Lactomax Mechanism of Action

Laxative.
Pharmacology: Lactitol is a sugar alcohol derived from Lactulose. It is obtained from lactose and is least absorbed following oral administration. It is more palatable, better tolerated and produces a more predictable cathartic activity than lactulose. Lactitol monohydrate has caloric value of 2kcal/g (8.5kj/g) and has no significant effect on blood glucose levels.
Pharmacodynamics: Mechanism of Action: Lactitol is sugar alcohol, consisting of galactose and sorbitol, which is mainly absorbed and is not hydrolyzed by the disaccharides of the gastrointestinal tract and thus reaches the colon unchanged. It breaks down in the colon to short chain organic acid mainly acetic, propionic and butyric acid, by the intestinal flora, in particular by the bacteroides and lactobacilli, thus acidifying the content of the colon. The effect of this acidication is reduction in the absorption of ammonia. The transformation of lactitol into low molecular weight organic acid results in the increase in osmotic pressure in the colon therapy causing an increase in the stool water content and stool volume which explain the laxative effect.
The mechanism of action in hepatic encephalopathy is related to suppression of the absorption of unionized ammonia via lowering of colonic pH, a cathartic action also enhances fecal nitrogen excretion and decreases intestinal transit time, with a reduction in the time for production and absorption of ammonia and other potential toxins. Other speculated mechanisms includes stimulation of ammonia incorporation into bacterial protein and intestinal ammonia generation.
Pharmacokinetics: Lactitol is not significantly absorbed in the small intestine; only 0.5% to 2% of a dose is partially absorbed. Upon reaching the colon, lactitol is rapidly and extensively metabolized to volatile fatty acids by the bacterial metabolism resulting to carbon dioxide formation and loss of 27.4% of the dose, 64% of the dose was calculated to be absorbed by the colonic mucosa as volatile fatty acids, with 6.5% excreted in the feces. Small amounts of unchanged lactitol appear in the urine (2% of less of a dose).