Duphalac

Therapeutic Indications

Duphalac is part of the medicine group called Laxatives used to treat acute constipation. The drug is a synthetic sugar, which improves the number of bowel movements in a day. It can also increase the regularity of bowel movement.

Lactulose, the key ingredient of Duphalac is a non-digestible oligosaccharide.  More significantly, ingested lactulose reaches the colon unaltered. Here, specific bacteria act on it and break it down to low molecular weight organic acids. That is why Duphalac is a colonic acidifier.

What this means is the drug is capable of increasing the water content in the stool and improving its texture. Since it is a synthetic sugar, it gets broken down into substances that draw water from the body into the colon. This water content helps to make the stools soft. Softened stools make for easy movement and this eases constipation.

Healthcare providers also prescribe Duphalac to alleviate symptoms in victims of chronic liver disease. This drug helps in lowering the ammonia levels in the blood of victims of the liver disease. This is because the bacteria in the gut use lactulose as a source of energy instead of protein, and this results in reduced ammonia production.

Cirrhosis patients receive Duphalac in higher doses to combat problems like hepatic encephalopathy and hepatic coma. These two conditions are a complication of liver disease. Duphalac helps reduce the toxic effect of liver failure on the brain.

Since Duphalacis not absorbed in the bloodstream, diabetics can use this drug without worrying about its adverse effect on blood sugar levels. Some of the benefits of Duphalac are that it activates the gut to work harder which results in diarrhea. Essentially this drug helps eliminate toxic substances from the body.

Do I Need a Prescription?

Duphalac is a schedule H drug.  It is available at a pharmacy or drug store.  You need a prescription from a qualified healthcare professional to purchase this drug.

Dosage

• Duphalac is available as an oral liquid (syrup) as well as a dry crystalline powder form.
• It is imperative to strictly adhere to your doctor’s dosage guidelines for Duphalac and take it as per the schedule.
• You can consume Duphalac solution either diluted or undiluted. Maintain the same schedule every day especially if it is a single dose. For instance, if you start taking the dose in the morning post breakfast, make sure you take it at the same time every day.
• Make sure you gulp the single dose of Duphalac in one shot, do not allow it to linger in the mouth for a longer time
• While on the Duphalac medication, make sure you drink at least 1.5 to 2 liters of water every day.
• In case you are taking Duphalac oral powder, take it with a spoon or you can also directly tip it on the tongue and wash it down with water or any fluid. Alternatively, sprinkle the dry crystal powder on food. Mix it with water or fluids before gulping it down.
• Subsequently, it is possible to adjust the posology during follow up consultations with the healthcare provider.

Dosage for constipation

Chronic Constipation

The initial dose to treat constipation in adults is 15 to 45 mL of Duphalac oral liquid every day. Later the maintaining dose is set at 15 to 30 ml. If it is Duphalac powder, take 10 to 30 gms ( 1 to 3 sachets) and maintenance dosage of  10 to 20 gm daily. The improvement and results begin to show within one or two days of treatment.

For children, Duphalac needs to be administered with caution.

The normal dosage is:

Infants below 1 year: The starting dose is 5 mL daily of Duphalac oral liquid for the first 3 days. If it isDuphalac powder dosage can be up to 3 grams (1/3 sachet). Maintenance dose is 5 mL daily for Duphalac oral liquid and up to 3 grams (1/3 sachet) for powder form.

Children 1-6 years: Starting dose is 5 to 10 mL daily for 3 days and 3 – 7 grams (1/3 – 2/3 sachet) if it is in powder form. The maintenance dose is 5 to 10 mL daily oral liquid and 3 – 7 grams (1/3 – 2/3 sachet) in powder form of Duphalac.

Children 7-14 years: Starting dose is 15 mL daily for first 3 days and maintenance dose is10 to 15 mL daily. If it is in powder form, the starting dose is 10 grams (1 sachet) and maintenance dose is 7 – 10 grams (3/4 – 1 sachet)

Portal-Systemic Encephalopathy

To treat Portal-Systemic Encephalopathy, the dose is set at 30 to 45 mL of oral solution three to four times daily.

Storage

• It is good to store Duphalac in a cool area. That said, it is not required to be stored in a refrigerator or freezer; temperature below 25°C is good.
• Duphalac should be stored beyond the reach of children

Chemical Composition

Duphalac oral solution appears a pale brown and yellow liquid. Lactulose is the active ingredient of Duphalac®.

Ingredients of 15 mL of Duphalac

10 g Lactulose

0.1 g Fructose

0.9 g Lactose

1.5 g Galactose

0.3 g Tagatose

0.7 g Epilactose

Facts on Duphalac

• Hepatic encephalopathy is a result of the liver’s inability to filter the blood from the intestines and eliminate ammonia. This manifests as a gradual type of memory impairment causing confusion.
• Duphalac is a simple yet able remedy to lower the level of ammonia in the blood. This largely clears “brain fog.”
• The causes of constipation could be any or all of these reasons- sedentary lifestyle, inadequate intake of fiber, aging, insufficient intake of fluids, excessive use of laxatives, and delaying going to the bathroom during the urge of a bowel movement, and/or use of narcotics.
• Human or animal enzymes cannot degrade Lactulose, which is a synthetic sugar that does not occur naturally.
• Duphalac is also categorized under osmotic laxatives. This essentially means that its working is restricted to the bowel and is not absorbed into the bloodstream.

