What is Hepatic Encephalopathy (HE)?

HE is a collection of neurological and psychiatric symptoms seen in as many as one third of patients with any kind of liver dysfunction. It is caused by the build-up of toxins such as ammonia in the blood, as these toxins alter your brain function.1

High blood ammonia levels in liver cirrhosis

Ammonia is a substance that is made in our bodies as a by-product of various metabolic processes. Ammonia is toxic to your nervous system at high levels, but the levels of it in your blood are normally kept under control by your liver, which stops ammonia from entering your circulation by converting it into other substances. Your muscles are also able to remove ammonia from the blood.1

In advanced liver disease, dysfunction of the liver and wasting of the muscles means that both of these important ammonia-clearing processes are impaired. Ammonia levels start to build up in the blood and contribute to the development of HE.1

The role of lactulose in treating hepatic encephalopathy

Lactulose is a type of sugar that is commonly used as a treatment for constipation as well as for HE. It is taken orally and often comes as a liquid solution.2

Lactulose appears to prevent the production of ammonia in the intestines by increasing the number of a certain type of bacteria in the colon that produce acid.2

What dose of lactulose should I take for HE?

Lactulose dosage can vary, so ask your doctor about the best dose for you2. It is important not to overdose on lactulose, as you could end up experiencing severe diarrhea, which can lead to a dangerous loss of fluids and electrolytes. Overdose can also slow down the movement of your intestines – the opposite effect of what you want in HE, so make sure you follow the advice of your healthcare team.1

Lactulose is a type of sugar that is commonly used as a treatment for constipation as well as for HE.


  1. Shaker M, et al. Hepatic Encephalopathy. Cleveland Clinic. Published: June 201, last reviewed: August 2017. Available at: https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/hepatology/hepatic-encephalopathy/ (Last accessed Nov 2020)
  2. Duphalac 3.335 g/5 ml Oral Solution, Summary of Product Characteristics. 2020.

May 2021. GL-HEP-XIF-2000182

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