Dyufalak

General characteristics. Structure:

Active agent: lactulose of 66,7 g

Excipient: the water purified — to 100 ml.

Pharmacological properties:

Pharmacodynamics. Has hyperosmotic laxative effect, stimulates an intestines peristaltics, improves absorption of phosphates and Ca2+ salts, promotes removal of ions of ammonium.

Lactulose is split by an indestinal flora of a large intestine on low-molecular organic acids which lead to decrease in pH, and, due to increase in osmotic pressure, to increase in volume of intestinal contents. The specified effects stimulate a peristaltics of intestines and exert impact on a chair consistence. The lock disappears, and the physiological rhythm of emptying of a large intestine is recovered.

At hepatic encephalopathy and a hepatic coma the effect is attributed to suppression of proteolytic bacteria by means of increase in quantity of acidophilic bacteria (for example lactobacilli); to transition of ammonia to an ionic form due to acidulation of contents of a large intestine; to bowel emptying owing to decrease in pH in a large intestine and osmotic effect; and also to reduction of nitrogen-containing toxic substances by stimulation of the bacteria utilizing ammonia for bacterial proteinaceous synthesis.
Inhibits growth of salmonellas in intestines, reduces the bakteriovydeleniye period.

Pharmacokinetics. Absorption is low; without being soaked up, reaches a large intestine where it is split by an indestinal flora. It is completely metabolized at doses to 45–70 ml; at higher dosage — it is partially removed in not changed look.

Indications to use:

- lock: regulation of a physiological rhythm of emptying of a large intestine;

- a chair softening in the medical purposes (hemorrhoidal nodes, a large intestine operations and in an anus);

- hepatic encephalopathy — treatment and prevention of a hepatic coma and prekoma;

- intestinal dysbiosis; the enteritis caused by salmonellas, shigellas, a salmonellosis in a bacteriocarrier stage; a syndrome of putrefactive dyspepsia (at children of early age as a result of acute food poisonings).

Route of administration and doses:

Inside, during food (morning), the dose is established individually.

At treatment of a lock or for a softening of a chair the following dosages are accepted (see the table).
Dosing ^{of Dyufalaka®} at treatment of a lock or for a chair softening

Age	Initial dose, ml	Maintenance dose, ml
Adults	15–45	10–25
Children of 7-14 years	15	10
Children of 3-6 years	5–10	5–10
Children up to 3 years	5	5

As a rule, the dose can be lowered after 2 days of reception depending on need of the patient. The clinical effect occurs in 2 days. It is peculiar to effect of lactulose. The dose or frequency of reception are increased if within 2 days of administration of drug improvement of a condition of the patient is not observed.
At treatment of a hepatic coma and prekoma: an initial dose — 30–45 ml 3 times a day. Then pass to individually picked up maintenance dose that the soft chair was at most 2-3 times a day, and an indicator рН a chair was in limits 5,0–5,5.
In acute cases of Dyufalak® 300 ml of drug and 700 ml of water can be appointed in the form of enemas in the ratio.
At treatment of an intestinal dysbiosis: to children till 1 year a daily dose — 1,5–3 ml, 1–3 years — 3 ml, 4–7 years — 5 ml, are more senior than 7 years and adult — 10 ml.
At treatment of a salmonellosis, shigellosis: in the first 10–12 days — on 15 ml 3 times a day, after a week break — in the same dose of 5 times a day.

Features of use:

In case of lack of therapeutic effect within 2 days or when resuming a lock after treatment it is necessary to consult with the doctor.
Patients with a lactose intolerance, at use of this drug, need to consider the content of lactose in drug (Dyufalak® contains up to 1,7 g of a galactose and to 0,9 g of lactose in 15 ml of syrup).

The dose which is usually used at a lock should not represent a problem for patients with a diabetes mellitus. The dose used at treatment of a hepatic coma is usually much higher and therefore it has to be specified at appointment to patients with a diabetes mellitus.
At prolonged treatment (more than 6 months) the raised doses of drug it is regularly necessary to control the level of electrolytes in a blood plasma.

Drug does not influence or exerts insignificant impact on ability to driving of the car and to control of cars and mechanisms.

Side effects:

In the first days emergence of a meteorism (passes in 2 days) is possible, at overdose pains in a stomach, diarrhea can be observed that demands dose adjustment. In case of use of the raised doses for a long time at treatment of hepatic encephalopathy disturbances of electrolytic balance owing to diarrhea are possible.

Gastrointestinal frustration: meteorism, nausea, vomiting. When using high doses — diarrhea.

Interaction with other medicines:

Because of the mechanism of the effect of lactulose consisting in decrease in pH in a large intestine, HP which release depends on pH in a large intestine (such as drugs of 5-aminosalicylic acid) can be inactivated.

Contraindications:

- hypersensitivity to active component or fructose, a galactose, lactose;
- galactosemia;
- impassability of intestines.

With care:
diabetes mellitus.

Use at pregnancy and feeding by a breast
Lactulose can safely be applied at pregnant women and nursing mothers.

Overdose:

Symptoms: when using high doses — an abdominal pain, diarrhea.

Treatment: administration of drug it is necessary to stop or reduce a dose.

Storage conditions:

In the place protected from light, at a temperature of 10-25 °C.
To store in the place, unavailable to children.

Issue conditions:

Without recipe

Packaging:

In polyethylene bottles on 200, 500 or 1000 ml with the screw-on cover, complete with a measured glass; in one-time bags from polyethylene and aluminum foil on 15 ml; in a box of cardboard 10 packages.