lactulose
Enulose (lactulose) is a liquid osmotic laxative. It's used in adults and children to treat and prevent symptoms of hepatic encephalopathy, a serious condition sometimes seen in people with liver problems. Enulose (lactulose) is a liquid solution. It's typically taken by mouth 3 to 4 times a day until you have 2 or 3 soft stools daily. But healthcare professionals (HCPs) can give it as a rectal enema to people who are in a coma caused by hepatic encephalopathy. Some common side effects of Enulose (lactulose) include stomach pain and passing gas. Keep in mind there are other lactulose products that are prescribed for constipation.
What is Enulose (lactulose)?
What is Enulose (lactulose) used for?
Prevention and treatment of brain-related complications from liver problems (hepatic encephalopathy)
How Enulose (lactulose) works
People who have liver problems sometimes experience a condition called hepatic encephalopathy. This happens because the liver isn't able to clear the toxins in the body, and so there's a build up of toxins in the blood. This can lead to brain-related problems, such as confusion or sleepiness.
One toxin that can build up is called ammonia. Enulose (lactulose) treats hepatic encephalopathy by lowering the amount of ammonia in your gut.
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What are the side effects of Enulose (lactulose)?
Common Side Effects
- Flatulence or passing gas (20%)
- Burping (20%)
- Stomach cramps (20%)
Other Side Effects
- Nausea or vomiting
- Diarrhea
Source: DailyMed
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
For bulk-forming-containing
Difficulty in breathing
intestinal blockage
skin rash or itching
swallowing difficulty (feeling of lump in throat)
For hyperosmotic-containing
Confusion
dizziness or light-headedness
irregular heartbeat
muscle cramps
unusual tiredness or weakness
For stimulant-containing
Confusion
irregular heartbeat
muscle cramps
pink to red, red to violet, or red to brown coloration of alkaline urine (for cascara, danthron, and/or senna only)
skin rash
unusual tiredness or weakness
yellow to brown coloration of acid urine (for cascara, and/or senna only)
For stool softener (emollient)-containing
Skin rash
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
For lubricant-containing
Skin irritation surrounding rectal area
For stool softener (emollient)-containing
Stomach and/or intestinal cramping
throat irritation (liquid forms only)
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Enulose (lactulose)
Pros
Might improve symptoms, such as confusion, within 1-2 days
A option for children and infants, under guidance of HCP
Can be given as a rectal enema to people who can't take medications by mouth
Cons
Not appropriate for people who need a low-galactose diet
Need to take multiple times throughout the day
Might not work well if taken with antacids, such as calcium carbonate (Tums)
Pharmacist tips for Enulose (lactulose)
Talk with your healthcare team if you've questions about how Enulose (lactulose) might affect your blood sugar. Enulose (lactulose) does contain galactose and lactose, which are two types of sugars. But limited research shows that Enulose (lactulose) isn't likely to raise your blood sugar levels.
Make sure to tell your healthcare team if you're lactose intolerant. Enulose (lactulose) contains lactose, which might cause people with this condition to have bloating, cramping, and diarrhea.
Don’t take antacids, like Mylanta Maximum Strength (aluminum hydroxide / magnesium hydroxide / simethicone) or calcium carbonate (Tums), at the same time as Enulose (lactulose). They might cause Enulose (lactulose) to not work as well. If you need medications for heartburn, ask your healthcare team about other options that won't interact with Enulose (lactulose).
If your Enulose (lactulose) solution didn't come with a measuring device, ask your local pharmacist for a device to use in order to measure out your doses. Don't use a household tablespoon because these can be inaccurate and cause you to take the wrong dose.
It's normal for Enulose (lactulose) solution to darken in color during storage at room temperature (between 36° to 86°F). This won't affect how well the medication works. But if you've stored Enulose (lactulose) at temperatures higher than 86°F for an extended period of time, then don't take it because it might not work as it should.
Keep Enulose (lactulose) stored at room temperature. If it happens to get too cold or frozen, the solution can become solid-like. If this happens, leave the solution out at room temperature and it will return back to normal.
There aren't enough studies about whether Enulose (lactulose) is safe during pregnancy. But Enulose (lactulose) might not be appropriate to take during pregnancy because it can cause nausea and bloating, which can be very uncomfortable. If you have plans to get pregnant, ask your healthcare team about safer options to treat your condition.
Frequently asked questions about Enulose (lactulose)
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What are the risks and warnings for Enulose (lactulose)?
