Comparative Pharmacology
Head-to-head clinical analysis: GO EVAC versus PORTALAC.
Peer-Reviewed Evidence
Head-to-head clinical analysis: GO EVAC versus PORTALAC.
GO-EVAC vs PORTALAC
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
Promotes gastrointestinal motility by acting as a stimulant laxative, likely through direct irritation of the colonic mucosa and possibly via local effects on enteric neurons.
Lactulose is a synthetic disaccharide that is not absorbed from the gastrointestinal tract. It is metabolized by colonic bacteria to short-chain fatty acids (e.g., acetic, lactic, and formic acid), resulting in acidification of colonic contents and an increase in osmotic pressure, which stimulates bowel evacuation. In hepatic encephalopathy, acidification reduces blood ammonia levels by converting NH3 to NH4+ in the colon, inhibiting ammonia absorption.
10 mg orally once daily, with or without food.
Initial: 15-30 mL (10-20 g lactulose) orally, 2-3 times daily; titrate to 2-3 soft stools daily. For acute hepatic encephalopathy: 30-45 mL (20-30 g) orally every hour until evacuation, then 3-4 times daily.
None Documented
None Documented
4.5-6 hours in healthy volunteers; prolonged to 10-14 hours in elderly patients and those with moderate renal impairment (CrCl 30-50 mL/min).
1.7-2.0 hours (terminal); clinical context: short t1/2 allows rapid dose adjustment in hepatic encephalopathy.
Primarily renal; approximately 60% eliminated unchanged in urine within 24 hours, with 20% as metabolites. Biliary/fecal excretion accounts for 15-20%, and the remainder is metabolized via glucuronidation.
Renal: ~40% as unchanged drug; fecal: ~60% as metabolites (biliary excretion of conjugates and lactulose).
Category C
Category C
Osmotic Laxative
Osmotic Laxative