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Lactulose vs Senna
Introduction
For patients dealing with constipation or those needing to empty their bowel before a surgical procedure or colonoscopy, there are certain drugs that can help increase the water content and volume of stools in the gut and assist elimination. Lactulose and Senna are two such medications often recommended for these conditions. The two drugs work differently within the digestive system, but both aid in promoting smoother bowel movements.
Lactulose is classified as an osmotic laxative. This means that it works by drawing water into the intestines from surrounding body tissues, thereby softening stools and increasing their volume, stimulating bowel movement.
Senna falls under a different category known as stimulant laxatives. It functions by irritating the lining of your intestines, which helps stimulate muscle contractions to facilitate stool passage.
Lactulose vs Senna Side By Side
| Attribute | Kristalose | Senokot |
|---|---|---|
| Brand Name | Kristalose | Senokot |
| Contraindications | Intestinal obstruction, caution in patients with diabetes due to sugar content | Intestinal obstruction, long-term use can lead to dependency and electrolyte imbalances |
| Cost | Approximately $0.50–$2/day for generic versions | As low as $.03/day for generic versions based on standard dosages |
| Generic Name | Lactulose | Senna |
| Most Serious Side Effect | Electrolyte imbalance, severe abdominal pain or cramping, persistent nausea or vomiting | Liver damage, electrolyte imbalance, and dependency for bowel movements |
| Severe Drug Interactions | Not specifically mentioned, but patients should consult healthcare providers for potential interactions | Not specifically mentioned, but caution is advised due to potential for electrolyte imbalance |
| Typical Dose | 15–60 mL/day for adults, 0.5–1 g/kg for children | 17.2 mg/day, up to 34.4 mg/day divided into two doses |
What is lactulose?
Lactulose and Senna are both used to alleviate constipation, but their mechanisms of action and side effects differ.
Lactulose is an osmotic laxative that works by increasing the amount of water in the intestines, which softens stools and prompts bowel movements. It was first approved by the FDA in 1976 for this use, and it is also approved for reducing blood ammonia levels in patients with hepatic encephalopathy.
What conditions is lactulose approved to treat?
Lactulose has been approved for managing the following conditions:
- Chronic idiopathic constipation, a common digestive issue
- Hepatic encephalopathy, a severe liver disorder that can cause confusion and altered levels of consciousness. Lactulose can be used to reduce the amount of ammonia in the blood of people with this condition.
How does lactulose help with these illnesses?
Lactulose aids in the management of constipation by increasing the amount of water in the intestines, which helps to soften stools and stimulate bowel movements. This occurs because lactulose is a non-absorbable type of sugar, meaning it stays within the digestive tract, pulling water into the intenstines through osmosis while it's there. This increase in water content softens stool and also increases its volume, promoting bowel movement.
Both lactulose and Senna are effective for treating constipation; however, their mechanisms differ significantly, as we will see next. Where lactulose acts mainly as an osmotic agent changing stool consistency, senna primarily affects intestinal muscle contractions, helping move stool through the system.
What is senna?
Senna, also known as Senokot among other brand names, is a non-prescription laxative used to treat constipation. It works by irritating the lining of the bowel, causing a laxative effect. Senna was first approved by the FDA in 1982 and remains one of the most commonly recommended over-the-counter treatments for short-term relief from occasional constipation.
As an anthraquinone stimulant laxative, its mechanism differs substantially from osmotic laxatives like lactulose. The active components in senna are transformed by gut bacteria into rhein-anthrone derivatives that stimulate peristalsis, the rhythmic contractions of intestinal muscles that move stool along.
In terms of side effects, while it does not usually cause bloating or cramping (common side effects of lactulose), extended use can lead to dependence on senna for normal bowel movements and can potentially cause liver damage, among other complications. However, when taken judiciously under professional guidance for brief periods (not exceeding two weeks), these risks remain low.
What conditions is senna approved to treat?
Senna is a natural medicine approved by the FDA for the treatment of:
- Chronic constipation
- Preparation before bowel surgery or colonoscopy
It is an effective stimulant laxative that works by irritating the lining of the bowels to promote stool movement. It's also frequently used in combination with other laxative drugs to enhance their efficacy.
How does senna help with these illnesses?
Senna acts directly on the muscles in the large intestine. It contains compounds called sennosides which irritate the lining of the bowel, causing a laxative effect. This irritation stimulates muscle contractions that help to move stool through your digestive tract, thereby relieving constipation. Its effects can usually be felt within 6 to 12 hours after taking it.
As compared to lactulose, senna works more aggressively and may cause cramping as a side effect due its stronger action on intestinal muscles. While both are effective remedies for constipation, senna might be chosen when quicker relief is needed or when other softer approaches have failed.
How effective are lactulose and senna?
