Therapeutic Indications

(1) Constipation

(2) Acute and chronic Portal systemic encephalopathy

 

Mode of action

Lactitol is a disaccharide derivative consisting of galactose and sorbitol which is only minimally absorbed and is not hydrolysed by the disaccharidases of the gastrointestinal tract and thus reaches the colon unchanged. In the colon it is broken down to short chain organic acids, mainly acetic, propionic and butyric acid, by the intestinal flora, in particular by the bacteroides and lactobacilli, thus acidifying the contents of the colon. The effect of this acidification is to reduce the absorption of ammonia. It also seems that the above-mentioned bacteria prefer Lactitol to amino acids: an in-vitro faecal incubation study has shown that presence of Lactitol reduces the production of ammonia by bacteria.The transformation of Lactitol into low molecular weight organic acids results in an increase in osmotic pressure in the colon, thereby causing an increase in the stool water content and stool volume, which explains the laxative effect.Lactitol produces its effect in the lumen of the colon, where it is virtually 100% bioavailable.

 

Dosage and administration

It can be mixed with hot or cold beverages, cereals, puddings, etc.

(1) Constipation:

Adults (including the elderly): The initial daily dosage should be 20g (two 10g sachets)

taken in a single does with the morning or evening meal. After a few days, a daily does of 20g (one sachets) may be sufficient for many patients

 

Children: The mean dosage is 0.25g/kg body weight daily, e.g.:

1 to 6 years old: ¼ to ½ sachet daily (2.5 to 5g)

6 to 12 years old: ½ to 1 sachet daily (5 to 10g)

12 to 16 years old: 1 to 2 sachet daily (10 to 20g)

In all cases dosage should be individually adjusted to obtain one daily bowel movement.

 

(2) Acute and Chronic portal systemic encephalopathy:

The initial recommended dose is 0.5 to 0.7g/kg body weight daily, divided into three daily doses with

meals

The dosage should then be adjusted to produce two soft bowel movements daily

 

To obtain a 40% solution for administration by nasogastric tube if required, in patients with acute portal

systemic encephalopathy proceed as follows: add 200g of Lactitol monohydrate to 200ml of hot distilled

water, stirring continuously. When dissolved, complete to a final volume of 500ml with cold distilled water

This solution can be given by nasogastric tube at a dosage of 1 to 2ml/kg body weight daily

(corresponding to 0.4 to 0.8g/kg).