Hi clovers. I was thinking about that too because it helps elimination, it helps eliminate toxins & decrease brain fog. Fog is increasing with me but my blood work- nitrogen & electrolytes - doesn't support a dx of HE.
You could try it as he prescribes, see how it affects you, report back to dr.

Hope some more experienced members reply; I'd like to know more, too.

I just asked that exact question to my doctor yesterday because I HATE the effect it has on me. I am eating a lot more fiber and everything and am "going" the number of times a day they want me to "go". So I had quit taking it. I got yelled at. I was told by her and by the ER doctor on Friday that I "HAVE" to take the lactulose. It helps to extract the toxins I guess. So, I started it again. Yuck.

Shelley

thnx 4 reply, curious how much lac do u guys take? I take 1 Tbs

30 ml (1 ounce) 3x's a day the toilet and I are becoming fast friends.. I have named him Fred. ha ha ha. So now I just say, I'm going to visit Fred. ;)

As with Shelley, I'm one of the anti-lactulose people on the board.

Some people do okay, you just have to try it and experiment with the dosage to see if you can handle it.

I despise it and have 5 1/2 pints in my cupboards where they will probably stay until they expire and I flush them. I restarted it again this past spring, about three tablespoons twice a day. Horrible, even as I kept dropping the dose and gave up again after about a month. As Shelley said, make sure "Fred" is nearby.

While the laxative effect of Lactulose is important, that is not the reason that doctors prescribe this particular medication. Otherwise, they could just prescribe ANY laxative or a stool softener or fiber and be done with it - as long as they have enough bowel movements.

The special thing about Lactulose is the chemical reaction it has in the body - which is why it is the preferred medication to take instead of other laxatives. I'm not pretending to be a chemist or anything, but this is how it was explained to me... the medication has a certain chemical formula... when it interacts with the ammonia (the chemical formula for ammonia), it turns it into a salt... in other words, no more ammonia to bring up to the brain. And it pulls that into the stool and eliminates it (laxative bit). However, lactulose then needs to be taken continuously for the ammonia to continue to be converted to a salt or it just travels right back up to the brain.

Why they have not made a medication JUST for the chemical reaction (aka minus the laxative bit), I do not know. Probably because it's just good for people to get other toxins out through their bowel movements because we know ammonia is not the only offender when it comes to HE.

Keribearie, thank you for balancing out my somewhat negative reply.

It does play a very important part in clearing ammonia. I also wish somebody would come up with a way to eliminate the ammonia salts created without the side effects.

I just remember when hospitalized having to take four of those Nyquil sized caps, twice a day. Not sure of the measurement, but it was a lot. Then they upped me to seven, twice a day. That was an incredibly high dose, and should only be taken in a hospital, where they can monitor your fluids and keep you hydrated with IVs.

Not a pleasant time so probably has a lot to do with why I don't care for it.

Hi, I'm Amy. I have been reading this forum for a few months now trying to wrap my head around my new diagnosis I received 12/28/2012. I have learned a lot from you all about so many things. I was reading tonight and saw this post, I decided to join because I do take lactulose . I take 30ml a day, it expels the ammonia from the liver where HE stays in check.
What trick I have found is that I take it before bed, and basically sleep through the "effects". When I get up, there is no diarrhea 9 out of 10 times.
Just thought I would put my 2 cents in :) Have a great day!

Welcome to the group Amy.

Thanks for the advice, never even occurred to me. I've always taken it first thing in the morning which then affects me the rest of the day.

I'm going to try your night-time routine and see if I can deal with the medication a little better.

The side effects are not fun, but I wish they could somehow convert it into a pill or capsule. Just drinking the dose I almost vomit. You'd think there would be a way to remove the water, leaving a solid pill which you could then take with water, but without the gag effect.

I have had success with Lactulose, taken twice daily,in eliminating ammonia in the blood stream that goes to the brain and causes varying degrees of HE. I have only minor "episodes" of HE now whereas before, my husband was worried that I may have been developing Alzheimers or something. Not so...........

I still have confusion with some things and dare not drive a car. In fact I sold it and now rely on husband to take me where I need to go......That's ok......he isn't doing anything anyway!!! I seem to "know" when I am experiencing the brain fog and confusion and he always says that I have that distinct smell of "sweet ammonia" on my breath when it happens. He knows to steer me towards the chair and away from my grandkids, especially, because I would die if my grandkids were to see me when I am having an episode. So far, so good.

Hope this helps. I know that if Lactulose is prescribed then you should make the effort to take it with the understanding that the doseage will be altered as allowed. Sometimes, when a person has a diarhea (sp) problem from maybe something they ate or a tummy bug of some kind, it would be a good idea to alter the dose of Lactulose until the body returns to a more normal schedule.
This has been my pattern anyway. Hugs and prayers to all and have a wonderful, blessed weekend and keep each other in your thoughts and prayers.........we all need it! CarolLentz

My wife Jaymee was just released from the hospital again and her ammonia levels were up in the mid 50's. They put her on lactulose and it destroyed her stomach, so we switched to Xifaxin. I will say that the lactulose was effective in immediately dropping the ammonia levels down to the mid 30's within two days, but it took a nasty toll on her stomach & colon. The Xifaxin is not as quick, and the cost will make your head spin, but has had no side-effects in the past week and a half of taking it. The whole purpose of the drugs in our case is to avoid/delay Hepatic Encephalopothy while we are heading towards liver transplant. Hope this helps.

Xifaxan is the way to go, but like you said, the cost is insane.

If you've got good insurance, a much better solution than lactulose.

Haven't looked in over a year, but at that time would have run me $1400 a month. Will do some checking with the Social Security add-on plans this year, might work out cheaper, since I'm still paying 20% for all the other things.

The Xifaxin was just under $1400, but at least the manufacturer help us out with a whopping $135 coupon...Lol. Something is better than nothing. Luckily we do have good insurance and we get 80% back, but those pills are now under armed guard and are taken nowhere near a sink or open drain...

NASH induced end stage cirrhosis...also have insulin pump for diabetes. have a TIPS and take 3 doses (30ml) daily....the quality of life issue is a constant concern. I have diarrhea most of the time and hate to go anywhere or do anything...constant fear of accidents. Even taking lactulose...I still usually have ammonia level in the low hundreds so constantly fight HE. Also difficult to manage diabetes due to the unpredictability of my lactulose treatment. My labs are steady though I also have Hepatopulmonary syndrome which further limits my function. Frustrated. ..dr. appears pleased when I visit but I feel I've given up so much...please share your experiences with TIPS and lactulose treatment.