How to give Duphalac to a newborn? Indications and method of use

Duphalac is the most effective and safe drug to prevent constipation in newborns. In the first days of birth, the frequency of stool reaches 5-7 times, from 3 months it decreases to 2-3 times a day. However, even a slight violation of the diet can lead to constipation. Duphalac will allow you to quickly cope with the problem and empty the intestines. How to give Duphalac to a newborn?

What is Duphalac used for?

The probiotic contained in the medicine stimulates intestinal peristalsis, increases the volume of feces and affects the metabolism of minerals: phosphorus, nitrogen salts and calcium. As a result, the absorption of toxic substances is reduced, internal microflora is normalized and defecation is facilitated.

Duphalac is indicated to eliminate intestinal dysfunction:

• acute and chronic constipation;
• slowing down the physiological emptying of the colon;
• excessively dense feces;
• various types of intestinal dysbacteriosis;
• dyspeptic syndrome;
• increased fermentation process;
• acute symptoms of hemorrhoids;
• hepatic encephalopathy and stool disorders caused by it

In some cases, Duphalac is used to prevent complications and to cleanse the intestinal lumen before abdominal surgery.

Information about the drug and indications for use

Newborns often suffer from tummies

The drug, which stimulates bowel function, is available in the form of a syrup that can be added to both water and breast milk. The main active ingredient is lactulose - it allows you to activate the natural intestinal microflora. In addition, the drug helps soften stool, preventing the absorption of liquid.

It also removes toxins and ammonium salts from the body, which can cause constipation. Duphalac stimulates intestinal peristalsis: the walls begin to contract more actively, ensuring the excretion of feces. However, this drug has an important feature: the therapeutic effect does not occur immediately, but only within 24 hours after use. If constipation has been a problem for a long time, you should use other medications prescribed by your doctor.

In addition, Duphalac is not prescribed for chronic constipation; in this case, a comprehensive restoration of digestive functions is required. Main indications for use:

1. Disturbance of the physiological rhythm in the functioning of the colon. Often constipation is a consequence of switching from breast milk to formula or deviations in feeding regimen. It cannot be left unattended so that problems with intestinal function do not become chronic.
2. Dysbacteriosis, which in young children is usually a consequence of poisoning or taking potent drugs. Duphalac makes it possible to restore the normal functioning of the microflora.
3. Pathologies in the liver, enteritis, dyspepsia and other diseases of the digestive tract. In such cases, the dosage is set only by the attending physician; self-medication is unacceptable. Hepatic encephalopathy can lead to serious consequences.

Duphalac is not prescribed for intestinal obstruction - in this case, other methods are used, including surgical ones.

Also a contraindication is high sensitivity to lactose, fructose, galactose and other components of the drug. Duphalac should also not be used for diabetes mellitus, lactase deficiency and some other digestive disorders.

Who is Duphalac contraindicated for?

Treatment with the drug is excluded:

• in case of individual intolerance to components;
• rectal and other internal bleeding;
• intestinal obstruction;
• acute pain syndrome of unknown origin;
• suspected development of appendicitis;
• galactosemia.

The medicine is used with caution in cases of carbohydrate metabolism disorders and diabetes mellitus.

Contraindications, overdose and side effects

Since this laxative contains galactose, glucose, fructose, it is contraindicated for persons with individual intolerance to these components and should be taken with caution by those with diabetes. Additional contraindications are obstruction of the large intestine, rectal bleeding, and the presence of a colostomy.

The drug has no side effects, it is so safe that it can be used in newborns and infants, as well as in pregnant and lactating women. In case of overdose, diarrhea, abdominal pain, increased gas formation, and in very rare cases, vomiting may occur. After stopping taking Duphalac, these phenomena disappear without special therapy.

How to take Duphalac correctly

The syrup is recommended for oral use: ingested, diluting with water if necessary. It is undesirable to retain the substrate in the mouth; you need to drink it quickly, in one sip, at regular intervals. Usually - 1 time per day.

Dosages depend on the severity of the physical condition. General recommendation: 15–45 ml of product per day. In this case, the initial dose is usually higher: 30–45 ml, and the maintenance dose: 15–25 ml. During the treatment period, you should drink at least 2 liters of liquid.

