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Pharmacotherapeutic group: Osmotically acting laxatives. ATC Code: A06A D11.
Pharmacology: Pharmacodynamics: The following is a detailed description of how Duphalac oral solution works. If the patient would like an explanation or further information regarding this, consult a doctor.
In the colon lactulose is broken down by colonic bacteria into low-molecular organic acids. These acids lower the pH in the colonic lumen and increase the volume of the colonic contents via an osmotic effect. These effects stimulate peristalsis of the colon and return normal consistency of the stool. Constipation is corrected and the physiological rhythm of the colon is reinstated.
In hepatic encephalopathy (HE), the effect has been attributed to suppression of proteolytic bacteria by an increase of acidophilic bacteria (e.g. lactobacillus), trapping of ammonia in the ionic form by acidification of the colonic contents, catharsis due to the low pH in the colon as well as an osmotic effect and alteration of bacterial nitrogen metabolism by stimulating the bacteria to utilize ammonia for bacterial protein synthesis. Within this context, however, it should be realized that hyperammonemia alone cannot explain the neuropsychiatric manifestations of HE. The ammonia might, however, serve as a model compound for other nitrogenous substances.
Lactulose as a prebiotic substance strengthens the growth of health promoting bacteria, like Bifidobacterium and Lactobacillus, whereas potentially pathogenic bacteria, like Clostridium and Escherichia coli may be suppressed.
This may lead to a more favorable balance of the intestinal flora.
Pharmacokinetics: The following is a detailed description of how Duphalac oral solution is metabolized in the body. If the patient would like an explanation or further information regarding this, consult a doctor.
Lactulose is poorly absorbed after oral administration and reaches the colon unchanged. There it is metabolised by the colonic bacterial flora. Metabolism is complete at doses up to 25-50 g or 40-75 ml; at higher dosages, a proportion may be excreted unchanged.
