Bifiteral®

introduction

Bifiteral® is the trade name of a laxative based on the active ingredient lactulose. (100 ml Bifiteral® contain approx. 67 g lactulose.) It is used in constipation (Constipation) is used when it can no longer be remedied naturally.
Bifiteral® is included in the group of osmotic laxatives (Water-attracting laxatives) classified. This includes the subgroup of saline laxatives (Epsom salt, Glauber's salt), synthetic sugar (Lactulose) and polyethylene glycols (Macrogol).

Mode of action

The contained in Bifiteral® Lactulose is a disaccharide (Double sugar) consisting of the sugars Galactose and Fructose. She can't from Intestines are absorbed, i.e. not ins blood pass over. The lactulose consequently remains in the intestine, which leads to that too more water in the intestines remains behind. The reason for this is that Bifiteral® is osmotically effective. Under the term of osmosis is understood to be a biochemical process occurring in different places in the body.

If a semipermeable membrane (a membrane that is only permeable to water) separates two liquid containers and one on one side of the membrane more concentrated solution present (more particles of one substance per amount of liquid), then water from the lower concentrated side flow through the membrane to the more concentrated side, so that one ends up on both sides equally concentrated solution present.
This process also takes place in the intestine. Usually the different nutrients (Sugar, proteins, fats) absorbed (absorbed through the intestinal wall). However, since the lactulose cannot be absorbed from the Bifiteral®, a more concentrated solution of lactulose is formed inside the intestine.
According to the principle of osmosis (see above) is now water from our body through the membrane (here the intestinal wall) flow into the intestine to lower the lactulose concentration (because: more water for the same number of lactulose particles means a lower concentration). By now more water in the intestines is located The stool is softer and easier to pass.

Another mechanism is that some of the lactulose from the Bifiteral® in the intestine is from the natural Intestinal flora (Bacteria that live in the gut) is split into acetic acid and lactic acid. This leads to the The pH value in the intestine drops. The pH describes how angry is a liquid (The more acidic a solution, the more positively charged hydrogen atoms (H +) there are in it, the lower the pH value).
When the intestine becomes more acidic, it is stimulated to do so to move more intensely (the intestinal motility increases). The increased movement makes the stool better towards the anus (nach) and the bowel movement is facilitated.

The bacteria occurring in the intestine produce in their metabolism, among other things ammonia. The ammonia is also in our body End product or breakdown product of proteins (Proteins). It cannot and will no longer be used excreted in the stool and urine. When it accumulates in large quantities (accrues), then this is toxic to the body and causes, among other things, Damage in brain and the lung.
If the pH value drops due to the breakdown of lactulose from the Bifiteral® in the intestine and more H + ions are present, then these combine with ammonia to form NH4 + (Ammonium ions). It is important that the ammonium ions in contrast to the ammonia in the intestine not absorbed can be. That in turn means that the administration of Bifiteral® can help a lot Lower ammonia levels, because the ammonium ions that are created do not get into our circulation, but are excreted with the stool.

Ingestion

Bifiteral® can be used as Powder or syrup be taken.

The syrup is measured in the required amount and can then be stirred into drinks or food or taken with these foods. Basically, however, the Bifteral® applies in terms of time regardless of meals can be taken.

The period in which the effects start can vary greatly from person to person. So the laxative effect can already follow 2-10 hours start, but also only after 1-2 days.

The use of the powder is basically no different from that of the syrup. The powder is also stirred into drinks and food.

Bifiteral® should not have the maximum time of 2 weeks can also be taken.

application

Bifteral® can help Constipation (Constipation) that cannot be used in other ways (Fiber, exercise) dissolve. In general, it can be used for diseases in which easier bowel movements are indicated, e.g. at hemorrhoids.

Another area of ​​application is that portocaval or hepatic encephalopathy. This is a Disorder of the brain due to advanced liver damage, e.g. one Cirrhosis of the liver. Because the liver is damaged, it no longer works properly and can remove the degradation product ammonia can no longer be excreted sufficiently, whereby the ammonia (NH3) accumulates in the body and various damage (e.g. in the brain) can trigger. The use of Bifiteral® can support the Lower ammonia levels (see above).

Bifiteral can also be taken when renovating Salmonella excretors. These are people who are infected with Salmonella from Gastrointestinal tract had. Such an infection can heal by itself or with antibiotics, but a depot of the pathogen can also remain (e.g. in the biliary tract). In such cases, those affected continue to excrete salmonella in their stool. When Bifiteral® is given, the increased number of stools is intended to flush the pathogen out of the gastrointestinal tract.

dosage

When taking, the dosage should be adhered to prescribed by the attending physician has been. The amount of Bifiteral® depends on Group of people, severity and type of illness.

If you are constipated 7.5-15ml 1-2 times a day indicated in adults. With children only 4.5-9ml 1-2 times a day.

At hepatic encephalopathy in adults from a dose of 7.5-15ml 3-4 times a day talked about that carefully in the course of treatment 30-45 times 3-4 times a day should be increased.

When renovating Salmonella excretors is by two 10-12 day courses gone out, being in the first cure 13.5ml 3 times a day be taken and in the second course (after a week off) 13.5ml 5 times a day.

If side effects occur in the course of use, it is advisable to consult the attending physician.

Side effects

At medium dosage are light stomach pain and Flatulence possible. If higher dosages are used then can nausea, Vomit and diarrhea With Disorders of the water and electrolyte balance (diarrhea causes the body to lose vital salts) occur.

With a long-term use of Bifiteral® this leads to thin stools and can have the above side effects, including water and electrolyte disorders.

In the case of the occurrence of the above-mentioned disorders, a doctor should be consulted, as treatment with medication may have to be carried out.

Interactions

With an increased number of bowel movements and the increased loss of fluids and potassium, the effects of cardiac glycosides (Medication that Heart failure/ Heart failure and Atrial fibrillation be used) come.

When taking water tablets (diuretics), the loss of potassium may increase.

Diabetics must note that Bifiteral® also contains a small amount of carbohydrates that can be absorbed. If necessary, the insulin medication must be adjusted according to the amount of Bifiteral® taken.

Contraindications

• Inflammation in the Gastrointestinal tract
• Intestinal obstruction (Ileus)
• Lactulose intolerance
• Galactose intolerance
• Fructose intolerance
• Disturbances in the electrolyte and water balance (The presence of disturbances in potassium, sodium and other salt concentrations)