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Lactulose vs Miralax
Introduction
For patients dealing with constipation, certain medications that alter the water content and consistency of stool can help in easing bowel movements and managing symptoms. Lactulose and Miralax are two such drugs that are often prescribed for this purpose. They each work differently within the digestive tract but both have stool-softening effects in patients suffering from constipation. Lactulose is a synthetic sugar used to treat constipation which works by increasing the amount of water in the stool, making it easier to pass. On the other hand, Miralax is classified as an osmotic-type laxative, working primarily by holding water in the stool to soften it and increase bowel movements.
Lactulose vs Miralax Side By Side
| Attribute | Lactulose | Miralax |
|---|---|---|
| Brand Name | Lactulose | Miralax |
| Contraindications | Bowel obstruction or perforation, severe cramping, bloating, or an increase in irregular bowel movements, diabetes patients need to monitor blood sugar levels closely | Bowel obstruction or perforation, kidney disease due to the risk of electrolyte imbalance |
| Cost | $20-$35 for a 473 ml bottle | $25 for a 30-dose supply |
| Generic Name | Lactulose | Polyethylene glycol 3350 |
| Most Serious Side Effect | Electrolyte imbalance, dehydration signs, severe stomach pain, nausea and vomiting | Allergic reactions such as skin rash; itching; difficulty swallowing; facial swelling, irregular heartbeat, bloody diarrhea, severe abdominal pain |
| Severe Drug Interactions | Antacids with magnesium can interact negatively | Not specifically mentioned, but caution advised with other medications due to potential for electrolyte imbalance |
| Typical Dose | 15-60 ml/day for adults, 5-15ml per day for children | 17 grams mixed into 4–8 ounces of beverage once per day |
What is Lactulose?
Lactulose, a synthetic sugar used for the treatment of constipation and hepatic encephalopathy, was one of the first choices for managing these conditions. It works by increasing water content and volume in the bowel, thus promoting bowel movement. Lactulose is broken down in the colon into products that pull water out from the body and into the colon. This water softens stools. Lactulose is also helpful for people with liver disease as it helps to reduce high levels of ammonia.
On the other hand, Polyethylene glycol 3350 (the generic name for Miralax) functions similarly but operates more gently than lactulose. It's an osmotic-type laxative which increases the amount of water in your intestinal tract to stimulate bowel movements while causing fewer side effects such as bloating or gas compared to lactulose. Miralax doesn't interact directly with any specific neurotransmitters like serotonin or dopamine; instead, it purely focuses on alleviating constipation.
What conditions is Lactulose approved to treat?
Lactulose is approved for the treatment of various conditions, such as:
- Chronic constipation
- Prevention and treatment of portal-systemic encephalopathy, including the stages of hepatic pre-coma and coma
Miralax on the other hand is approved for:
- Occasional constipation
How does Lactulose help with these illnesses?
Lactulose aids in managing constipation by increasing the amount of water in the intestines, which can soften stools and stimulate bowel movements. It does this by drawing water into the colon from surrounding body tissues, thereby increasing stool liquidity which makes it easier to pass. On the other hand, Miralax also manages constipation but functions differently than Lactulose. Instead of direct osmotic activity like lactulose, it works by retaining water with stool to soften it and increase intestinal movement through a process called passive diffusion. Both laxatives play an important role in digestion and relieving constipation symptoms. By understanding how these medications function within your body system, you will be better equipped to manage your condition effectively.
What is Miralax?
MiraLAX is a brand name for polyethylene glycol 3350, which is an osmotic laxative. This means it works by retaining water in the stool, thereby softening it and increasing bowel movements. It was first approved by the FDA in 1999. Unlike lactulose, another commonly used laxative that works by drawing water into the colon to stimulate bowel movements, MiraLAX does not produce gas as a side effect since it's not fermented into gases within your intestines like lactulose can be.
Its lack of fermentation means its side-effect profile is also different from that of lactulose; particularly in that it doesn't cause bloating or cramping (common side effects with lactulose). The way MiraLAX increases water content can be beneficial for treating constipation, especially when bulk-forming or stimulant laxatives have failed.
What conditions is Miralax approved to treat?
MiraLAX is approved for the treatment of:
- Occasional constipation
- Irregular bowel movements
This over-the-counter medication works by drawing water into your bowels, which helps to soften stools and increase their frequency. It's an osmotic-type laxative that can be used both in adults and children aged 17 years and above.
How does Miralax help with these illnesses?
Miralax, similar to lactulose, is a highly effective osmotic laxative that aids in alleviating constipation. It operates by drawing water into the colon from other body tissues, thereby softening stools and inducing bowel movements. This process helps to clear the intestines for patients struggling with constipation or irregular bowel movements. Miralax's action hinges on its active ingredient, polyethylene glycol 3350. Unlike lactulose which can cause bloating and gas as side effects due to its fermentation in the colon, Miralax generally does not produce these side effects since it isn't metabolized by gut bacteria. Therefore, it may be preferred when a patient doesn't tolerate lactulose well or needs long-term treatment for chronic constipation.
