Lactulose Solution
FDA Label NDC 60687-917

Lactulose is a synthetic disaccharide in solution form for oral administration. Each 15 mL of lactulose solution, USP contains: 10 g lactulose (and less than 1.6 g galactose, less than 1.2 g lactose, and 0.1 g or less of fructose).

Lactulose is a colonic acidifier which promotes laxation.

The chemical name for lactulose is 4-O- β-D-galactopyranosyl-D-fructofuranose. It has the following structural formula:

3bfff862-figure-01 (Image 1)

The molecular weight is 342 .30. It is freely soluble in water.

Lactulose is poorly absorbed from the gastrointestinal tract and no enzyme capable of hydrolysis of this disaccharide is present in human gastrointestinal tissue. As a result, oral doses of lactulose reach the colon virtually unchanged. In the colon, lactulose is broken down primarily to lactic acid, and also to small amounts of formic and acetic acids, by the action of colonic bacteria, which results in an increase in osmotic pressure and slight acidification of the colonic contents. This in turn causes an increase in stool water content and softens the stool.

Since lactulose does not exert its effect until it reaches the colon, and since transit time through the colon may be slow, 24 to 48 hours may be required to produce the desired bowel movement.

Lactulose given orally to man and experimental animals resulted in only small amounts reaching the blood. Urinary excretion has been determined to be 3% or less and is essentially complete within 24 hours.

For the treatment of constipation. In patients with a history of chronic constipation, lactulose solution therapy increases the number of bowel movements per day and the number of days on which bowel movements occur.

Since lactulose solution contains galactose (less than 1.6 g/15 mL), it is contraindicated in patients who require a low galactose diet.

A theoretical hazard may exist for patients being treated with lactulose solution who may be required to undergo electrocautery procedures during proctoscopy or colonoscopy. Accumulation of H ₂ gas in significant concentration in the presence of an electrical spark may result in an explosive reaction. Although this complication has not been reported with lactulose, patients on lactulose therapy undergoing such procedures should have a thorough bowel cleansing with a non-fermentable solution. Insufflation of CO ₂ as an additional safeguard may be pursued but is considered to be a redundant measure.

Since lactulose solution contains galactose (less than 1.6 g/15 mL) and lactose (less than 1.2 g/15 mL) it should be used with caution in diabetics.

In the event that an unusual diarrheal condition occurs, contact your physician.

Elderly, debilitated patients who receive lactulose for more than six months should have serum electrolytes (potassium, chloride, carbon dioxide) measured periodically.

Results of preliminary studies in humans and rats suggest that non-absorbable antacids given concurrently with lactulose may inhibit the desired lactulose-induced drop in colonic pH. Therefore, a possible lack of desired effect of treatment should be taken into consideration before such drugs are given concomitantly with lactulose solution.

There are no known human data on long-term potential for carcinogenicity, mutagenicity, or impairment of fertility.

There are no known animal data on long-term potential for mutagenicity.

Administration of lactulose solution in the diet of mice for 18 months in concentrations of 3 and 10 percent (v/w) did not produce any evidence of carcinogenicity.

In studies of mice, rats, and rabbits, doses of lactulose solution up to 6 or 12 mL/kg/day produced no deleterious effects in breeding, conception, or parturition.

Teratogenic Effects
Pregnancy category B. Reproduction studies have been performed in mice, rats, and rabbits at doses up to 3 or 6 times the usual human oral dose and have revealed no evidence of impaired fertility or harm to the fetus due to lactulose. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.

It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when lactulose solution is administered to a nursing woman.

Safety and effectiveness in pediatric patients have not been established.

Precise frequency data are not available.

Initial dosing may produce flatulence and intestinal cramps, which are usually transient. Excessive dosage can lead to diarrhea with potential complications such as loss of fluids, hypokalemia, and hypernatremia.

Nausea and vomiting have been reported.

To report SUSPECTED ADVERSE EVENTS, contact the FDA at 1-800-FDA-1088 or http://www.fda.gov/ for voluntary reporting of adverse reactions.

