): Electrolyte imbalance (due to diarrhoea) and diarrhoea (usually a sign of overdose).
- Rare (<1/1000): Allergic reactions.
Drug interaction
Formal drug interaction studies are limited due to lactulose’s minimal systemic absorption. However, theoretical and practical considerations include:
- Antacids: Concomitant use with non-absorbable antacids (e.g., containing aluminum or magnesium hydroxide) may reduce the acidifying effect of Duphalac in the colon, potentially diminishing its efficacy for hepatic encephalopathy.
- Other Laxatives: The combined use with other laxatives is not generally recommended unless directed by a physician, as it may increase the risk of diarrhoea and electrolyte disturbances.
- Oral Medications: Due to its potential to accelerate intestinal transit time, Duphalac could theoretically affect the absorption of other orally administered drugs. It is advisable to take other medications at least 2 hours before or after Duphalac.
Missed dose
If a dose is missed, it should be taken as soon as it is remembered. However, if it is almost time for the next scheduled dose, the missed dose should be skipped. Do not double the dose to make up for a forgotten one. Resume the regular dosing schedule.
Overdose
Overdose will lead to severe diarrhoea and abdominal cramps. The primary risk from severe diarrhoea is dehydration and electrolyte loss (particularly potassium). Treatment is symptomatic and supportive: discontinue Duphalac, ensure adequate fluid and electrolyte intake. In severe cases of dehydration, medical attention should be sought for possible electrolyte correction.
Storage
- Store below 25°C (77°F). Do not freeze.
- Keep the bottle tightly closed to protect from light and moisture.
- Keep out of the sight and reach of children.
- Do not use this medicine after the expiry date printed on the bottle and carton.
Disclaimer
This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here.
Reviews
- Dr. Eleanor Vance, Gastroenterologist: “In my practice, Duphalac is a cornerstone for managing functional constipation, especially in the elderly. Its predictable action and lack of dependency make it superior to stimulant laxatives for long-term care. The prebiotic effect is a valuable bonus for overall gut health.”
- Hepatic Care Unit Nurse: “For our hepatic encephalopathy patients, titrating Duphalac to achieve 2-3 soft stools is a critical nursing intervention. It’s remarkably effective at controlling ammonia levels and is generally well-accepted by patients compared to some alternatives.”
- Patient (Long-term user, 68): “After years of struggling with irregularity and harsh laxatives, my doctor recommended Duphalac. It took a few days to work fully, but now my routine is regular and comfortable without any cramps. It’s been a life-changer for me.”
- Pediatrician: “It’s my go-to for infant and childhood constipation. The ability to titrate the dose precisely and its excellent safety profile provide great reassurance to both me and the parents. It effectively resolves the issue while allowing the child’s natural rhythm to re-establish itself.”