Both lactulose and senna have established histories of success in treating patients with constipation. Since they act through different mechanisms, they may be prescribed under different circumstances. The effectiveness of lactulose and senna in alleviating constipation has been studied in multiple clinical trials. The two drugs have demonstrated similar efficacy in managing symptoms of constipation, and they have comparable safety profiles.
A review of various studies on lactulose demonstrated that it is effective at inducing bowel movements within 24 to 48 hours of taking it. Its side effect profile is generally favorable over that of many other laxatives, and it is well-tolerated even in the elderly population where chronic constipation is common. Lactulose works by pulling water into the intestines, which helps soften stools and stimulate bowel movement.
Senna appears to be more effective than placebo at easing constipation, as per the results of numerous clinical trials. Nonetheless, senna is typically considered when dietary changes or bulk-forming laxatives have not been successful, since its stimulatory mechanism of action is considered somewhat harsher. Senna has been used for centuries as a natural remedy for digestive issues, but can cause abdominal cramping or discomfort in some individuals due to stimulation of muscle contractions within the gut.
While both senna and lactulose are effective treatments for occasional bouts of constipation, long-term use should be monitored closely by a healthcare professional due to potential complications such as electrolyte imbalance or dependency.
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At what dose is lactulose typically prescribed?
Oral dosages of lactulose range from 15–60 mL/day, but studies have shown that 15 mL/day is often enough to treat constipation in most people. Dosages for children can be decided based on their body weight (0.5–1 g/kg). In both adults and children, the dosage can be increased after a few days if there is no response. The maximum dosage for adults should not exceed 60 mL/day, and for children it should not exceed the advised amount as per their body weight.
At what dose is senna typically prescribed?
Senna usually comes in tablet form, and treatment typically begins with a dosage of 17.2 mg (1 tablet) per day. This dose can be increased to two tablets if necessary, equivalent to 34.4 mg/day, divided into two doses spaced about 12 hours apart. For severe constipation (or as directed by your physician), the maximum dose can be up to four tablets per day, distributed into two doses of two tablets each, spaced roughly 12 hours apart. If there's no response to the initial dose after a few days, an increase might be considered by your healthcare provider.
Children over six years of age may start with one tablet, but this can later be adjusted based on individual response.
It's important to note that prolonged use of senna (for more than two weeks) requires medical supervision, in consideration of its potential side effects.
What are the most common side effects of lactulose?
The common side effects of lactulose include:
- Bloating
- Flatulence (gas)
- Stomach cramps
- Diarrhea
- Nausea or vomiting
If any of these symptoms persist, you should consult with your healthcare provider immediately.
Are there any potential serious side effects for Lactulose?
In rare cases, lactulose can have potentially serious side effects:
- An allergic reaction that could cause difficulty breathing or swelling of the face and throat
- Severe abdominal pain or cramping
- Persistent nausea or vomiting
- Electrolyte imbalance: symptoms may include muscle spasms, weakness, twitching, irregular heartbeat, confusion
Contact a healthcare professional immediately if any of these severe adverse reactions occur while taking lactulose.
What are the most common side effects for Senna?
On the other hand, Senna could lead to potential side effects such as:
- Abdominal pain or discomfort
- Cramping or bloating
- Diarrhea
- Nausea or vomiting
- Loss of appetite
- Loss of fluids and electrolytes if used excessively
- Changes in urine color to a pinkish brown
- Other dehydration symptoms, such as dizziness, headache, thirst, or decreased urination
Be aware that prolonged use (or overdose) can lead to more serious issues like liver damage, laxative dependence, and an imbalance of salts in your body (including potassium). It is crucial not to exceed the recommended dosage, unless directed to do so by a healthcare professional.
Are there any potential serious side effects for Senna?
While Senna is generally safe for short-term use, it can occasionally cause serious side effects. You should immediately seek medical attention if you experience any of the following:
- Signs of an allergic reaction including hives, itching, difficulty breathing or swallowing, swelling in the face or throat
- Severe stomach pain or cramping
- Bloody stools or rectal bleeding
- Irregular heartbeat (a sign of electrolyte imbalance)
- Fainting or lightheadedness, which may be related to dehydration caused by overuse
- High potassium level: symptoms include slow heart rate, weak pulse, muscle weakness (especially if you're also tired), numbness/tingling/crawling feelings in the hands/feet/lips.
Aim to minimize the use of senna (only when needed), and follow the recommended dosages as advised by a healthcare professional.
Contraindications for lactulose and senna
Both lactulose and senna, like many other laxative medications, have the potential to cause discomfort or side effects in some individuals. If you notice worsening abdominal pain, persistent diarrhea or vomiting, blood in your stools, or a sudden change in bowel habits that lasts for more than two weeks while taking either of these medications, please seek immediate medical attention.
Neither lactulose nor senna should be taken if you are suffering from intestinal obstruction. Always disclose any existing health conditions to your doctor to avoid potentially harmful interactions. Those with diabetes must be particularly cautious when using lactulose as it contains sugars that can elevate blood glucose levels.
