LACTULOSE
-
lactulose solution
ANIP Acquisition Company
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Lactulose is a synthetic disaccharide in solution form for oral administration. Each 15 mL of lactulose solution contains: 10 g lactulose (and less than 1.6 g galactose, less than 1.2 g lactose, and 0.1 g or less of fructose.)
Lactulose is a colonic acidifier which promotes laxation.
The chemical name for Lactulose is 4-0-β-D-galactopyranosyl-D-fructofuranose. It has the following structural formula:
The molecular weight is 342.30. It is freely soluble in water.
Lactulose is poorly absorbed from the gastrointestinal tract and no enzyme capable of hydrolysis of this disaccharide is present in human gastrointestinal tissue. As a result, oral doses of Lactulose reach the colon virtually unchanged. In the colon, Lactulose is broken down primarily to lactic acid, and also to small amounts of formic and acetic acids, by the action of colonic bacteria, which results in an increase in osmotic pressure and slight acidification of the colonic contents. This in turn causes an increase in stool water content and softens the stool.
Since Lactulose does not exert its effect until it reaches the colon, and since transit time through the colon may be slow, 24 to 48 hours may be required to produce the desired bowel movement.
Lactulose given orally to man and experimental animals resulted in only small amounts reaching the blood. Urinary excretion has been determined to be 3% or less and is essentially complete within 24 hours.
For the treatment of constipation. In patients with a history of chronic constipation, Lactulose solution therapy increases the number of bowel movements per day and the number of days on which bowel movements occur.
Since Lactulose solution contains galactose (less than 1.6 g/15 mL), it is contraindicated in patients who require a low galactose diet.
A theoretical hazard may exist for patients being treated with lactulose solution who may be required to undergo electrocautery procedures during proctoscopy or colonoscopy. Accumulation of H2 gas in significant concentration in the presence of an electrical spark may result in an explosive reaction. Although this complication has not been reported with lactulose, patients on lactulose therapy undergoing such procedures should have a thorough bowel cleansing with a non-fermentable solution. Insufflation of CO2 as an additional safeguard may be pursued but is considered to be a redundant measure.
Since lactulose solution contains galactose (less than 1.6 g/15 mL) and lactose (less than 1.2 g/15 mL), it should be used with caution in diabetics.
In the event that an unusual diarrheal condition occurs, contact your physician.
Elderly, debilitated patients who receive lactulose for more than six months should have serum electrolytes (potassium, chloride, carbon dioxide) measured periodically.
Results of preliminary studies in humans and rats suggest that nonabsorbable antacids given concurrently with Lactulose may inhibit the desired lactulose-induced drop in colonic pH. Therefore, a possible lack of desired effect of treatment should be taken into consideration before such drugs are given concomitantly with lactulose solution.
There are no known human data on long-term potential for carcinogenicity, mutagenicity, or impairment of fertility.
There are no known animal data on long-term potential for mutagenicity.
Administration of lactulose solution in the diet of mice for 18 months in concentrations of 3 and 10 percent (v/w) did not produce any evidence of carcinogenicity.
In studies of mice, rats, and rabbits, doses of lactulose solution up to 6 or 12 mL/kg/day produced no deleterious effects in breeding, conception, or parturition
Pregnancy category B. Reproduction studies have been performed in mice, rats and rabbits at doses up to 3 or 6 times the usual human oral dose and have revealed no evidence of impaired fertility or harm to the fetus due to lactulose. There are, however, no adequate and well controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.
Precise frequency data are not available.
Initial dosing may produce flatulence and intestinal cramps, which are usually transient. Excessive dosage can lead to diarrhea with potential complications such as loss of fluids, hypokalemia, and hypernatremia.
Nausea and vomiting have been reported.
There have been no reports of accidental overdosage. In the event of overdosage it is expected that diarrhea and abdominal cramps would be the major symptoms. Medication should be terminated.
Oral LD50: The acute oral LD50 of the drug is 48.8 mL/kg in mice and greater than 30 mL/kg in rats.
Dialysis: Dialysis data are not available for Lactulose. Its molecular similarity to sucrose, however, would suggest that it should be dialyzable.
The usual dose is 1 to 2 tablespoonfuls (15 to 30 mL, containing 10 g to 20 g of lactulose) daily. The dose may be increased to 60 mL daily if necessary. Twenty-four to 48 hours may be required to produce a normal bowel movement.
Note: Some patients have found that lactulose solution may be more acceptable when mixed with fruit juice, water, or milk.
Lactulose Solution is a natural colored and an unflavored solution available in 8 fl. oz. (237 mL); 16 fl. oz. (473 mL) and 1 quart (946 mL) bottles.
Lactulose Solution contains lactulose 667 mg/mL (10 g per 15 mL).
NDC 62559-5501-8: bottles of 237 mL.
NDC 62559-5501-6: bottles of 473 mL.
NDC 62559-5501-3: bottles of 946 mL.
Store between 36°–77° F (2° to 25°C). Do not freeze.
Under recommended storage conditions, a normal darkening of color may occur. Such darkening is characteristic of sugar solutions and does not affect therapeutic action. Prolonged exposure to temperatures above 86°F (30°C) or to direct light may cause extreme darkening and turbidity which may be pharmaceutically objectionable. If this condition develops, do not use.
