lactose question

[Share16]

My husband has been diagnosed with cirrhosis and he has been prescribed lactulose. He goes to the bathroom with diarrhea all day long. Is this normal? He quit taking it for a week and still had really bad diarrhea so I made him start taking it again. He doesn't even make it to the bathroom a lot and he goes at least 20 times a day.

[Share16]

Thank you for taking the time to answer my question Hector. I really appreciate it as I'm sure everyone on this site does. I posted that question hoping you would answer.  Have a great day!

[HectorSF]

Yes, call his GI. He should only have 2-4 bowel movements per day. Any more than that its increases his risk of dehydration resulting HE. Which defeats the whole purpose of the lactulose. He has only been on it for a month. From personal experience I can tell you it can some tweaking of the dose to get the right dose. But remember the goal is 2-4 bowel movements per day. That is when the lactulose is most effective against HE.

When your husband goes to UPMC let his doctor know about the diarrhea experiences and don't forget to mention the Xifaxan which has no problematic bowel movement effects. Just a simple pill, if his insurance will cover it.

I am hoping "things" settle down soon for your husband.

Take care.
Hector

[Share16]

Thank you for the info, his doctor did reduce his intake to two tablespoons (he was taking four a day.)  He still goes to the bathroom a lot during the day and night. He has only been on this med since his last hospital stay which was a month ago. He went off of it for a week and he still had diarrhea so I made him start taking it again. I just thought it was normal. I will call his GI today, we were kinda waiting until his appointment to complain about it, he has an appointment on Friday.  We have an appointment with a liver specialist on Sept 10 at UPMC in Pittsburgh. My husband says he will be dead by then.

[HectorSF]

Hello and welcome to the Cirrhosis of the Liver community.

No it is not normal to have diarrhea from lactulose. In fact having diarrhea can cause dehydration which can trigger an episode of hepatic encephalopathy (HE).  While lactulose is designed to keep the digestive system moving to prevent the build up of toxins which can go to the brain through the blood, too much lactulose can cause diarrhea which defeats the purpose of taking lactulose. So both constipation (food sitting in the digestion system for too long) and diarrhea can trigger episodes of HE.

The usual adult, oral dosage is 2 to 3 tablespoonfuls (about 30 to 45 mL) three or four times daily. The dosage may be adjusted every day or two to produce 2 or 4 soft stools daily. "soft stools" means loose not necessarily hard stools but NOT runny diarrhea.

It can take awhile to find the right dose so be patient. If your husband has diarrhea now I would reduce the dose to 2 tablespoons a day and then when his system is used to that dose then increase or decrease the dose until he is having 2-4 loose stools per day. At that point the lactulose will be most effective for managing his HE.

Also keep in your husband should not eat red meats which can cause increased toxins during their digestion and lead to HE.

You might also want to ask his doctor about Xifaxan (rifaximin), an antibiotic that has none of lactulose's nasty side effects that can be taken along with lactulose to help manage HE. The only only issue is that Xifaxan is a very expensive drug and depending on a person's health insurance is not always covered. For more information see their web site.
http://www.xifaxan.com/he/about-hepatic-encephalopathy/treating-he/?utm_source=bing&utm_medium=cpc&utm_campaign=Search%20|%20PAT%20|%20Branded&utm_term=xifaxan

I would also call the doctor that prescribed the lactulose and let them know what is going on. I think they will tell you just what I am telling you as to how to find (titrate) the proper dose for his lactulose.

I hope this helps.
Hector