Our Comment:
Lactulose seems to be more beneficial than other laxatives (except lactitol) for hepatic encephalopathy. Whether this is also true for its use in relation with constipation is not clear. The effect of small doses of lactulose resembles the effect of nutritional fibers. As a matter of fact one can expect good tolerance in elderly patients. There are indications that a similar result could be reached with significantly less expensive drugs (e.g. with sorbitol or cautious doses of a fiber/senna combination).