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Lactulose is not a treatment that reverses liver fibrosis or removes cirrhosis. It treats a complication of advanced liver disease rather than the underlying liver scarring. The cause of liver disease still requires separate medical management (1, 2)
In people with advanced liver disease, lactulose is mainly used to treat or prevent hepatic encephalopathy (HE) - a brain disorder associated partly with the buildup of ammonia and other toxins when the damaged liver cannot process them effectively (1, 2)
A prescription for lactulose commonly indicates that a clinician is treating or preventing confusion, drowsiness, personality changes, or other HE symptoms, or preventing another episode after one has occurred (1, 2)
Lactulose is a non-absorbable synthetic sugar that reaches the colon. It acidifies bowel contents, helping convert absorbable ammonia (NH₃) into ammonium (NH₄⁺), which is less readily absorbed. It also speeds intestinal transit and increases bowel movements, helping remove nitrogen and ammonia from the body (1, 2)
The dose should be individualized according to the treating clinician’s instructions. Lactulose is generally adjusted to produce about 2–3 soft bowel movements per day (1, 2)
Excessive diarrhea can cause dehydration, electrolyte abnormalities, skin irritation, and may worsen encephalopathy. Constipation, infection, gastrointestinal bleeding, dehydration, sedating medicines, and electrolyte disturbances can also trigger HE and require medical evaluation (1, 2)
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