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Enulose
Enulose (generic name: lactulose) is a synthetic sugar used to treat constipation and complications of liver disease, such as hepatic encephalopathy (a decline in brain function due to liver failure). It works as a laxative by drawing water into the bowel, softening stools, and promoting bowel movements. In patients with liver disease, Enulose helps reduce the absorption of ammonia from the intestines, which helps prevent confusion, drowsiness, and coma caused by hepatic encephalopathy.
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Frequently Asked Questions
How long does it take for Enulose to work?
For constipation, it may take 24 to 48 hours for Enulose to produce a bowel movement. For hepatic encephalopathy, the medication may start lowering ammonia levels within a few days, but the full effect may take longer depending on the severity of the condition.
Can I take Enulose daily for constipation?
Yes, Enulose can be used daily for chronic constipation. However, it’s important to adjust the dose to prevent diarrhea and dehydration. Consult your healthcare provider for long-term use.
Can I mix Enulose with juice or water?
Yes, Enulose can be mixed with juice, water, or milk to improve its taste and reduce stomach upset.
Can I use Enulose while pregnant?
Enulose is generally considered safe for use during pregnancy, but you should discuss its use with your healthcare provider to ensure it is appropriate for your condition.
What should I do if I experience diarrhea while taking Enulose?
If you experience diarrhea, reduce the dose of Enulose and contact your healthcare provider if the diarrhea persists. It is important to maintain proper hydration to avoid dehydration.
Comprehensive Drug Guide
How Does Enulose Work?
Enulose works by pulling water into the bowel through osmosis, which helps soften stools and stimulate bowel movements. In patients with hepatic encephalopathy, lactulose acidifies the contents of the colon, converting ammonia (NH3) into ammonium (NH4+), which is less easily absorbed into the bloodstream. This helps lower blood ammonia levels, reducing the neurological symptoms associated with liver disease.
Common Dosages
- For constipation, the typical starting dose is 15 to 30 mL once daily, with adjustments made based on response.
- For hepatic encephalopathy, the starting dose is usually 30 to 45 mL three to four times daily, adjusted to produce two to three soft stools per day.
Typical Dosing
- For constipation: The usual dose is 10 to 20 grams (15-30 mL) once daily. Some patients may require larger doses for relief, up to 60 mL daily.
- For hepatic encephalopathy: The usual dose is 30 to 45 mL two to four times daily, adjusted to produce two to three soft stools per day.
Typical Dosing
FDA Approved Indications
- Chronic constipation
- Prevention and treatment of hepatic encephalopathy in patients with liver disease
Who Shouldn't Take Enulose?
- Galactosemia (a rare genetic disorder that affects the body's ability to process galactose)
- Hypersensitivity to lactulose or any of the components of the formulation
Advice From The Pharmacist
- Enulose can be taken with or without food. If you experience stomach upset, taking it with food or mixing it with juice, water, or milk may help improve tolerability.
- It may take 24 to 48 hours for the full effects of Enulose to be felt for constipation relief.
- For hepatic encephalopathy, it is important to take the medication consistently to maintain reduced blood ammonia levels.
- Drink plenty of fluids to stay hydrated while taking Enulose, as it works by drawing water into the bowel.
- Monitor for signs of electrolyte imbalances, such as muscle cramps, weakness, or irregular heartbeat, as prolonged use can lead to dehydration and low potassium levels.
Side Effects of Enulose
Common Side Effects
- Diarrhea
- Abdominal cramping
- Flatulence (gas)
- Nausea
- Bloating
Uncommon/Severe Side Effects
- Severe diarrhea leading to dehydration or electrolyte imbalances
- Allergic reactions (rash, itching, swelling, difficulty breathing)
Risks and Warnings of Enulose
- Electrolyte Imbalance: Prolonged use of Enulose, especially in higher doses, can lead to dehydration and electrolyte imbalances (such as low potassium or sodium levels). Patients should be monitored for symptoms such as muscle weakness, irregular heartbeat, or confusion.
- Severe Diarrhea: If you experience persistent or severe diarrhea while taking Enulose, contact your healthcare provider, as dose adjustments may be necessary.
- Use in Diabetics: Enulose contains small amounts of sugars, so patients with diabetes should be aware that it may slightly affect blood sugar levels.
Interactions with Enulose
Common Drug Interactions
- Antacids: Antacids may reduce the effectiveness of Enulose by altering the pH of the intestines. Avoid using antacids with Enulose unless directed by your healthcare provider.
- Neomycin: This antibiotic, used to treat hepatic encephalopathy, may work synergistically with Enulose, but careful monitoring is required due to potential electrolyte imbalances.
Alternatives to Enulose
- Polyethylene glycol (Miralax): Another osmotic laxative used to treat constipation.
- Senna (Senokot): A stimulant laxative that helps with constipation by promoting bowel movement through the stimulation of intestinal muscles.
- Rifaximin (Xifaxan): An antibiotic used to treat hepatic encephalopathy, often in combination with lactulose.
- Sorbitol: A sugar alcohol that acts as an osmotic laxative and is used similarly to lactulose for constipation.