Duphalac in the treatment of constipation in elderly patients suffering from cardiovascular diseases

Among the main mechanisms of constipation in the elderly, a decrease in blood supply to the pelvis due to physical inactivity, weakening of the muscles of the anterior abdominal wall and diaphragm, progressive weakness of the pelvic floor muscles due to hypoxia and impaired tissue repair, atrophic denervation of the anal sphincter and puborectal muscles, decreased sensitivity of the anal sphincter, predominate. violation of VIPergic and serotonic regulation [2,3]. In addition, taking many medications for various chronic diseases that affect older patients can also worsen constipation and reduce the effectiveness of medications used to treat it. Hospitalization of patients due to the worsening of cardiovascular diseases most often requires a decrease in physical activity and relative physical inactivity, and also makes it necessary to intensify drug treatment (possibly increasing the doses and number of medications taken). Drugs that can aggravate constipation include drugs actively used in cardiac practice, such as b-blockers, calcium antagonists, centrally acting antiadrenergic drugs, angiotensin II receptor blockers, angiotensin-converting enzyme inhibitors, diuretics, etc. Many causative factors cause constipation is reflected in a wide variety of non-drug and drug treatments. Recommendations from gastroenterologists to change lifestyle and increase fluid and fiber intake are mainly theoretical, since most patients simply act in order to regulate bowel movements - use over-the-counter laxatives. In this case, they are usually guided by affordability and an indication of the herbal origin of the medicine. In the vast majority of cases, the drugs used independently by elderly patients are stimulant laxatives, which, contrary to official recommendations for their use, are usually used by patients frequently or constantly. But this group of laxatives, both of plant origin (based on alkaloids of hay, buckthorn, rhubarb, aloe), and of a synthetic nature, with long-term use, requires an increase in dose due to the rapid development of the addictive effect, and especially in elderly patients it is dangerous due to the potential for the development of serious side effects. effects. In elderly patients, with repeated use of laxatives that stimulate intestinal functions (motor and secretory), as a result of significant loss of salts, weakness may increase, coordination of movements may be impaired, dizziness, orthostatic hypotension and arrhythmia may develop. Sena-based laxatives stimulate excessive loss of potassium through the intestines, and this must also be taken into account when prescribing potassium-sparing diuretics. It can also be said that elderly patients are not shown laxatives, the laxative effect of which is associated with an increase in the volume of intestinal contents (methylcellulose, polycarbophil). The use of laxatives in this group can reduce the expected effect of anticoagulants, cardiac glycosides, and antibiotics. Laxatives that lubricate the intestinal mucosa (vaseline oil), disrupting the processes of normal absorption of medications, significantly reduce their effectiveness. In this regard, for elderly patients suffering from cardiovascular diseases, especially during hospitalization, the choice of an effective and safest drug for the treatment of constipation becomes relevant. Along with its effectiveness, this drug must be combined and not reduce the activity of other medications taken by the patient. The principal effect of the drug Duphalac is due to the fact that its active substance lactulose, entering the colon intact, is biotransformed in it to short-chain fatty acids, as a result of which the intestinal contents are acidified and the osmotic pressure in the colon increases [4,5] . The purpose of our study was to study the effectiveness of Duphalac therapy in elderly patients with chronic constipation undergoing hospital treatment for cardiovascular diseases. Material and methods The study included 32 patients over 65 years of age (15 men and 17 women, average age 72.8±1.5 years) hospitalized at the City Clinical Hospital named after. S.P. Botkin regarding exacerbation of various cardiovascular diseases. Table 1 presents a list of diseases that caused hospitalization of the examined patients. Due to the inclusion of elderly patients in the study, most of them had concomitant pathology. All patients in the hospital were selected for drug therapy aimed at improving prognosis, quality of life and eliminating symptoms of the disease. The main groups of medications used in the examined patients are presented in Table 2. The study included patients with diagnostic criteria for functional constipation (according to the Rome II consensus). The criteria for functional constipation noted in the examined patients are presented in Table 3. Accordingly, the severity of chronic constipation was assessed on an 8-point scale. The patients were divided into two groups: – with severe constipation (8 points) – 18 people, – with