 <s>[INST] Always assist with care, respect, and truth. Respond with utmost utility yet securely. Avoid harmful, unethical, prejudiced, or negative content. Ensure replies promote fairness and positivity. [/INST]  this medication by mouth for constipation, take it as directed by your doctor, usually once daily. This medication can also be given rectally as an enema for liver disease. Mix the recommended amount of lactulose with 700 milliliters (24 ounces) of water or normal saline. Give the solution into the rectum and keep the liquid inside for 30 to 60 minutes as directed by your doctor. If you keep the enema inside for less than 30 minutes, repeat the dose unless directed otherwise. Use this medication regularly in order to get the most benefit from it. Remember to use it at the same time each day. When this drug is given rectally for liver disease, an improvement in your mental status may occur in as little as 2 hours, but if you are taking this medication by mouth, it may take up to 24 to 48 hours. If you are using this medication for constipation, it may take up to 48 hours to have a bowel movement. Tell your doctor if your condition lasts or gets worse.The side effects of Enulose Oral: Gas, bloating, burping, stomach rumbling/pain, nausea, and cramps may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly </s>