Regular use of senna over long periods can lead to dependency on the drug for normal bowel movements, and might cause imbalances of electrolytes (like potassium and calcium), which can have harmful impacts on heart function. Thus, careful monitoring is required while taking senna, especially for elderly patients and those with cardiac issues.
Always consult with your healthcare provider before starting a new medication regimen, as they will be able to provide appropriate guidance based on your specific needs and medical history.
How much do Lactulose and Senna cost?
For the brand name versions of these drugs:
- The price of a 30 oz bottle of Kristalose (a branded version of lactulose) averages around $120, which works out to about $4/day based on an average dose.
- Senna tablets under the brand name Senokot are typically sold in packs of 100 tablets, costing approximately $20. Assuming a daily dosage of two tablets, this works out to roughly $0.40 per day.
Thus, if you're taking lactulose or senna in average doses, then branded senna is significantly less expensive than branded lactulose on a per-day treatment basis. It's important to remember that cost should not be your primary consideration when deciding which medication is right for you.
As for their generic versions:
- Generic lactulose comes in various sizes, with costs ranging from around $10–$60 depending on volume and concentration. This equates to an approximate cost of $0.50–$2/day based on typical dosages.
- Generic senna is available in packs ranging from 20 up to several hundred tablets, with prices starting as low as about $3 for smaller packs. This means generic senna can cost as little as $.03/day based on standard dosages, if you buy a larger quantity upfront (but remember, senna should not be used long-term unless directed otherwise by a healthcare professional).
Again, generic senna is less expensive than generic lactulose, but these medications work through entirely different mechanisms of action. The choice should be made according to which works better for you.
Popularity of Lactulose and Senna
Lactulose and senna are both widely used laxatives, albeit with different mechanisms of action.
Lactulose is a type of indigestible sugar that works by softening stools and increasing bowel movements. In 2020, approximately 10 million prescriptions were filled for lactulose in the US, accounting for roughly 15% of all laxative prescriptions. Its use has remained generally steady over the past decade.
On the other hand, senna stimulates the muscles in your gut to help move stool through your bowels. It was prescribed to about 8 million people in the USA in 2020, making up just under 13% of all laxative prescriptions. The prevalence of senna as a treatment option for constipation has seen moderate growth since its introduction into common practice.
Conclusion
Both lactulose and senna have long-standing records of successful use in patients with constipation, and both are backed by numerous clinical studies indicating their effectiveness. Occasionally, these laxatives may be combined for greater efficacy. However, this should only be done under careful consideration by a healthcare professional due to the potential side effects such as diarrhea and abdominal cramps.
Lactulose works primarily by softening the stools and promoting bowel movements through osmotic action, whereas senna stimulates the muscles in your gut to move stool through the intestine. They tend to be prescribed under different circumstances. Lactulose is often considered as a first-line treatment for chronic constipation or hepatic encephalopathy (a liver condition), while denna is usually used on a short-term basis to relieve occasional constipation.
Both drugs are available in generic form, offering significant cost savings especially for those paying out-of-pocket. Both lactulose and senna may require an adjustment period, meaning that effects may not be noticeable right away.
The side effect profiles of the two drugs are similar, but both are generally well-tolerated. Overuse of senna can lead to electrolyte imbalance and dependency for bowel movements, whereas long-term use of lactulose can cause bloating and gas. As with all medications, it's important for patients to closely monitor their response when starting treatment and seek medical advice if symptoms persist or worsen.
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Refrences
- Sharma, A., & Rao, S. (2016). Constipation: Pathophysiology and Current Therapeutic Approaches. Handbook of Experimental Pharmacology. Springer International Publishing.http://doi.org/10.1007/164_2016_111
- Fiati Kenston, S. S., Song, X., Li, Z., & Zhao, J. (2018, August 19). Mechanistic insight, diagnosis, and treatment of ammonia‐induced hepatic encephalopathy. Journal of Gastroenterology and Hepatology. Wiley.http://doi.org/10.1111/jgh.14408
- Jouët, P., Sabaté, J. ‐m ., Cuillerier, E., Coffin, B., Lémann, M., Jian, R., & Flourié, B. (2005, October 25). Low‐dose lactulose produces a tonic contraction in the human colon. Neurogastroenterology & Motility. Wiley.http://doi.org/10.1111/j.1365-2982.2005.00727.x
- Kot, T. V., & Pettit-Young, N. A. (1992, October). Lactulose in the Management of Constipation: A Current Review. Annals of Pharmacotherapy. SAGE Publications.http://doi.org/10.1177/106002809202601017
- van der Schaaf, M., Vermeulen, H., Storm-Versloot, M. N., Goossens, A., Simons, R., & Eijsman, L. (2004, February). Effectiveness of lactulose syrup after cardiac surgery. Applied Nursing Research. Elsevier BV.http://doi.org/10.1016/j.apnr.2003.10.005