moderate constipation (5–7 points) – 14 people. Concomitant gastroenterological diseases that some patients had were in remission and did not aggravate constipation. For the treatment of functional constipation, patients were prescribed lactulose (Duphalac, pharmaceutical company Solvay Pharma) in initial doses of 20–40 ml depending on the severity of constipation: – for severe constipation – 20–40 ml (average dose 34.7 ± 1.7 ml ), – for moderate constipation – 20–30 ml (average dose 24.3±1.4 ml). Almost all patients took the entire dose at one time during breakfast. The effectiveness of the drug was assessed on an 8-point scale on the 3rd and 14th days of treatment, as well as its safety. At the same time, if necessary, the dose of the drug was adjusted. In addition, all patients were monitored for hemodynamic parameters (BP, pulse), ECG, and biochemical blood parameters initially, as well as on the 3rd and 14th days of therapy. Statistical processing of data with reliability assessment using Student's t test was carried out using the Biostatistics program (version 4.03). Results of the study The study showed that in the majority of patients on the 3rd day of Duphalac therapy using an initial average dose of 30.2 ± 1.5 ml (for patients with severe constipation - 34.7 ± 1.7 ml, with moderate constipation – 24.3±1.4 ml) the manifestations of chronic constipation significantly (p<0.001) decreased (from 7.4±0.1 to 1.0±0.3 points) (Table 4). At the same time, 9 (29%) patients (including 7 people with severe constipation) still had a feeling of incomplete bowel movement, 6 (19.4%) patients (including 5 people with severe constipation) had a feeling of obstruction in the anorectal area, in 2 (6.5%) patients (all with severe constipation) straining for more than 1/4 of the time of bowel movement, 1 person (3.2%) (with severe constipation) continued to require manual bowel emptying. Moreover, 4 (12.9%) subjects (all with severe constipation) did not have bowel movement on the 3rd day of observation. On the other hand, 9 (29%) patients (6 of them with severe constipation) noted rapid bowel movements (within 2–4 hours), 2–3 times per day, and mushy stools. Considering the results obtained, from the 4th day of the study in 10 (32.3%) patients, due to insufficient effect, the daily dose of Duphalac was increased, and in 9 (29%) patients it was reduced and was divided into groups: in persons with severe constipation 15–60 ml (average 36.2±3.1 ml), in persons with moderate constipation 10–40 ml (average 25.4±2.4 ml). On the 14th day of Duphalac therapy, almost all symptoms of chronic constipation disappeared in 30 (96.8%) patients (p<0.001). Only 1 patient (3.2%) with severe constipation maintained a frequency of bowel movements less than 3 times a week and a feeling of obstruction in the anorectal area. The same patient and 2 other patients with severe constipation (9.7% in total) still had a feeling of incomplete bowel movement, and therefore they were recommended to subsequently increase the dose of the drug to achieve a greater osmotic effect. A comparative analysis of the presence of criteria for chronic constipation in the examined patients on the 3rd and 14th days of Duphalac therapy did not reveal significant differences, which makes it possible to select the dose of the drug already in the first 2-3 days from the start of treatment. A decrease in the manifestations of constipation in the examined patients was accompanied by an improvement in the clinical course of the underlying disease. During the observation period, all patients showed positive dynamics of hemodynamic parameters, increased tolerance to physical activity, and improved general well-being. None of the patients had statistically significant deviations from the initial biochemical blood parameters (liver enzymes, lipids, glucose, electrolytes, urea, creatinine). The drug was generally well tolerated by elderly patients. In 7 (21.9%) patients who received an average of 26.3±3.8 ml of Duphalac, transient flatulence was observed in the first 2 days of administration, in 4 (12.5%) of them it was accompanied by mild abdominal pain that disappeared in the next few days. 2–3 days alone or against the background of small doses of myotropic antispasmodics. The use of antispasmodics (especially mebeverine) in these patients and/or the recommendation to pre-dissolve the drug in water made it possible to avoid discontinuation of the drug and improve its tolerability. Despite this, 1 patient (3.1%) with severe constipation independently stopped taking the drug on the 2nd day. The data obtained in our study are consistent with the results of previous studies of lactulose in geriatric patients [4,5]. Conclusions 1. Duphalac is effective and safe in the treatment of chronic constipation in elderly patients hospitalized for cardiovascular diseases. 2. Selection of the laxative dose is carried out individually and is possible in the first 2–3 days. The optimal initial dose is 20–40 ml of the drug. 3. Duphalac is metabolically neutral and does not worsen the main biochemical parameters of the blood.

