Lactulose (Constulose, Enulose, Generlac)

Drug Class: Laxative, ammonia detoxicant

Prevents absorption of ammonia in the colon by acidifying stool; increases water, softens
ACTION stool
Chronic constipation, portal-systemic encephalopathy (PSE) in patients with hepatic disease
INDICATION

GI: nausea, vomiting, anorexia, abdominal cramps, diarrhea, flatulence, distention, and
MAJOR SIDE
belching.
EFFECTS
META: Hypernatremia, hypokalemia, hyperglycemia (diabetes)
Hypersensitivity, low-galactose diet
CONTRAINDICATIONS Precautions: Pregnancy, breastfeeding, geriatric patients, debilitated patients, DM
Assess:
- Stool: amount, color, consistency, frequency, abdominal pain/distention, bowel
sound prior to use and after use
- Cause of constipation; determine whether fluids, bulk, or exercise is missing from
lifestyle; use of constipating products.
- Hepatic encephalopathy: blood ammonia level, may decrease ammonia level by 25%
- 50%; clearing of confusion, lethargy, restlessness, irritability if postal-systemic
encephalopathy; monitor sodium in higher doses.
- Blood, and urine electrolytes if the product is used often; may cause diarrhea,
hypokalemia, and hyponatremia.
NURSING - I&O ratio to identify fluid loss and replace any loss.
CONSIDERATION - Cramping, rectal bleeding, nausea, vomiting; if these symptoms occur, they should
be discontinued.
- Evaluate: therapeutic response; decrease constipation, decrease blood ammonia
level, clearing of mental state
Patient/Family Teaching:
- Not to use as laxative long term, to use only as prescribed.
- To dilute with water or fruit juice, to counteract the sweet taste.
- To store in a cool environment, not freeze
- To take on an empty stomach for rapid action
- To report diarrhea, number, amount, and consistency of stool; may indicate an
overdose
 Polyethylene Glycol
Class: Laxatives
Mechanism of Action Polyethylene glycol functions as an osmotic laxative that causes increased water
retention in the lumen of the colon by binding to water molecules, thereby producing
loose stools.
Indication Polyethylene glycol is indicated for use as an over-the-counter osmotic laxative to
relieve occasional constipation. When used in combination with sodium ascorbate,
sodium sulfate, ascorbic acid, sodium chloride, and potassium chloride, it is used for
cleansing of the colon in preparation for colonoscopy in adults
Major Side Effects  severe or bloody diarrhea, severe and worsening stomach pain
 rectal bleeding and blood in your stools
Contraindications Contraindicated in patients with known or suspected bowel obstruction, appendicitis,
inflamed bowel disease, perforated bowel, and hypersensitivity to polyethylene glycol,
any component of the formulation.
Nursing Considerations Assess the patient for abdominal distention, presence of bowel sounds, and usual
pattern of bowel obstruction.
Check stool after the medication is given.
Patient Teaching Inform the patient that 2-4 days may be required to produce bowel movements. Should
not be used for more than a week. Prolonged, frequent, or excessive use may result in
electrolyte imbalance and laxative dependence. Notify the health care provider if
unusual cramps, bloating, or diarrhea occurs.

Reference:
Polyethylene Glycol. Uses, Interactions, Mechanism of Action | DrugBank Online. (n.d.).
https://go.drugbank.com/drugs/DB09287

Skidmore-Roth, L. (2022). Mosby’s 2022 Nursing Drug Reference (35th Edition). Elsevier.