Action And Clinical Pharmacology: Lactose is a nonabsorbable disaccharide found as a common constituent in most dairy products. Under normal conditions, dietary lactose is hydrolyzed in the jejunum and proximal ileum by beta-D-galactosidase or lactase. Lactase is produced in the brush border of the columnar epithelial cells of the intestinal villi. Lactase hydrolyzes lactose into 2 monosaccharides, glucose and galactose, that are readily absorbed by the intestine.
Though lactase is normally present in adequate quantities in infants, in many populations its concentration naturally declines starting at about 4 to 5 years of age and is low in a substantial number of individuals by their teens or early 20’s. Within certain geographic and ethnic groups, especially in adult Blacks, Orientals, Indians, and Eastern European Jews, the lactase activity may be low even earlier. Although many of them can easily digest smaller quantities of lactose in milk, after consumption of an excessive volume of milk or dairy products, they may exhibit symptoms of lactose intolerance.
When available lactase is insufficient to split the lactose, the unabsorbable sugar remains in the small intestine for an extended period, presenting an osmotic load that increases and retains intraluminal fluid and intensifies intestinal motility; thus the individual reports a bloated feeling and cramps. The undigested lactose is decomposed by the intestinal flora in the lower intestine and excessive carbon dioxide and hydrogen is produced. These gases contribute to flatulence and increased abdominal discomfort. The lactic acid and other short chain acids raise the osmolality, hinder fluid reabsorption and decrease transit time of the contents of the colon, leading to diarrhea. Often hydrogen is noticed in the expired breath of a lactase deficient patient.
Indications And Clinical Uses: For individuals exhibiting symptoms of lactose intolerance or lactase insufficiency as identified by a lactose tolerance test or by symptoms of gastrointestinal disturbances after consumption of milk or dairy products.
Precautions: It should be noted that in diabetic persons who use Lactrase, the milk sugar will be metabolically available and may result in increased blood glucose levels. Individuals with galactosemia may not have milk in any form, lactase enzyme modified or not.
Adverse Reactions: Virtually unknown.
Dosage And Administration: Generally, 1 or 2 capsules taken orally with milk or dairy products is all that is necessary to digest the milk sugar contained in a normal serving. If the patient is more intolerant to lactose, the patient may need more than 2 capsules; increase the dose until the correct dose is found. Lactrase capsules are safe to take and higher doses will be well tolerated.
If the patient prefers, milk can also be pretreated; simply add the contents from 1 to 2 capsules to each L of milk, shake gently, and store the milk in the refrigerator for 24 hours. Lactrase will break down milk sugars to digestible simple sugars. Lactrase powder will not alter the appearance of milk; however, the taste may be slightly sweeter than untreated milk.
If the patient cannot swallow capsules, the contents of the capsules can be sprinkled onto their favorite dairy product before consuming. Lactrase will not alter the taste of the dairy product when used in this manner.
Availability And Storage: Each opaque orange and opaque white capsule imprinted with “SCHWARZ” and “505” contains: standardized lactase 250 mg. Nonmedicinal ingredients: magnesium stearate and maltodextrin. Gluten-, lactose- and tartrazine-free. Bottles of 100.
LACTRASE® Rivex Pharma Lactase Lactose Digestant