References 1. Barret JA Faecal incontinence & constipation in the elderly. – Falk symposium, No. 95, 1996, p. 211–225. 2. Diarrhoea & constipation in geriatric practice. – Ed. Ratnaike RN – Cambridge University press, 1999. 3. Constipation. – Ed. Kamm MA, Lennard–Jones JE – Wrighston Biomedical Publishing LTD, USA, 1994. 4. Kr?ger M., Schumann C: Lactulose treatment of constipation in the elderly (Publication in Verbereitung. Data on file, Solvay Arzneimittel 1994, Report number H. 105.904G). 5. Sanders JF Lactulose syrup assessed in a double–blind study of elderly constipated patients. – J. Am. Gereat. Soc. 1978; 26, 236–239.

When does Duphalac start to work?

This medicine is not an instant-acting medicine. It works gently without disturbing your overall well-being. For minor digestive disorders, the effect occurs within 4–8 hours. For persistent constipation, relief may take 1 to 3 days.

Positive signs:

• reducing the feeling of heaviness in the intestines;
• disappearance of spasms;
• softening of stool;
• defecation without difficulty.

Does it help you lose weight

Using Duphalac, it is recommended to cleanse the intestines if signs of slagging in the body appear: attacks of nausea, dizziness, unhealthy appearance, frequent colds. According to user reviews, taking a medicinal product with lactulose allows you to lose 5-7 kilograms. However, doctors are in no hurry to attribute this process to real weight loss.

Since Duphalac works exclusively in the intestines, there is an increase in the intensity of its work, nothing more. The syrup does not have any effect on calories or fats: the act of defecation occurs due to stimulation of the muscles of the intestinal walls and their further contraction. Simply put, every kilogram lost on Duphalac is not fat. However, under the influence of the drug, feces are excreted in full. In this case, even old deposits of food that have settled on the intestinal walls in the form of fecal stones are removed. Sometimes their number reaches several kilograms, which significantly affects the weight.

A laxative product with lactulose can be used for weight loss, but the effect will be short-term. At the end of the course of taking the drug, the lost kilograms will return.

The cleansing that occurs while taking lactulose syrup is not the only positive aspect for weight loss. Proper use can improve metabolism, which is an excellent start for a diet to eliminate extra pounds. And indeed, in order for the body to begin to “give back” kilograms, it is first necessary to improve the functioning of the intestines. Additionally, during the course, excess fluid leaves the body, which means swelling is prevented.

Important! Experts in matters of weight loss warn that laxatives with lactulose can not only improve metabolism, but also work in the opposite direction, that is, cause a total disruption of metabolic processes and a number of other pathologies.

To summarize, it should be noted: as an independent product for weight loss, Duphalac is unlikely to be effective, but it can be safely used in the complex therapy of excess weight.

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Advantages and disadvantages

A mild action is the main, but not the only advantage of a laxative. Other positive points include:

1. No addiction. Duphalac acts according to its intended purpose, that is, it reaches the large intestine, without being absorbed into the blood and tissues along the way.
2. Prebiotic affiliation. The product belongs to the group of prebiotics, therefore it improves the intestinal microflora, positively affecting the condition of the whole organism.
3. Antitoxic activity. The amount of harmful substances in the intestines when consuming lactulose is reduced. At the same time, the negative effects of toxins on the brain are prevented.
4. Stimulation of peristalsis. Since the product acts gently, the stool gradually liquefies and passes naturally without causing harm.

Along with the advantages, there are some disadvantages of the drug:

• Too sweet taste. The excessive sweetness of lactulose may appeal to children, but cause discomfort to adults.

Important! Despite the sweetness, the product does not contain sugar. Calorie content per 100 ml – 60 kcal. This dose does not lead to weight gain.

• Harm due to long-term use. Despite the mildness of the action, extremely long-term therapy can result in destabilization of the level of electrolytes in the blood plasma.
• High price. Compared to similar drugs, Duphalac is considered an expensive drug.

Analogs

Duphalac is considered a fairly expensive laxative, so many are trying to find a quality replacement for it. Among Russian drugs, in this case, Lactusan syrup, which also contains lactulose, is recommended. The cost of a 300 ml bottle is 290 rubles. Among foreign analogues, Normaze syrup from the Italian pharmaceutical company Molteni and Fratelli is distinguished. The average price of a 200 ml bottle is 250 rubles.

Other analogues of Duphalac are:

• Portalac syrup (Croatia);
• Goodluck syrup (Switzerland);
• gel for oral administration Transulose (France);
• Poslabin tablets (Russia).