Signs and Symptoms:
There have been no reports of accidental overdosage. In the event of overdosage, it is expected that diarrhea and abdominal cramps would be the major symptoms. Medication should be terminated.

Oral LD ₅₀: The acute oral LD ₅₀ of the drug is 48 .8 mL/kg in mice and greater than 30 mL/kg in rats.

Dialysis: Dialysis data are not available for lactulose. Its molecular similarity to sucrose, however, would suggest that it should be dialyzable.

The usual dose is 1 to 2 tablespoonfuls (15 to 30 mL, containing 10 g to 20 g of lactulose) daily. The dose may be increased to 60 mL daily if necessary. Twenty-four to 48 hours may be required to produce a normal bowel movement.

Note: Some patients have found that lactulose solution may be more acceptable when mixed with fruit juice, water or milk.

Lactulose Solution, USP is a natural colored and an unflavored solution available in:
15 ml unit dose cups: 40 cups (4 x 10) NDC 60687-917-64
30 ml unit dose cups: 40 cups (4 x 10) NDC 60687-917-14
30 ml unit dose cups: 100 cups (10 x 10) NDC 60687‐917‐76

Lactulose Solution, USP contains lactulose 670 mg/mL (10 g/15 mL).

Store between 36° to 86°F (2° to 30°C). Do not freeze.

Under recommended storage conditions, a normal darkening of color may occur. Such darkening is characteristic of sugar solutions and does not affect therapeutic action. Prolonged exposure to temperatures above 86°F (30°C) or to direct light may cause extreme darkening and turbidity which may be pharmaceutically objectionable. If this condition develops, do not use.

Prolonged exposure to freezing temperatures may cause change to a semi-solid, too viscous to pour. Viscosity will return to normal upon warming to room temperature.

DO NOT USE IF SEAL IS BROKEN.

PACKAGING INFORMATION
American Health Packaging unit dose cups (see How Supplied section) contain drug product from Teva Pharmaceuticals as follows:

(10 g/15 mL / 40 UD) NDC 60687‐917‐64 packaged from NDC 45963‐439
(20 g/30 mL / 40 UD) NDC 60687‐917‐14 packaged from NDC 45963‐439
(20 g/30 mL / 100 UD) NDC 60687‐917‐76 packaged from NDC 45963‐439

Distributed by:
American Health Packaging
Columbus, OH 43217

8491764/0725F

Lactulose
Solution, USP

Rx Only

FOR INSTITUTIONAL USE ONLY

Store at 2° to 30°C (36° to 86°F). Do not freeze.

FOR ORAL ADMINISTRATION

INDICATIONS AND DOSAGE: For the treatment of
constipation. See Prescribing Information for full details.

EACH 15 mL (ONE TABLESPOONFUL) CONTAINS:
10 g lactulose (and less than 1.6 g galactose,
less than 1.2 g lactose, and 0.1 g or less of fructose).

Since lactulose does not exert its effect until it reaches the
colon, and since transit time through the colon may be slow,
24 to 48 hours may be required to produce a normal bowel movement.

Some patients have found that lactulose solution may be
more acceptable when mixed with fruit juice, water, or milk.
Product may darken slightly but therapeutic action is not
affected. Do not use if extreme darkening or turbidity occurs.

8491764/0725F

Rx Only

NDC 60687- 917-44

LACTULOSE
SOLUTION, USP

10 g/15 mL
Delivers 15 mL

For Oral Administration | Do not freeze.

See package insert for full
prescribing information and storage.

For Institutional Use Only.

American Health Packaging
Columbus, Ohio 43217

0491764/0725

Rx Only

NDC 60687- 917-45

LACTULOSE
SOLUTION, USP

20 g/30 mL
Delivers 30 mL

For Oral Administration | Do not freeze.

See package insert for full
prescribing information and storage.

For Institutional Use Only.

American Health Packaging
Columbus, Ohio 43217

0491714/0725