Abbott Duphalac Syrup

Abbott Duphalac Syrup is an over-the-counter oral solution whose active ingredient is lactulose, supplied at 3.335 g per 5 mL (equivalent to 667 mg per mL). Lactulose is a synthetic disaccharide, meaning a sugar made of two linked sugar units, and it belongs to the osmotic laxative class of medicines. The Duphalac brand has been marketed internationally for many decades, and the product is sold in Malaysia under the Abbott name in a clear to pale-brown syrup form that is taken by mouth.

One of the distinctive features of lactulose is that it is barely absorbed in the small intestine, so very little of the medicine enters the bloodstream. For this reason, official product information describes systemic exposure as negligible, and no special dosing adjustments are described for older adults. The syrup can be swallowed straight from the measuring cup or diluted in water, fruit juice or milk, and DoctorOnCall lists a 200 mL bottle as the pack size.

Because the syrup is made from a sugar-based compound, it contains small amounts of other sugars such as galactose, lactose and fructose left over from the manufacturing process. This is why the product information advises caution for people with lactose intolerance and rules it out for people with galactosaemia, and why people with diabetes are encouraged to ask a pharmacist about the sugar content. As with all OTC medicines, please read the pack label, keep the bottle out of reach of children, and speak to a pharmacist or doctor if you are pregnant, breastfeeding, taking other medicines or have a long-term bowel or digestive condition.

Duphalac Syrup is taken by mouth. Measure the dose with the cup supplied with the bottle, and swallow it undiluted or mix it with a glass of water, fruit juice or milk if preferred.

• Take the daily dose as a single dose, ideally at the same time each morning or with breakfast, or divide it into two doses as directed on the label.
• Swallow the dose promptly after measuring it, and do not keep the diluted mixture for later.
• Drink plenty of fluids throughout the day while using this product.
• Start with the lower end of the dose range for your age group, and adjust gradually as shown on the pack label.
• Do not use other laxatives together with Duphalac unless a doctor or pharmacist has advised it.

The label dose depends on age and is taken as a single daily dose or as two divided doses. The values below follow the product information for the syrup (3.335 g lactulose per 5 mL).

• Adults and adolescents: starting dose 15 to 45 mL daily; maintenance dose 15 to 30 mL daily.
• Children 7 to 14 years: starting dose 15 mL daily; maintenance dose 10 to 15 mL daily.
• Children 1 to 6 years: 5 to 10 mL daily for both starting and maintenance doses.
• Infants under 1 year: up to 5 mL daily, and only under the guidance of a doctor.
• Missed dose: if a dose is missed, take it when remembered on the same day, but do not double up the next day. If loose stools develop, reduce the dose or stop and speak to a doctor or pharmacist.
• Higher doses used for other medical conditions are directed by a doctor and are outside the scope of self-care use.

Duphalac Syrup generally has a shelf life of about 3 years from the date of manufacture when kept unopened and stored correctly. Always follow the expiry date printed on the bottle and carton, and discard any syrup that has changed in appearance or smell.

Store at room temperature, away from direct sunlight and heat, and follow the storage temperature printed on the pack (generally not above 25°C). Keep the bottle tightly closed after each use, do not freeze it, and keep it out of the sight and reach of children.

• Galactosaemia, an inherited condition in which the body cannot process galactose, because the syrup contains galactose.
• Intestinal or digestive tract obstruction (blockage).
• Digestive tract perforation or a risk of perforation.
• Known hypersensitivity (allergy) to lactulose or to any other ingredient in the syrup.

• Other laxatives: Using Duphalac together with other laxatives may increase the risk of loose stools and loss of fluid and salts, so ask a pharmacist before combining them.
• Potassium-lowering medicines: Prolonged high-dose use with diuretics, corticosteroids or amphotericin B may increase the risk of low potassium, and low potassium can strengthen the effect of heart medicines such as digoxin.
• Certain oral antibiotics: Some antibiotics that act on gut bacteria, such as neomycin, may alter how lactulose is broken down in the bowel, so tell your doctor or pharmacist about antibiotics you are taking.
• Antacids and acid-lowering products: Older references mention that antacids may reduce the acidifying action of lactulose, so a pharmacist should be consulted if you take these regularly.
• Food and drink: The syrup can be mixed with water, fruit juice or milk; diets that are high in sugar-containing drinks may add to wind and loose stools, and adequate daily fluids are recommended.
• Diabetes and blood sugar: Lactulose is barely absorbed, but the syrup contains small amounts of other sugars, so people with diabetes should seek advice from their doctor or pharmacist.

• Always measure the dose with the cup provided rather than a household spoon so that the amount is accurate.
• If the taste is too sweet, dilute the dose in water, fruit juice or milk and drink it straight away.
• Drink enough fluids through the day and keep your usual meals, because lactulose works by drawing water into the bowel.
• Start at the lower end of the label dose and change it gradually rather than in big steps.
• Keep a short note of the dose you take each day so that you can tell your pharmacist or doctor if the dose needs to be reviewed.
• Store the bottle upright with the cap tightly closed and wipe the rim and the cup after use.

Precautions: Speak to a doctor or pharmacist before use if you are pregnant, breastfeeding, have diabetes, are lactose intolerant, take heart medicines such as digoxin, take diuretics or corticosteroids, or have a long-term digestive condition. Do not use the syrup for longer than the label or your healthcare professional advises, because prolonged high doses may lead to dehydration and salt imbalance. Older adults and frail people should take extra care to keep up their fluid intake. Children should only be given the doses stated for their age group, and infants should only receive it under a doctor’s guidance.

When to See a Doctor or Pharmacist: See a doctor if you have unexplained abdominal pain, repeated vomiting, blood from the back passage, a sudden change in your bowel habit that lasts, or unexplained weight loss. Stop the syrup and seek advice if you develop severe or persistent diarrhoea, dizziness or signs of dehydration, or a rash or swelling that may signal an allergic reaction. Seek emergency care straight away for difficulty breathing or swelling of the face, lips or throat.