Lactolose Oral Solution.pptx

Lactulose is a laxative use to treat different types of complications. This presentation will give an idea of its mechanism in different indications like constipation, jaundice, obstructive jaundice, hepatic encephalopathy. Lactulose has some other benefits. It's dose, side effects and market positioning is also included.

1. Presentation on Lactulose Oral Solution Corporate Logo

2. The Novel Laxative With Multiple Actions Constipation is one of the most common digestive problems of the people regardless of age Company Name offers Product Image Logo Corporate Logo

3. Indications Constipation Intestinal flora disturbances Increased blood ammonia levels Diseases of the gums and the periodontal apparatus Intestinal flora : The various bacteria that normally live in the intestinal tract. Normal intestinal floras are important to aid in the breakdown of certain foods for absorption. Fecal flora: Fecal flora is the term referring to the different kinds of healthy bacteria living in our intestines and colon which are used to digest food. Corporate Logo

4. Mechanism of action Lactolose in colon Broken down by Saccharolytic bacteria Some acids are formed which increase H + in colon NH 3 + H + NH 4 + Ammonia, mainly produced in colon or extracted from intracellular or extracellular space H 2 O in extracellular space Enters into colon due to increased osmotic pressure Increases volume of stool due to increased H 2 O in colon Softness of stool & increases peristaltic movement Easy defecation Increases osmotic pressure Corporate Logo

5. Lactulose works through a unique mechanism unlike other conventional laxatives. It doesn’t directly attract H 2 O in colon. It is first broken down into weak acid which binds with NH 3 to form NH 4 + . This NH 4 + attracts water in colon. Hence Lactulose , in addition to laxation, gives many other beneficial effects like helps in treating jaundice, hepatic encephalopathy, preventing gallstone formation, providing prebiotic effects etc., whereas other laxatives directly attract water. They don’t produce any acid and hence don’t detoxify NH 3 . Hence, they only relieve constipation but don’t give any other beneficial effect. Mechanism of action

6. Features Lactulose Lubiprostone Milk of Magnesia Polyethylene Glycol (Macrogol) Liquid Paraffin Sodium Picosulfate Description A non-absorbable sugar used in the treatment of all types of constipation & palatable in taste Used in the treatment of chronic idiopathic constipation only Used for occasional constipation, very astringent & unpleasant in taste & can not be used for long time A polyether compound used mainly in industrial manufacturing purpose Form of kerosene which is commonly used as fuel A stimulant laxative used for constipation or bowel clearance before surgery or colonoscopy Adverse effects  Found no significant side effects Causes headache and gastrointestinal events (nausea, diarrhea, abdominal distention or pain)   Common side effects are diarrhea, nausea, vomiting etc. Causes abdominal pain, nausea, vomiting, bloating etc.   Seeps from the anus & causes irritation, hampers the absorption of fat-soluble vitamin like A, D, E & K Abdominal cramp, diarrhea, electrolyte imbalance like hypokalemia and hyponatremia Pregnancy Category B C Unknown C Unknown Not established Pediatric use Safe even for infants Unknown Not safe for children below 2 years Not safe for children Not safe for children below 3 years Can be given for children under 4 years of age Additional Benefits   Besides laxation, Lactulose is also useful in- - Hepatic encephalopathy - Jaundice - Preventing gallstone formation - Promoting useful bacteria & inhibiting harmful bacteria in gut - Typhoid fever recurrence - Postmenopausal osteoporosis         Do not provide these additional benefits like Lactulose     Superior to Lubiprostone, Milk of Magnesia, Polyethylene Glycol, Sodium Picosulfate & Liquid Paraffin Corporate Logo

7. During jaundice & hepatic encephalopathy liver cannot detoxify ammonia coming from the colon. As a result, blood ammonia level is elevated which impairs neuronal function and causes generalized brain edema and hepatic encephalopathy. In such case, Lactulose helps to reduce ammonia level in blood. In this way, Lactulose prevents jaundice & hepatic encephalopathy as well. Jaundice: Jaundice is a term used to describe a yellowish shade to the skin and sclera (the white part of the eye) that is caused by hyperbilirubinemia (an excess of bilirubin in the blood). W ork s in jaundice & hepatic encephalopathy Corporate Logo

8. Bacteria use VFA as preferred substrate, thus reducing production of ammonia Lactulose fermented by colonic bacteria to H 2 and VFA Lactulose not absorbed in small intestine Excretion of NH 3 secondary to laxative effect NH 3 incorporated into stool NH 3 NH 3 W ork s in jaundice & hepatic encephalopathy *VFA= Volatile Fatty Acids Corporate Logo

9. The presence of endotoxins in the systemic circulation in patients with obstructive jaundice may occur acute renal failure during postoperative period. In such case, oral Lactulose reduces the incidence of endotoxemia and prevents post-operative renal dysfunction in patients with obstructive jaundice. Thus, Lactulose is useful in obstructive jaundice. Useful in obstructive jaundice Obstructive Jaundice: Obstructive jaundice is a particular type of jaundice that occurs when the essential flow of bile to the intestine is blocked and remains in the bloodstream.

10. Cholic acid Deoxycholic acid Formation of Gall stone Lactulose inhibits this step as it reduces pH of colon thus inhibits gall stone formation Deposition of cholesterol in the gall bladder 7-alpha dehydroxylase Conversion of cholic acid into deoxycholic acid is responsible for gallstone formation. For this conversion 7-alpha dehydroxylase is required. By reducing pH of colon, Lactulose inhibits this enzyme. By this way Lactulose prevents gallstone formation. Prevents gallstone formation Corporate Logo

11. Both lactulose and rifaximin work in dual mechanism to reduce the concentration of NH 3 in systemic circulation -   Lactulose converts NH 3 to NH 4 + ion. Rifaximin inhibits NH 3 producing colonic bacteria. Combined action of both drugs reduces NH 3 concentration in a greater extent than that of lactulose alone. Hence, combination therapy of lactulose and rifaximin provides better result in the treatment of hepatic encephalopathy.     Combined therapy of lactulose & rifaximin is more effective in the treatment of hepatic encephalopathy than lactulose monotherapy  Corporate Logo

12. What are the possible side effect? Flatulence Diarrhea Corporate Logo

13. Dosage and administration Indications Age Group Initially In long term therapy Constipation Adults 3-6 teaspoons daily 1.5-6 teaspoons daily Children up to 14 years 3 teaspoons daily 1-2 teaspoons daily Infants & toddlers 1-2 teaspoons daily 1 teaspoon daily Damaged intestinal flora (e.g. following long-term antibiotic treatment) Adults 1-2 teaspoons daily Children 1 teaspoon daily For reduction of blood ammonia level in Hepatic Encephalopathy 18-30 teaspoons daily Diseases of the gums & the paradontic apparatus (Paradontopathy) Adults 3-6 teaspoons daily Corporate Logo

14. Lactulose is not just a laxative, it also gives beneficial effects in Jaundice, Hepatic Encephalopathy, Gall Stone, Typhoid fever, Prebiotic effect, Postmenopausal Osteoporosis etc. which other laxatives can’t give Lactulose is superior to Liquid Paraffin, Milk of Magnesia, Polyethylene Glycol, Lubiprostone & Sodium Picosulfate Lactulose provides pure lactulose with honey like taste but is nonsystemic & sugar free. Hence, it is suitable for diabetic patients Lactulose + Rifaximin is the superb combination for better treatment of hepatic encephalopathy Lactulose is safe for all age group of people Key points Corporate Logo

15. THANK YOU