Chronic idiopathic constipation: Oral: 20 g once daily; may reduce dose to 10 g once daily for persistent loose stools.
Hepatic encephalopathy (off-label use):
Prevention:
Note: May consider as chronic therapy for the prevention of recurrent hepatic encephalopathy with or without other therapies (Ferenci 2021).
Oral: 30 to 60 g/day in 2 to 4 divided doses; adjust dose to achieve 2 to 3 soft stools per day (Ferenci 2021).
Treatment:
Note: Identify and treat precipitating factors. May use as monotherapy for initial treatment or in combination with other therapies when initial monotherapy is unsuccessful. Not recommended for routine treatment of minimal hepatic encephalopathy; may consider on a case-by-case basis in patients with decreased quality of life (AASLD [Vilstrup 2014]; Ferenci 2021; Prasad 2007).
Oral: 30 to 60 g/day in 2 to 4 divided doses; adjust dose to achieve 2 to 3 soft stools per day (AASLD [Vilstrup 2014]; Ferenci 2021; Heredia 1988; Mas 2003).
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
Pizensy: FDA approved February 2020; anticipated availability is currently unknown.
Oral: Administration with meals is preferred; drink entire contents of glass. Administer oral medications at least 2 hours before or 2 hours after lactitol.
Chronic idiopathic constipation: Treatment of chronic idiopathic constipation (CIC) in adult patients.
Hepatic encephalopathy, prevention; Hepatic encephalopathy, treatment
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
1% to 10%:
Cardiovascular: Increased blood pressure (3%)
Gastrointestinal: Flatulence (8%), diarrhea (4%), abdominal distention (3%), abdominal pain (3%), severe diarrhea (1%)
Genitourinary: Urinary tract infection (5%)
Neuromuscular & skeletal: Increased creatine phosphokinase in blood specimen (4%)
Respiratory: Upper respiratory tract infection (9%)
Postmarketing: Hypersensitivity reaction, pruritus, skin rash
Mechanical GI obstruction (known or suspected); galactosemia
Concurrent drug therapy issues:
• Absorption: May reduce the absorption of concomitantly administered oral medications. Administer oral medications at least 2 hours before or 2 hours after lactitol.
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Dichlorphenamide: Laxatives may enhance the hypokalemic effect of Dichlorphenamide. Risk C: Monitor therapy
Lactitol has minimal systemic absorption.
Treatment of constipation in pregnant women is similar to that of nonpregnant patients, and medications may be used when diet and lifestyle modifications are not effective. In general, osmotic laxatives are not initial therapy and should be used with caution and only for short durations in pregnancy due to the risk of electrolyte abnormalities (Body 2016).
It is not known if lactitol is present in breast milk; however, lactitol has minimal systemic absorption.
According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and the benefits of treatment to the mother.
Bowel movement frequency, serum ammonia in patients with hepatic encephalopathy (as clinically indicated) (AASLD [Vilstrup 2014]).
Simple monosaccharide sugar; produces laxative effect in colon by causing water influx into small intestine.
Absorption: Minimal.
Half-life elimination: 2.4 hours.
Excretion: Feces (minimal).
