Lactulose

Lactulose

Drug monograph · NCLEX study reference
Trade names	Enulose
Therapeutic class	Laxative, ammonia-reducing agent
Pharmacologic class	Osmotic laxative (nonabsorbable sugar)
Onset / peak / duration	Laxative onset 24 to 48 hours; faster in hepatic encephalopathy.
Half-life / level	Minimal absorption.
Routes	PO (oral), Rectal
High-alert (ISMP)	No
Black box warning	None
Antidote / reversal	Not applicable.
Pregnancy / lactation	Used when needed.

Nursing pharmacology study reference (NCLEX-style monograph). Numeric values are standard teaching ranges for study and must be verified against current manufacturer labeling before clinical use. This is educational content, not prescribing guidance.

Lactulose (brand name Enulose) — Laxative, ammonia-reducing agent; Osmotic laxative (nonabsorbable sugar).

Identification

• Therapeutic class: Laxative, ammonia-reducing agent.
• Pharmacologic class: Osmotic laxative (nonabsorbable sugar).

Pharmacology

• Mechanism of action: Draws water into the bowel and traps ammonia for elimination.
• Onset / peak / duration: Laxative onset 24 to 48 hours; faster in hepatic encephalopathy.
• Half-life / therapeutic level: Minimal absorption.

Clinical use

• Indications: Constipation, hepatic encephalopathy.
• Usual dose, route, frequency: 15 to 30 mL PO daily for constipation; higher and titrated to stools for encephalopathy; rectal in acute cases.
• Maximum dose / adjustments: Titrate to 2 to 3 soft stools per day for encephalopathy.

Safety

• Contraindications: Galactosemia, low-galactose diet.
• Black box warning: None.
• Interactions: Other laxatives, antibiotics (may reduce effect).
• Pregnancy / lactation: Used when needed.
• High-alert: No.

Adverse effects

• Common side effects: Bloating, flatulence, cramping, sweet taste.
• Serious effects to report: Excessive diarrhea with dehydration and electrolyte loss.
• Antidote / reversal: Not applicable.

Nursing process

• Assessment before administration: Bowel pattern, ammonia and mental status for encephalopathy.
• Interventions during therapy: Titrate to stool goal; can mix in juice for taste.
• Monitor: Stool frequency, ammonia, mental status, electrolytes.
• Evaluation / expected outcome: Regular stools or improved mental status.

Patient teaching

• Patient teaching: For encephalopathy, the goal is several soft stools daily.
• Notify provider if: Severe diarrhea, worsening confusion.
• Administration tips: Mix in juice or water; titrate as directed.