Enulose (lactulose) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Loss of fluids
Risk factors: Taking Enulose (lactulose) for more than 6 months | Age 65 years and older | Taking medications that cause electrolyte imbalances
Enulose (lactulose) can make you dehydrated which can affect your body's mineral levels. Electrolytes (minerals), such as sodium, potassium, and calcium, have many important functions in the body. Your healthcare professional (HCP) might want to check these regularly while you're taking Enulose (lactulose), especially if you’re older in age or have been taking Enulose (lactulose) for a long period of time. Call your HCP right away if you feel extremely thirsty, tired, or confused because these are signs that Enulose (lactulose) might be making you dehydrated and affecting your electrolyte levels.
Possible risk of high blood sugar
Risk factors: Diabetes
Be mindful that Enulose (lactulose) contains galactose and lactose, which are both forms of sugar. If you have high blood sugar, you’ll want to make sure that you are checking your blood sugars while taking Enulose (lactulose). Limited research shows that Enulose (lactulose) doesn't seem to cause a spike in blood sugar, but you're still recommended to check your blood sugar levels just in case.
Problems during colonoscopy
If you're planning to have a colonoscopy or a rectal exam, let your healthcare team know you're taking Enulose (lactulose). Your HCP might have you take different medications to clean out your gut before your exam.
Enulose (lactulose) dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 10g/15ml | 473 ml | $12.32 | $0.03 |
Typical dosing for Enulose (lactulose)
Each 15 mL of Enulose (lactulose) contains 10 grams of lactulose.
Adults: The typical dose is 30 mL to 45 mL by mouth 3 or 4 times daily. Your healthcare team might adjust your dose every day or two until you're able to have 2 or 3 soft stools daily.
Children: The typical dose for an infant is 2.5 mL to 10 mL, divided into multiple doses and taken throughout the day. In general, your child's pediatrician will give enough Enulose (lactulose) so that your child is able to have 2 or 3 soft stools daily.
Enulose (lactulose) is sometimes given as a rectal enema by a trained healthcare professional (HCP) every 4 to 6 hours to adults who are in a coma from hepatic encephalopathy.
Interactions between Enulose (lactulose) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking any of these medicines, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using medicines in this class with any of the following medicines is not recommended. Your doctor may decide not to treat you with a medication in this class or change some of the other medicines you take.
- Amantadine
- Atropine
- Belladonna
- Belladonna Alkaloids
- Benztropine
- Bepridil
- Biperiden
- Burosumab-twza
- Cisapride
- Clidinium
- Darifenacin
- Dicyclomine
- Dronedarone
- Eplerenone
- Fesoterodine
- Glycopyrrolate
- Hyoscyamine
- Mesoridazine
- Methscopolamine
- Oxybutynin
- Pimozide
- Piperaquine
- Procyclidine
- Saquinavir
- Scopolamine
- Solifenacin
- Sparfloxacin
- Terfenadine
- Thioridazine
- Tolterodine
- Trihexyphenidyl
- Trospium
- Ziprasidone
Using medicines in this class with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acalabrutinib
- Alacepril
- Alfuzosin
- Amiloride
- Amiodarone
- Amisulpride
- Amitriptyline
- Amoxapine
- Amphetamine
- Amygdalin
- Anagrelide
- Apomorphine
- Aripiprazole
- Aripiprazole Lauroxil
- Arsenic Trioxide
- Asenapine
- Astemizole
- Azathioprine
- Azithromycin
- Baloxavir Marboxil
- Bedaquiline
- Benazepril
- Benzphetamine
- Bictegravir
- Bisacodyl
- Bupivacaine
- Buprenorphine
- Buserelin
- Cabotegravir
- Canrenoate
- Captopril
- Ceritinib
- Chloroquine
- Chlorpromazine
- Cilazapril
- Ciprofloxacin
- Citalopram
- Clarithromycin
- Clofazimine
- Clomipramine
- Clozapine
- Crizotinib
- Cyclobenzaprine
- Cyclosporine
- Dabrafenib
- Dasatinib
- Deferoxamine
- Degarelix
- Delamanid
- Delapril
- Desipramine
- Deslorelin
- Deutetrabenazine
- Dextroamphetamine
- Digoxin
- Dimercaprol
- Disopyramide
