Doses - LACTULOSE

Dogs:

For hepatic encephalopathy:
a) 15 - 30 ml PO qid; adjust the dosage to produce 2-3 soft stools per day (Cornelius and Bjorling 1988)
b) 30 - 45 mls PO q8h (Kirk 1986)
c) 5 - 15 ml PO tid; adjust dose to induce 2-3 soft stools per day; reduce dosage if diarrhea develops. In certain cases, neomycin with lactulose may be superior to either drug alone. (Hardy 1985)
For constipation:
a) 1 ml per 4.5 kg of body weight PO q8h initially, then adjust prn (Kirk 1986)

Cats:

For hepatic encephalopathy:
a) 0.25 - 1 ml PO; individualize dosage until semi-formed stools are produced. (Center,
Hornbuckle, and Scavelli 1986)
For constipation:
a) 1 ml per 4.5 kg of body weight PO q8h initially, then adjust prn (Kirk 1986)
b) 0.5 ml/kg q8-12h PO (Sherding 1989)

Birds:

For hepatic encephalopathy; to stimulate appetite, improve intestinal flora:
a) Cockatiel: 0.03 ml PO bid-tid; Amazon: 0.1 ml PO bid-tid. Reduce dosage if diarrheadevelops. May be used for weeks. (Clubb 1986)
Monitoring Parameters -

1) Clinical efficacy (2-3 soft stools per day) when used for PSE

2) In long-term use (months) or in patients with preexisting fluid/electrolyte problems, serum electrolytes should be monitored.
Client Information - Contact veterinarian if diarrhea develops. Also contact veterinarian whenlactulose is used for hepatic encephalopathy if symptoms worsen or less than 2-3 soft stools areproduced per day.
Dosage Forms/Preparations/FDA Approval Status/Withholding Times - Veterinary-Approved Products: None

Human-Approved Products:

Lactulose 666 mg/ml (10 grams/15 ml); [containing (per ml): < 147 mg galactose, < 80 mglactose, and ?80 mg other sugars] in 237, 240, 473, 480, 946, 960, 1920 ml, gal and UD 30 ml;
Chronulac® or Cephulac® (Merrill Dow), Constilac® or Cholac® (Alra), Constulose® or Enulose® (Barre), Generic; (Rx)
Note: Two separate products (trade names) are marketed by the same company; one product ismarketed as a laxative and one product is marketed for hepatic encephalopathy.