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Duphalac solution contains the active ingredient lactulose, which is a type of medicine called an osmotic laxative. Lactulose has two quite different uses: treating constipation and, in higher doses, reducing a complication associated with liver disease called hepatic encephalopathy.In treating constipation lactulose works by increasing the water content and volume of the stools in the bowel, making them softer and easier to pass. Lactulose is made up of sugar molecules and is broken down by the bacteria that live in the lower part of the gut. This leads to the contents of the gut becoming more acidic, which reduces the absorption of a chemical called ammonia. The presence of ammonia in the gut causes water to be drawn into the lower bowel. This increases the amount of water in the stools, softening them and making them easier to pass, thus relieving constipation. It can take two to three days of treatment for the lactulose to have an effect.In treating hepatic encephalopathy lactulose also works by reducing the absorption of ammonia from the gut. The liver normally breaks down ammonia, but in liver disease such as cirrhosis the blood may bypass the liver, allowing this poisonous substance to pass to the brain. Here it can impair brain function, causing confusion, drowsiness and finally coma. By acidifying the contents of the gut, lactulose reduces the absorption of ammonia from the gut, thereby preventing this complication of liver disease.Lactulose is not absorbed into the bloodstream.