- Dofetilide
- Dolasetron
- Dolutegravir
- Domperidone
- Donepezil
- Droperidol
- Efavirenz
- Eltrombopag
- Elvitegravir
- Encorafenib
- Entrectinib
- Erdafitinib
- Erythromycin
- Escitalopram
- Fingolimod
- Flecainide
- Fluconazole
- Fluoxetine
- Formoterol
- Foscarnet
- Fosinopril
- Fostemsavir
- Gatifloxacin
- Gefitinib
- Gemifloxacin
- Glasdegib
- Gonadorelin
- Goserelin
- Granisetron
- Halofantrine
- Haloperidol
- Histrelin
- Hyaluronidase
- Hydroxychloroquine
- Hydroxyzine
- Ibutilide
- Iloperidone
- Imidapril
- Imipramine
- Indomethacin
- Inotuzumab Ozogamicin
- Ivabradine
- Ivosidenib
- Ketoconazole
- Lamivudine
- Lapatinib
- Ledipasvir
- Lefamulin
- Lenvatinib
- Levofloxacin
- Levomethadyl
- Licorice
- Lisdexamfetamine
- Lisinopril
- Lofexidine
- Lopinavir
- Lumefantrine
- Macimorelin
- Mefenamic Acid
- Mefloquine
- Memantine
- Mercaptopurine
- Methadone
- Methamphetamine
- Metronidazole
- Mifepristone
- Mirtazapine
- Moexipril
- Moxifloxacin
- Mycophenolate Mofetil
- Mycophenolic Acid
- Nafarelin
- Neratinib
- Nilotinib
- Norfloxacin
- Nortriptyline
- Octreotide
- Ofloxacin
- Ondansetron
- Osilodrostat
- Osimertinib
- Oxaliplatin
- Ozanimod
- Paliperidone
- Panobinostat
- Pasireotide
- Pazopanib
- Pentopril
- Perindopril
- Phenytoin
- Pimavanserin
- Piperaquine
- Pitolisant
- Polyethylene Glycol 3350
- Ponesimod
- Posaconazole
- Procainamide
- Prochlorperazine
- Promethazine
- Propafenone
- Protriptyline
- Quetiapine
- Quinapril
- Quinidine
- Quinine
- Raltegravir
- Ramipril
- Ranolazine
- Ribociclib
- Rilpivirine
- Selpercatinib
- Senna
- Sertraline
- Sevoflurane
- Siponimod
- Sodium Picosulfate
- Sodium Polystyrene Sulfonate
- Solifenacin
- Sorafenib
- Sotalol
- Spirapril
- Spironolactone
- St John's Wort
- Sulpiride
- Sunitinib
- Tacrolimus
- Telavancin
- Telithromycin
- Temocapril
- Tetrabenazine
- Toremifene
- Trandolapril
- Trazodone
- Triamterene
- Triclabendazole
- Trifluoperazine
- Trimipramine
- Triptorelin
- Vandetanib
- Vardenafil
- Vemurafenib
- Vinflunine
- Vismodegib
- Voclosporin
- Voriconazole
- Zofenopril
- Zuclopenthixol
How much does Enulose (lactulose) cost?
Enulose (lactulose) contraindications
People on a low-galactose diet
What are alternatives to Enulose (lactulose)?
Prevention and treatment of brain-related complications from liver problems (hepatic encephalopathy)
Treatment of travelers' diarrhea caused by E. coli in people ages 12 years and older
Treatment of irritable bowel syndrome with diarrhea (IBS-D) in adults
Prevention of hepatic encephalopathy (HE) in adults
What is the latest news about Enulose (lactulose)?
Enulose (lactulose) images
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References
Best studies we foundActavis Pharma, Inc. (2022). Enulose- lactulose solution [package insert]. DailyMed.
Bloom, P. P., et al. (2023). Lactulose in cirrhosis: Current understanding of efficacy, mechanism, and practical considerations. Hepatology Communications.
Bosch, A. M. (2011). Classic galactosemia: Dietary dilemmas. Journal of Inherited Metabolic Disease.
Butterworth, R. F. (2003). Hepatic encephalopathy. Alcohol Research & Health.
Ferenci, P. (2017). Hepatic encephalopathy. Gastroenterology Report.
Fresenius Kabi Austria GmbH. (2022). Lactulose- lactulose solution [package insert]. DailyMed.
Longo, S. A., et al. (2010). Gastrointestinal conditions during pregnancy. Clinics in Colon and Rectal Surgery.
MedlinePlus. (2023). Ammonia levels.
Mukherjee, S., et al. (2024). Lactulose. StatPearls.
National Center for Emerging and Zoonotic Infectious Disease (U.S.). (2018). Spoons are for soup / Milliliters (mL) are for medicine.
National Organization for Rare Disorders. (2011). Hepatic encephalopathy.
Pieber, T. R., et al. (2021). Blood glucose response after oral lactulose intake in type 2 diabetic individuals. World Journal of Diabetes.
Steudle, J., et al. (2018). Blood glucose response after oral intake of lactulose in healthy volunteers: A randomized, controlled, cross-over study. World Journal of Gastrointestinal Pharmacology and Therapeutics.
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