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9662954 tn?1405606159

Lactulouse....what's your dose?

I just started lactulouse today and wondered if there is a standard dose, or does it change from one person to the next?  I'm on the other drug xifaxan 550 mg 2X a day to help keep amonia down and prevent a certain infection.

I am on these drugs and diet restrictions salt, red meat, only liver friendly foods too for my portal hypertension that has now definitively turned on H. E.  I'm trying hard to work, and not get too confused, but I've had a really tuff time. A couple of weeks ago I thought summer started in two months again? My short term memory loss is profound, and lately, essentially due to fear, I've been a mess--which activates my vertigo and wham... I'm a drunk walking ditz!

Anyway, I was wondering about dosing and managing my newest drug.  Will I ever be normal again? I am also post S&O June 27, 2014---with a sustained response. No hep c, now it's picking up the pieces and the worst seems to be cirrhosis and all its symptoms.

Any advice or comments would be very appreciated.

Sincerely, dbzc

Ps. A recipe for the perfect liver friendly sandwich would be so appreciated!
9 Responses
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317787 tn?1473358451
Hi there!  I would use whole grain bread and cook a turkey.
Processed meats are really not good for us, too much salt.  If a turkey is too much it could be a chicken you can just slice portions, add lettuce tomato, etc.
I have been using whey protein drinks, adding  fruit for breakfast for the past year.  I had read that branch chain amino acids were good for the liver and they are in the whey protein that I am drinking.  It is a good idea to have something to eat ready so that I don't eat any junk :)
Take Care, Dee
Helpful - 0
1198742 tn?1293503376
Hi my husband is going through ESLD and been on lactulose for 4 years now,, As for lactulose it is a man made sugar that's makes you go to the bathroom, My husband use to take 5 table spoons a day, Now he just drinks it from the bottle, Depends if he goes or not he will take more,, You can never overdose on lactulose,, The liver doctor told me I was doing a good job by giving him more, Some days it less just depends, Take more if you haven't went by the end of the day
Helpful - 0
9662954 tn?1405606159
Did you see the comment on the sheet for both drugs where it says, regardless of the side effects, your doctor has determined that they outweigh the benefit.

My original directions were exactly what my rx was.  All I know is that is too much.  Cutting back has helped a lot so far!  Now that it seems everyone else had to adjust to get it right I am relieved!

Thanks for the extra info.  Now I want to know why the new extra pain when I eat? I do not have a gall bladder, so I think it's the food. I had applesauce, (natural) and I got the pain again!  I don't know if it's the drugs and the food, or just the type of food?  They are new and different foods?  

The other thing I am clueless about are signs and symptoms that mean isomething is amiss with the portal hypertension? Like if the pressure goes up is there pain? That's weird because it's def related to food?

So, if anyone knows about liver pain and portal hypertension that would be helpful too. I don't recall seeing anthing about this in the toolkit? So far I can't find anything specific via a search,


Thank you Lynn!
Helpful - 0
9662954 tn?1405606159
Thanks Dee! The idea that things can get better is so helpful!  

What is your go to liver friendly food, and did you do something special to get normal? I'm trying to figure out a routine to follow along with what I hope are temporary   Symptoms,  

I'm checking the Hector link as soon as I send this. I already have the cirrhosis toolkit he suggested--it is a life  Thank you so much for sharing and for for your help!  I am finding I am learning more from you all than from my nurse!  Thank you.
Helpful - 0
9662954 tn?1405606159
Thank you! I did cut back and so far this day has not been as bad as the first day and full dose.  Since taking the antibiotic, I do not think things are better or worse?  Then again it's hard to keep up with myself?

One thing that has resurfaced that I have NOT had since the beginning of the S&O treatment is more actual liver pain? It's in my front liver area and then travels to my back, neck and then right arm..its a neuropathy type pain except stabbing shoulder (like post biopsy pain).    And, it is most pronounced about 15 to 30 minutes after I eat?   I can deal, I just think the timing is too coincidental.

