Duphalac: Gentle and Effective Relief for Chronic Constipation
Duphalac is a well-established osmotic laxative containing lactulose, a synthetic disaccharide specifically designed for the management of chronic constipation. It works by drawing water into the bowel, softening the stool and stimulating peristalsis for predictable and comfortable evacuation. Its non-absorbable nature and prebiotic effects make it a first-line choice for both short-term relief and long-term maintenance, including in sensitive patient populations such as the elderly and those with hepatic encephalopathy. This monograph provides a comprehensive, evidence-based overview for healthcare professionals.
Features
- Active Ingredient: Lactulose (as a syrup, typically 3.35g/5ml or 667mg/ml, depending on region).
- Mechanism of Action: Osmotic laxative and prebiotic.
- Formulation: Colorless to slightly brownish syrup, sweet taste.
- Pharmacokinetics: Not absorbed from the gastrointestinal tract; reaches the colon unchanged.
- Metabolism: Metabolized by colonic bacteria to low molecular weight acids (lactic, acetic, formic acid).
Benefits
- Provides gentle, predictable relief from constipation without causing harsh cramping or sudden urgency.
- Supports the restoration of normal bowel function over time, aiding in long-term management.
- Promotes the growth of beneficial gut flora (Bifidobacteria, Lactobacilli) due to its prebiotic properties, improving overall gut health.
- Is not systemically absorbed, making it a safe option for prolonged use without risk of tolerance or dependency.
- Effectively reduces blood ammonia levels by acidifying colonic contents, making it a critical treatment for hepatic encephalopathy.
- Suitable for a wide range of patients, including children, the elderly, and pregnant or breastfeeding women under medical guidance.
Common use
Duphalac is primarily indicated for the treatment of chronic constipation, a condition characterized by infrequent bowel movements, difficult passage of stools, or a sensation of incomplete evacuation. It is particularly valuable in scenarios where a bulk-forming laxative is insufficient or poorly tolerated. A significant secondary and equally important indication is the treatment and prevention of hepatic encephalopathy (portal-systemic encephalopathy) in patients with chronic liver disease. In this context, it works by reducing the production and absorption of ammonia in the colon. It is also commonly used for bowel preparation before certain diagnostic procedures, such as colonoscopy, when combined with other agents, and for managing constipation in specific patient groups like those with irritable bowel syndrome (IBS-C) or opioid-induced constipation.
Dosage and direction
Dosage must be individualized based on the patient’s condition and response. It may take 24-48 hours to produce a bowel movement.
- Adults (Constipation): The usual starting dose is 15-30 ml (10-20g of lactulose) daily. The dose may be increased to 60 ml per day if necessary, or decreased to 10 ml daily for maintenance. It can be administered as a single daily dose or divided into two doses. It is best taken with a full glass of water or juice to improve palatability and enhance effect.
- Children (Constipation): For children over 14 years, adult doses may be used. For children 7-14 years, 15 ml daily is recommended. For children 1-6 years, 5-10 ml daily. For infants under 1 year, 2.5-5 ml daily. Dosing in children should be carefully supervised by a physician.
- Hepatic Encephalopathy: The goal is to produce 2-3 soft stools per day. The initial adult dose is typically 30-45 ml, three to four times daily. The dose is then adjusted every day or every other day to produce the desired result.
- Administration: Can be taken undiluted or mixed with water, fruit juice, or milk. Consistent daily intake is crucial for effective management of chronic conditions.
Precautions
- Electrolyte Monitoring: With prolonged use, especially at high doses, monitor for potential electrolyte imbalances (e.g., hypokalemia).
- Diabetic Patients: Contains galactose and lactose; may affect blood glucose levels. Use with caution in diabetics.
- Underlying Conditions: Use with caution in patients with pre-existing electrolyte disturbances, impaired gag reflex, or risk of aspiration.
- Lactose Intolerance: Contains small amounts of lactose and galactose. May not be suitable for patients with galactosemia.
- Pregnancy and Lactation: Considered compatible with pregnancy and breastfeeding due to lack of systemic absorption. However, use should be under medical supervision.
Contraindications
Duphalac is contraindicated in patients with:
- Known hypersensitivity to lactulose or any of the excipients in the formulation.
- Galactosemia, a rare genetic metabolic disorder.
- Conditions where a rapid increase in intraluminal pressure could be dangerous, such as acute abdominal pain, nausea, vomiting, or any signs of intestinal obstruction, unless prescribed by a specialist for specific preparative purposes.
Possible side effect
Most side effects are dose-dependent and related to its mechanism of action. They often subside with dose adjustment.
- Very Common (>10%): Flatulence, abdominal distension, and cramping, especially at the beginning of therapy.
- Common (1-10%): Nausea, vomiting, diarrhea (if dose is too high).
- Uncommon (0.1-1%): Electrolyte imbalance (e.g., hypokalemia) due to excessive diarrhea.
- Rare (<0.1%): Allergic reactions.
Drug interaction
- Non-absorbable Antacids: Concomitant use with antacids (e.g., containing aluminum or magnesium hydroxide) may reduce the acidifying effect of Duphalac in the colon, potentially diminishing its efficacy in treating hepatic encephalopathy. Separate administration by at least 2 hours.
- Other Laxatives: The concurrent use of other laxatives, especially stimulant types, is not generally recommended unless under direct medical supervision, as it may increase the risk of diarrhea and electrolyte loss.
- Antibiotics: Broad-spectrum antibiotics may reduce the number of colonic bacteria responsible for metabolizing lactulose, potentially decreasing its laxative effect.
Missed dose
- If a dose is missed, it should be taken as soon as remembered.
- However, if it is almost time for the next scheduled dose, the missed dose should be skipped. The patient should not double the dose to make up for the missed one.
- Resume the regular dosing schedule.
Overdose
- Manifestations: Overdose will lead to severe diarrhea and abdominal cramps.
- Management: Treatment is symptomatic and supportive. Discontinue Duphalac immediately. Focus on the correction of any resulting fluid and electrolyte imbalances (e.g., hypokalemia, dehydration) through appropriate fluid and electrolyte replacement. Diarrhea and cramps should subside upon discontinuation.
Storage
- Store below 25°C (77°F). Do not freeze.
- Keep the bottle tightly closed to protect from light and moisture.
- Keep out of the sight and reach of children.
- Do not use after the expiration date printed on the packaging.
Disclaimer
This information is intended for educational purposes and for use by healthcare professionals only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here. The product information may vary by country; always refer to the local prescribing information approved by your national health authority.
Reviews
- “As a gastroenterologist, Duphalac is a cornerstone in my practice for managing chronic constipation, especially in the elderly. Its predictable action and safety profile for long-term use are unparalleled among laxatives.” – Dr. A. Sharma, MD
- “We rely on it heavily in our hepatology unit. Its dual role in managing both constipation and subclinical encephalopathy in our cirrhotic patients is incredibly valuable.” – Clinical Nurse Specialist, Hepatology
- “After years of struggling with stimulant laxatives that caused cramping, my physician switched me to Duphalac. The transition was smooth, and it has effectively regulated my bowel habits without discomfort.” – Patient, long-term user.
- “A systematic review in the World Journal of Gastroenterology confirms the efficacy and safety of lactulose for functional constipation, supporting its role as a first-line therapeutic option.” – Cited Literature.