Prolonged exposure to freezing temperatures may cause change to a semisolid, too viscous to pour. Viscosity will return to normal upon warming to room temperature.
Dispense in a tight, light resistant container as defined in the USP, with a child-resistant closure.
Rx Only
Distributed By:
ANI Pharmaceuticals, Inc.
Gulfport, MS 39501
501-55016-0
Rev. 07/2010
Ver. 3
NDC 62559-5501-8
Lactulose Solution, USP, 10g/15 mL
Each 15 mL (one tablespoonful)
contains: 10 g lactulose (and less than
1.6 g galactose, less than 1.2 g lactose
and 0.1 g or less of fructose).
INDICATIONS AND DOSAGE:
For the treatment of constipation.
See outsert labeling for full information.
Rx only
ANI
Pharmaceuticals, Inc.
NET CONTENTS: 8 fl. oz. (237 mL)
PHARMACIST:
Dispense in a tight, light
resistant container with a
child-resistant closure.
STORAGE: Store between
36°-77°F (2° to 25°C).
Do not freeze.
WARNING: Keep this and all
medication out of the reach of children.
Since lactulose does not
exert it's effect until it
reaches the colon, and since
transit time through the colon
may be slow, 24 to 48 hours
may be required to produce a
normal bowel movement.
Some patients have found
that lactulose solution may
be more acceptable when
mixed with fruit juice, water
or milk.
Product may darken slightly
but therapeutic action is not
affected. Do not use if
extreme darkening or
turbidity occurs.
Manufactured by
Lacsa (Pty) Limited
Natal South Africa
Packaged and distributed by
ANI Pharmaceuticals
Gulfport, MS 39501
N3 62559 55018 5
Lot No:
Exp. Date:
301-55018-0
NDC 62559-5501-6
Lactulose Solution, USP, 10g/15 mL
Each 15 mL (one tablespoonful)
contains: 10 g lactulose (and less than
1.6 g galactose, less than 1.2 g lactose
and 0.1 g or less of fructose).
INDICATIONS AND DOSAGE:
For the treatment of constipation.
See outsert labeling for full information.
Rx only
ANI
Pharmaceuticals, Inc.
NET CONTENTS: 16 fl. oz. (473 mL)
PHARMACIST:
Dispense in a tight, light
resistant container with a
child-resistant closure.
STORAGE: Store between
36°-77°F (2° to 25°C).
Do not freeze.
WARNING: Keep this and all
medication out of the reach of children.
Since lactulose does not
exert it's effect until it
reaches the colon, and since
transit time through the colon
may be slow, 24 to 48 hours
may be required to produce a
normal bowel movement.
Some patients have found
that lactulose solution may
be more acceptable when
mixed with fruit juice, water
or milk.
Product may darken slightly
but therapeutic action is not
affected. Do not use if
extreme darkening or
turbidity occurs.
Manufactured by
Lacsa (Pty) Limited
Natal South Africa
Packaged and distributed by
ANI Pharmaceuticals
Gulfport, MS 39501
N3 62559 55018 5
Lot No:
Exp. Date:
301-55018-0
NDC 62559-5501-8
Lactulose Solution, USP, 10g/15 mL
Each 15 mL (one tablespoonful)
contains: 10 g lactulose (and less than
1.6 g galactose, less than 1.2 g lactose
and 0.1 g or less of fructose).
INDICATIONS AND DOSAGE:
For the treatment of constipation.
See outsert labeling for full information.
Rx only
ANI
Pharmaceuticals, Inc.
NET CONTENTS: 32 fl. oz. (946 mL)
PHARMACIST:
Dispense in a tight, light
resistant container with a
child-resistant closure.
STORAGE: Store between
36°-77°F (2° to 25°C).
Do not freeze.
WARNING: Keep this and all
medication out of the reach of children.
Since lactulose does not
exert it's effect until it
reaches the colon, and since
transit time through the colon
may be slow, 24 to 48 hours
may be required to produce a
normal bowel movement.
Some patients have found
that lactulose solution may
be more acceptable when
mixed with fruit juice, water
or milk.
Product may darken slightly
but therapeutic action is not
affected. Do not use if
extreme darkening or
turbidity occurs.
Manufactured by
Lacsa (Pty) Limited
Natal South Africa
Packaged and distributed by
ANI Pharmaceuticals
Gulfport, MS 39501
N3 62559 55018 5
Lot No:
Exp. Date:
301-55018-0
LACTULOSE
lactulose solution |
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Marketing Information | |||
Marketing Category | Application Number or Monograph Citation | Marketing Start Date | Marketing End Date |
ANDA | ANDA078430 | 07/20/2010 | 04/27/2012 |
Labeler - ANIP Acquisition Company (145588013) |
Registrant - ANIP Acquisition Company (145588013) |
Establishment | |||
Name | Address | ID/FEI | Operations |
ANIP Acquisition Company | 148515737 | ANALYSIS, MANUFACTURE |
Revised: 05/2012 ANIP Acquisition Company