How effective are both Lactulose and Miralax?
Both lactulose and polyethylene glycol 3350 (Miralax) are recognized treatments for constipation, with proven histories of safety and efficacy. They were initially approved by the FDA several decades apart, with lactulose in the 1970s and Miralax in the late 1990s. Since they act through different mechanisms to alleviate constipation, they may be prescribed under different circumstances.
The effectiveness of lactulose and Miralax was directly compared in a randomized clinical trial conducted in 2011; both drugs demonstrated similar efficacy in managing symptoms of chronic constipation as well as comparable safety profiles. In this study, none of the metrics used to measure successful treatment of constipation significantly differed between patients receiving Miralax or those taking lactulose.
A review published in 2007 concluded that lactulose is an effective stool-softening laxative beginning from the first days of treatment. Its side effect profile is generally favorable when compared to other classes of laxatives, although some people do report bloating or excessive gas production. It's worth noting that these side effects are usually temporary and reduce over time.
In contrast, a meta-analysis published in 2015 indicated that polyethylene glycol-based solutions like Miralax seem more effective than placebo at treating chronic idiopathic constipation while being just as safe. Although it can cause minor gastrointestinal discomfort such as bloating or cramping these side effects tend to diminish over time. Importantly because it isn't absorbed into your bloodstream from your intestines it's considered safe for long-term use even among individuals who need daily assistance moving their bowels.
As always you should consult with a healthcare provider before starting any new medication routine especially if you're considering long term use which could potentially mask underlying health concerns.
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At what dose is Lactulose typically prescribed?
Dosages of Lactulose range from 15-60 ml/day for adults, but studies have shown that 15 ml/day is generally effective in treating constipation. Children's dosage may be started at 5-15ml per day, depending on their age and weight. In either population, the dosage can be increased after a few days if there is no response to treatment. However, the maximum dose should not exceed 120ml/day for adults or varying doses for children depending on their age and weight.
Similarly, dosages of Miralax typically start at one 17 gram scoop mixed with water per day for both adults and children over the age of seventeen; however, this can vary based upon individual needs as determined by a healthcare provider. For children under seventeen years old or those with kidney disease, it's important to consult with a medical professional before starting any new medication regimen.
At what dose is Miralax typically prescribed?
Miralax treatment for constipation typically commences with a dose of 17 grams (about one heaping tablespoon) mixed into 4–8 ounces of beverage once per day. This initial dosage can be adjusted as needed, up to twice daily depending on individual response and severity of constipation. The maximum daily dose is generally not more than 34 grams divided into two doses, spaced approximately 12 hours apart. If there are no signs of bowel movement or alleviation from the symptoms after three days, it would be advisable to consult your healthcare provider.
What are the most common side effects for Lactulose?
Common side effects of Lactulose include:
- Diarrhea
- Gas and bloating
- Nausea, vomiting
- Stomach cramps
- Dehydration (due to loss of fluids from diarrhea)
- Unusual tiredness or weakness
On the other hand, Miralax can cause some similar but also different side effects:
- Bloating, gas
- Abdominal pain or cramping
- Nausea, upset stomach
- Diarrhea
Are there any potential serious side effects for Lactulose?
While Lactulose and Miralax are both relatively safe laxatives, it is still essential to be aware of potential side effects. With Lactulose, these may include:
- Signs of allergic reaction: hives, difficult breathing, swelling in your face or throat
- Electrolyte imbalance - symptoms can include headache, confusion, irregular heartbeat, extreme thirst, increased urination, leg discomfort and muscle weakness or limp feeling
- Dehydration signs - feeling very thirsty or hot, being unable to urinate or producing less urine than usual
- Severe stomach pain
- Nausea and vomiting
In the case of Miralax:
- Allergic reactions such as skin rash; itching; difficulty swallowing; facial swelling.
- Irregular heartbeat
-Bloody diarrhea
-Severe abdominal pain that won't go away
-Unusual bleeding/bruising
If you experience any severe side effects when taking either medication seek medical attention immediately.
What are the most common side effects for Miralax?
With Miralax, the side effects are typically mild and can include:
- Bloating
- Gas or mild stomach upset
- Nausea, stomach cramps
- Increased sweating or thirst due to loss of fluids
- Headache or dizziness.
It is important to note that prolonged use can also cause an imbalance in your body's electrolytes and fluid levels. It should be used as directed by a healthcare professional.
Are there any potential serious side effects for Miralax?
