락툴로오스

이당류 하제 / 암모니아 저하제

**락툴로오스(Lactulose)**는 갈락토오스와 프럭토스로 구성된 합성 이당류 유도체입니다. 수의학에서는 주로 다음 두 가지 중요한 목적으로 사용됩니다: * **간성 뇌증(HE) 관리**：간 기능이 손상된 환자(예: 문맥전신단락, 중증 간경변)의 혈중 암모니아 수치를 낮추는 핵심 치료제입니다. 결장에서 암모니아를 포획하여 혈류 내 신경독성 물질의 축적을 방지합니다. * **삼투성 하제**：만성 변비 및 분변매복, 특히 거대결장증을 앓고 있는 고양이의 관리에 널리 사용됩니다. **임상 팁**：고양이는 끈적이고 단맛이 나는 시럽 형태의 락툴로오스를 매우 싫어하는 경향이 있어(침 흘림 및 거부 반응 유발), 결정형 제제(*Kristalose*)를 습식 사료에 섞어 투여하는 것이 내약성과 장기적인 순응도를 높이는 데 훨씬 유리합니다.

작용 기전: Lactulose exerts its effects locally in the gastrointestinal tract through two distinct mechanisms: * **Ammonia Reduction (Ion Trapping)**: Lactulose is not hydrolyzed by mammalian gut enzymes. It reaches the colon intact, where it is fermented by resident bacteria into low-molecular-weight organic acids (**lactic, formic, and acetic acids**). This fermentation drops the colonic pH. The acidic environment causes diffusible, neurotoxic ammonia (**NH3**) to migrate from the bloodstream into the colon, where it is protonated into the non-diffusible ammonium ion (**NH4+**). The ammonium is then trapped in the lumen and excreted in the feces. * **Osmotic Laxative Effect**: The unabsorbed disaccharide and its organic acid metabolites exert a strong osmotic pressure, drawing water into the bowel lumen. This increases fecal bulk and moisture, stimulating colonic peristalsis and facilitating bowel movements.

동물 종별 용량

Cats

Hepatic encephalopathy · 0.25-1 mL · PO · As needed · Individualize dosage until semi-formed stools are produced
Constipation · 1/2 to 3/4 of a teaspoonful · PO · twice daily · Suggested dose
Constipation · 5-10 mL per cat · Rectal · Once · Administered slowly as an enema with a well-lubricated 10-12 (french) rubber catheter or feeding tube
Constipation · 0.5 mL/kg · PO · two to three times a day
Chronic constipation (maintaining soft stools) · 0.5 mL/kg · PO · two to three times daily · Dosage is adjusted to obtain the stool quality desired
Hepatic encephalopathy / Constipation · Dose not specified in text. Titrate to effect (reduce dose if diarrhoea develops). · PO · Not specified · Ongoing · Alternative provided in text: Lactitol (β-galactosidosorbitol) powder at 500 mg/kg/day divided in 3 or 4 doses, adjusted to produce 2 or 3 soft stools per day.

Birds

Hepatic encephalopathy; to stimulate appetite, improve intestinal flora · 0.03 mL (Cockatiel); 0.1 mL (Amazon) · PO · two to three times a day · May be used for weeks · Reduce dosage if diarrhea develops

Reptiles

Laxative · 0.3 mL/kg · PO · q12h · Green Iguana

Dogs

투여 경로

PORectal (Enema)

금기

Patients requiring a low-galactose diet
Use with caution in diabetic patients (contains free lactose and galactose)
Use with caution in patients with preexisting fluid and electrolyte imbalances
Severely encephalopathic animals at risk of inhalation/aspiration
Gastrointestinal obstruction
Animals at risk of gastrointestinal perforation

이상반응

Flatulence
Gastric distention
Abdominal cramping
Diarrhea (dose-dependent)
Dehydration (secondary to excessive diarrhea)
Hypersalivation/aversion in cats (due to taste/texture)
Diarrhoea
Dehydration (with excessive dosing)

약물 상호작용

Oral Antacids · Non-adsorbable antacids may reduce the colonic acidification effects and overall efficacy of lactulose. · moderate
Other Laxatives · Should not be used concurrently; loose stools may be falsely attributed to lactulose, resulting in inadequate dosing for hepatic encephalopathy. · moderate
Neomycin (and other oral antibiotics) · Theoretically, oral antibiotics could eliminate the colonic bacteria required to metabolize lactulose, reducing its efficacy. However, clinical synergy is often observed when treating hepatic encephalopathy. Enhanced monitoring is recommended.
Oral antibiotics (e.g., neomycin) · Synergy may occur when used together for hepatic encephalopathy. · minor
Insulin · Lactulose syrup contains free lactose and galactose, which may alter insulin requirements in diabetic patients. · moderate
5-aminosalicylic acid (and other pH-dependent colon-release drugs) · Can be inactivated because lactulose decreases the pH of the colon. · major

모니터링

Clinical efficacy: Aim for 2-3 soft, semi-formed stools per day when used for hepatic encephalopathy or constipation.
Hydration status.
Serum electrolytes (especially during long-term use or in patients with preexisting fluid/electrolyte abnormalities).
Faecal consistency (aim for 2-3 soft, formed stools per day)
Blood ammonia levels (in hepatic encephalopathy)
Hydration status and electrolytes
Blood glucose levels (in diabetic patients)

과용량

Excessive doses of lactulose may cause **flatulence, severe diarrhea, abdominal cramping, and dehydration**. **Management**: * Reduce the dosage or temporarily discontinue the medication. * Provide supportive care, including **replacement of fluids and electrolytes** if dehydration or imbalances occur.

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