Possible Interaction: Ammonia and Lactulose

“Patients receiving lactulose showed statistically significant reduction in both encephalopathy and blood ammonia levels over the 10-day period as compared to the control patients.”

“ Lactulose appears to exert its action by diminishing the absorption of ammonia from the acidified co...”

“The current treatments for hyperammonemia, such as antibiotics or lactulose , are designed to decrease the intestinal production of ammonia and/or its absorption into the body and are not effective, besides being often accompanied by side effects.”

“ Lactulose , used in the treatment of acute and chronic PSE, acts by inhibiting gastrointestinal absorption of ammonia and other toxic nitrogenous substances, and by reducing urea degradation.”

“…,lactulose, … ammonia production and absorption.1 Moreover, evidence suggests that the latter effects occur because lactulose serves as a “prebiotic” ingredient,2 encouraging the growth of …) by prebiotics, probiotics, or a combination of the two (synbiotics) might work for HE, as reflected in this issue,5 is not novel.”

“The administration of lactulose causes a reduction in the urea production rate consistent with a reduced entry of ammonia into portal blood, but it does not appear to directly inhibit urea degradation.”

“The meta‐analysis revealed … with placebo, lactulose , and probiotics had … in reducing ammonia serum levels and total SIP (Sickness Impact Profil) score; ALC had better efficacy in lowering serum level of ammonia … increasing the serum level of albumin; rifaximin and LOLA had better efficacy in reducing total SIP score.”

“Synbiotic formulation of probiotic and lactulose can synergistically/additively reduce ammonia production , increase utilization and excretion of ammonia and other nitrogenous wastes, thereby improving the well-being of patients with hepatic encephalopathy.”

“ Arterial ammonia decreased after lactulose treatment compared to baseline (83.7±19.1 vs. 65.1±19.3 μmol/l, P=0.001).”

“Empiric therapy for HE is largely based on the principle of reducing the production and absorption of ammonia in the gut through administration of pharmacological agents such as rifaximin and lactulose , which are approved by the FDA for the treatment of HE.”