While Miralax is generally well-tolerated, there are potential side effects that users should be aware of. These may include:
- Allergic reactions such as hives, itching, or swelling of the face, lips, tongue or throat
- Difficulty breathing or swallowing
- Severe or persistent diarrhea
- Unusual changes in mood including confusion and irritability
- Persistent feelings of fullness after bowel movements
- Signs of electrolyte imbalance which can include increased thirst or urination, dry mouth, sweating profusely and fast heartbeat
If any of these symptoms occur when using Miralax for constipation relief, it's recommended to stop use and consult a healthcare professional immediately.
Contraindications for Lactulose and Miralax?
Lactulose and Miralax, like all laxatives, can cause side effects in some people. If you notice severe cramping, bloating or an increase in irregular bowel movements while taking these medications, please seek immediate medical attention.
Neither Lactulose nor Miralax should be taken if a person has a bowel obstruction or perforation. Always tell your physician which medications you are taking; certain medicines such as antacids with magnesium can interact negatively with Lactulose and Miralax causing serious side effects.
Miralax may not be suitable for those diagnosed with kidney disease due to the risk of electrolyte imbalance. On the other hand, lactulose is safe for long-term use but it can sometimes cause gas and stomach cramps.
People who have diabetes need to monitor their blood sugar levels closely while on lactulose as it contains sugars that could potentially affect blood glucose levels.
It's also important to note that overuse of any laxative including Lactulose and Miralax could lead to dependency where normal bowel function becomes reliant on them. Therefore consult your healthcare provider before starting any new medication regimen.
How much do Lactulose and Miralax cost?
For the brand-name versions of these drugs:
- The price for a 30-dose supply of Miralax (17 g) averages around $25, which works out to about $0.80/day.
- The price for a 473 ml bottle of lactulose solution, equivalent to approximately a two-week supply at the typical dose range (15 - 60 ml), is about $20-$35, working out to roughly between $1.40 and $2.50 per day.
Thus, if you are in the higher dosage range for Lactulose (i.e., taking more than 45ml daily), then brand-name Miralax could be less expensive on a per-day treatment basis. Please note that cost should not be your only consideration in determining which laxative is right for you.
As with most medications, generic versions offer cheaper alternatives:
- Polyethylene glycol (generic name for Miralax) costs between approximately $0.30 and $0.70 per dose based on retailer pricing.
- Generic lactulose can cost as low as about $.90 up to nearly two dollars ($2) per daily average dose depending on pharmacy pricing and other factors including insurance coverage.
With both of these medications available over-the-counter without prescription from doctors or pharmacists, it is important to balance cost considerations against effectiveness and potential side effects when choosing your preferred constipation remedy.
Popularity of Lactulose and Miralax
Polyethylene glycol 3350, commonly known by its brand name, Miralax, has been a popular choice for constipation relief in the US. In 2020, it was estimated that about 19 million people used this osmotic laxative. Accounting for approximately 37% of the total prescribed osmotic laxatives in the country.
Lactulose on the other hand, another type of osmotic laxative often used to treat constipation and hepatic encephalopathy, had an estimated prescription volume of around 4 million users in the same year. This accounted for just under 8% of total prescriptions within its class.
Both medications work by drawing water into your bowel from surrounding tissues to soften stools and stimulate bowel movements. While both are effective at relieving constipation, lactulose is also specifically indicated for reducing high levels of ammonia in patients with liver disease while Miralax is more often recommended where long term treatment may be necessary due to its lower risk profile and less bloating side effect.
Conclusion
Both Lactulose and Miralax (polyethylene glycol 3350) have long-standing records of usage in patients with chronic constipation, and are backed by numerous clinical studies indicating that they are more effective than placebo treatments. Due to their different mechanisms of action, with lactulose acting primarily as a stool softener by drawing water into the colon, and Miralax acting mainly as an osmotic laxative increasing fluid in the gastrointestinal tract for easier passage of stools, they tend to be prescribed under different circumstances. Lactulose is often considered when there's need for softer stools or in hepatic encephalopathy cases while Miralax would usually be chosen for its gentle yet effective relief from constipation.
Both drugs are available over-the-counter offering significant convenience to patients suffering from occasional bouts of constipation. However, like all medications, these may require some time before achieving full effect.
The side effect profile is similar between the two drugs; both being generally well-tolerated but can cause bloating, gas or diarrhea if taken at high doses. For both drugs, it’s important that users stay hydrated especially when starting treatment due to their mechanism which involves water retention in the bowel. Although rare serious side effects such as hives or rash should prompt immediate medical attention.
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Refrences
- Zurad, E. G., & Johanson, J. F. (2011, May 23). Over-the-counter laxative polyethylene glycol 3350: an evidence-based appraisal. Current Medical Research and Opinion. Informa Healthcare.http://doi.org/10.1185/03007995.2011.580339