Nan, what kind of food do you guys eat? I think my fancy protein drink is too strong?  Is there a sandwich your husband can eat or comfort food that does not break the rules?  I have zero appetite and just want something easy to make?  Plus if it help minimize this pain, that would be great!  
Helpful - 0
Avatar universal
Congratulations on achieving SVR. That is the most important thing for someone who has advanced cirrhosis.  Your question is one my husband and I have wrestled with for years now. He too has portal hypertension and bouts of HE. He has been keeping it under good control over the last two months since ending his Hep C treatment which unfortunately was not successful.  
He too is also taking Xifaxin, same as you - 550 mg twice a day. He takes 30 ml of lactulose twice a day, once in the morning after breakfast and another 30 ml at bedtime. Before starting back on Xifaxin, he was taking lactulose three times a day. He cut back to twice a day once he started on the antibiotic.
   That is my husband's experience. I hope you are able to find the right balance soon that will help prevent those bouts of HE. I know how difficult it is on you.
Keep us posted.
Nan
Helpful - 0
683231 tn?1467323017
Hi
I did find the prescribing information sheets that should come with your prescriptions they explain how to take and common side effects

here is the one for Xifaxan 550

Most common adverse reactions in HE (≥ 10%): Peripheral edema,
nausea, dizziness, fatigue, and ascites (6.1)

http://cdn.salix.com/shared/pi/xifaxan550-pi.pdf

The one I found for Lactulose is from the UK so the one you received may be somewhat different.

http://www.drugs.com/uk/pdf/leaflet/294875.pdf


HEPATIC ENCEPHALOPATHY:
Initially 30-50ml (6-10x5ml spoonfuls) three times daily: Adjust dose to produce 2 or 3 soft stools daily. Please note: Due to the action of Lactulose Solution BP it may take 2-3 days to show results. It is important to take the medicine regularly.

FOR THE TREATMENT OF HEPATIC ENCEPHALOPATHY
Initially 6 to 10 x 5ml spoonfuls (30ml to 50ml), three times a
day. The dosage may be adjusted until you produce 2 or 3 soft
stools a day. If you are unsure about how to go about this, see
your doctor. If you suffer with diarrhoea whilst taking lactulose,
your dosage will need to be reduced. Discuss this with your doctor
or pharmacist.
If you forget to take a dose, take the missed dose as soon as you
remember. If your next dose is due within 3 hours, take a single
dose straight away and skip the next.
If you take an unintentional extra dose, this should not cause
problems. If you or someone else has taken too much lactulose or
a large overdose has been taken, contact your doctor or hospital
accident and emergency department immediately.

also from H.E. 123

http://he123.liverfoundation.org/treatment-basics/treatment-medications/lactulose/

What are the Side Effects of Lactulose?
Side effects may include:
•Diarrhea
•Nausea
•Gas; feeling bloated
•Abdominal discomfort
•Dehydration (severe loss of water/fluids from your body)
Tell your doctor if any of these symptoms are severe or do not go away. Dehydration can actually trigger an Hepatic Encephalopathy recurrence.
If you have stomach pain, vomiting, muscle cramps, dizziness or weakness, stop taking the lactulose and call your doctor right away.
Although uncommon, if you should experience any signs of an allergic reaction like hives, difficulty breathing, swelling of your face, lips, tongue or throat seek emergency medical help.
The goal of treatment is to maximize benefits and minimize side effects. Communicating with your doctor is important so that he or she can determine the best dosage for you.


Hope that helps
Lynn
Helpful - 0
317787 tn?1473358451
Sorry, I meant to say it is a balancing act to take care of the HE without having diarrhea.  I started on a lower dose just to try to get used to it at first.  Since you are taking antibiotics you may not need as much of the lactulose
I found that taking it after eating it did not upset my stomach as much.
Helpful - 0
317787 tn?1473358451
Hey there, congratulations for getting through tx and being SVR.  As time goes by your liver should start to regenerate.  I tried to find information about lactulose, HE etc.  Hector is not feeling well or he would have answered you so I found a link where he explained everything.
When I was having problems I took two table spoons a day.  I no longer take it but I would imagine that others took more or less depending on how they were doing.
I did not have the antibiotic so can't comment but I did see that Hector wrote about it here.

http://www.medhelp.org/posts/Cirrhosis-of-the-Liver/Advanced-cirrhosis-and-lactulose-I-had-cirrhosis/show/1922693

I hope this helps you, for more information you can click on the magnifying glass icon at the top of the page and search.  I will try to find more.
Take Care
Dee
Helpful - 0
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