Mechanism of Action

Duphalac works well to relieve constipation by drawing more water into the colon. Consequently, when more water is drawn, the stool becomes soft. When the stool softens, it becomes very easy to pass. Usually, Duphalac acts well within 48 hours of consuming it.

To explain in detail, specific bacteria break down lactulose into low-molecular-weight organic acids. The acids released are butyric, lactic, propionic and acetic acids. This leads to acidification of intestinal contents causing improvement in the osmotic pressure. The benefit is an increase in the filling volume in the colon, the main reason behind softer stools; this ensures the bowel movement is smooth.

Duphalac relieves certain symptoms of liver disease and works by lowering the absorption of ammonia from the gut. To explain the process, normal liver function involves breaking down ammonia. In the presence of severe liver disease, for instance, cirrhosis, the liver is unable to perform its task. Therefore, the blood with all the toxic substances reaches the brain. Eventually, this leads to confusion, drowsiness and even coma.

Duphalac lowers the absorption of ammonia from the gut and helps offset the complication due to liver disease. The medicine helps draw ammonia from the bloodstream into the colon so that it is eliminated with the feces.

Contraindications

Duphalac can interact with other drugs as well as react adversely in the presence of certain medical conditions. Therefore, it is imperative that you discuss your medical history, diet, and medicines with your healthcare provider before starting Duphalac. If you are allergic to certain ingredients of the drug or if you already suffer from allergies, it is better to discuss with your healthcare provider to know the potential risks.

Duphalac and alcohol

Can you have alcohol if you are taking Duphalac? This link and potential interaction of Duphalac with alcohol are yet to be proved. It is better to ascertain from your doctor whether it is okay to take alcohol if you have started Duphalac.

Drug interaction

Duphalac can react adversely when taken along with other medicines. Duphalactaken along with other types of laxatives can be harmful. This is especially the case for victims of liver failure. Further, if you are already taking any type of antibiotics and antifungals, talk to your specialist regarding Duphalacinteraction with these drugs. It is very likely that the efficacy of Duphalacwill drop if you are on any type of antibiotic and antifungal medication.

The following medicines have the potential to react adversely when taken along with Duphalac.

• Senna
• Dexamethasone
• Azithromycin
• Aluminum Hydroxide
• Ketoconazole

Disease interactions

Victims of the following medical conditions should exercise caution and double check with their healthcare provider before taking Duphalac

• Avoid Duphalac if you are allergic to lactose, galactose, lactulose, or any other sugar.
• Diabetes: Duphalac contains sugar, which is taboo for diabetics. Hence, diabetics should tread with caution if they plan to start Duphalac. In the event of diabetics taking this medicine, doctors need to monitor the patients for blood glucose levels.
• Galactosemia: Duphalac is not advisable for victims of Galactosemia. This genetic condition impairs the body to breakdown sugar galactose adequately.
• Check before taking Duphalac if you suffer from a disaccharide deficiency
• Duphalac is contraindicated for those on a lactose-free, galactose-free or low-galactose diet

• Electrolyte imbalance: Those already suffering from electrolyte imbalance must take extra care while taking Duphalac. It can also cause an imbalance of key electrolytes in the body like magnesium and potassium.
• Those with intestinal obstruction or blockage in their gut should not take Duphalac
• Duphalac is dangerous to take for those who have a perforation in their gut.
• Avoid Duphalac if you need to undergo endoscopy or colonoscopy.

Pregnancy

Pregnant women will do better to avoid Duphalac unless it is necessary. Talk to your healthcare provider about the benefits and risks before starting this medicine.

Breastfeeding

Lactating mothers must know that Duphalaccan passes through breast milk to the baby. Consult your healthcare provider and ascertain the risks before taking this drug.

Substitutes for Duphalac

Side effects

The list below indicates some of the side effects of Duphalac. If the side effects gradually disappear in a few days, there is no cause to worry. Seek the guidance of a health care professional if side effects persist or worsen.

Major side effects

• Excessive bowel activity
• Diarrhea
• Abdominal pain and cramps
• Low potassium and magnesium

Minor side effects

• Flatulence
• Belching
• Nausea or Vomiting

What to do if you skip a dose?

In case you miss a dose, you may take it as soon as it strikes you. Yet, if it is already time for the next scheduled dose, then just skip the missed dose. Do not take a double dose at one time to compensate for the skipped dose.

Overdose

If an overdose has occurred, contact your specialist immediately. Symptoms of overdose are:

• Severe thirst
• Rapid heartbeat
• Cramps
• Weakness of muscles
• Confusion
• Increased urination

Generic brand names of Duphalac

Generic name: Lactulose

Brand names: Enulose, Generlac, Duphalac, Kristalose

Substitutes of Duphalac

Different Manufacturing Companies of Duphalac

• Abbott India Ltd manufactures Duphalac 150 ml, 200ml, 300 ml, and 450 ml oral liquid
• Solvay Pharma India Pvt Ltd manufactures Duphalac 100 ml, 200 ml, 450 ml. 60 ml

References

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