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Lactobacillus

Pronunciation

(lak toe ba SIL us)

Index Terms

  • Lactobacillus acidophilus
  • Lactobacillus bifidus
  • Lactobacillus bulgaricus
  • Lactobacillus casei
  • Lactobacillus paracasei
  • Lactobacillus plantarum
  • Lactobacillus reuteri
  • Lactobacillus rhamnosus GG
  • Acidoph/L.Bulg/Bif.B/S.Thermop
  • Acidophilus/Bulgaricus

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule, Oral:

Advanced Probiotic: L. acidophilus, L. casei, L. delbrueckii, and L. rhamnosus GG 10 billion live cultures [also includes Bifidobacterium lactis, and B. longum]

Culturelle: L. rhamnosus GG 10 billion colony-forming units

Dofus: L. acidophilus and L. bifidus 10:1 ratio [beet root powder base]

Flora-Q: L. acidophilus and L. paracasei ≥8 billion colony-forming units [also contains Bifidobacterium and S. thermophilus] [DSC}

Lacto-Key:

100: L. acidophilus 1 billion colony-forming units [milk, soy, and yeast free; rice derived]

600: L. acidophilus 6 billion colony-forming units [milk, soy, and yeast free; rice derived]

Lacto-Bifidus:

100: L. bifidus 1 billion colony-forming units [milk, soy, and yeast free; rice derived]

600: L. bifidus 6 billion colony-forming units [milk, soy, and yeast free; rice derived]

Lacto-Pectin: L. acidophilus, L. casei, L. plantarum, L. rhamnosus, Bifidobacterium breve, and B. longum 20 billion colony-forming units

Lacto-TriBlend:

100: L. acidophilus, L. bifidus, and L. bulgaricus 1 billion colony-forming units [milk, soy and yeast free; rice derived]

600: L. acidophilus, L. bifidus, and L. bulgaricus 6 billion colony-forming units [milk, soy and yeast free; rice derived]

Megadophilus, Superdophilus: L. acidophilus 2 billion units [available in dairy based or dairy free formulations]

Prodigen: L. acidophilus 42 billion colony-forming units and Bifidobacterium lactis 39 billion colony-forming units

RisaQuad: L. acidophilus and L. paracasei 8 billion colony-forming units [also includes Bifidobacterium and Streptococcus thermophilus]

RisaQuad-2: L. acidophilus and L. paracasei 16 billion colony-forming units [gluten free; also includes Bifidobacterium and Streptococcus thermophilus]

Visbiome: L. acidophilus, L. plantarum, L. paracasei, L. bulgaricus, Bifidobacterium breve, B. longum, B. infantis, and Streptococcus thermophilus112 billion live cells [gluten free; contains lactose, milk protein]

VSL #3: L. acidophilus, L. plantarum, L. paracasei, L. bulgaricus, Bifidobacterium breve, B. longum, B. infantis, and Streptococcus thermophilus 112 billion live cells [gluten free]

Caplet, Oral:

Risa-Bid: L. acidophilus and L. bulgaricus [also contains Bifidobacterium bifidum and Streptococcus thermophilus]

Granules:

Floranex: L. acidophilus and L. bulgaricus 100 million live cells per 1 g packet (12s) [contains milk, sodium 5 mg/packet, soy]

Lactinex: L. acidophilus and L. bulgaricus 100 million live cells per 1 g packet (12s) [gluten free; contains calcium 5 mg/packet, lactose 380 mg/packet, potassium 20 mg/packet, sodium 5 mg/packet, sucrose 34 mg/packet, whey, evaporated milk, and soy peptone]

Powder, Oral:

Lacto-TriBlend: L. acidophilus, L. bifidus, and L. bulgaricus 10 billion colony-forming units per ¼ teaspoon (60 g) [milk, soy, and yeast free; rice derived]

Megadophilus, Superdophilus: L. acidophilus 2 billion units per half-teaspoon (49 g, 70 g, 84 g, 126 g) [available in dairy based or dairy free (garbanzo bean) formulations]

MoreDophilus: L. acidophilus 12.4 billion units per teaspoon (30 g, 120 g) [dairy free, yeast free; soy and carrot derived]

Visbiome: L. acidophilus, L. plantarum, L. paracasei, L. bulgaricus 450 billion live cells per packet (30s) [gluten free; contains lactose, milk protein; also contains Bifidobacterium breve, B. longum, B. infantis, and Streptococcus thermophilus; lemon flavor and unflavored]

VSL #3: L. acidophilus, L. plantarum, L. paracasei, L. bulgaricus 450 billion live cells per sachet (10s, 30s) [gluten free; also contains Bifidobacterium breve, B. longum, B. infantis, and Streptococcus thermophilus; lemon cream flavor and unflavored]

VSL #3-DS: L. acidophilus, L. plantarum, L. paracasei, L. bulgaricus 900 billion live cells per packet (20s,) [gluten free; also contains Bifidobacterium breve, B. longum, B. infantis, and Streptococcus thermophilus]

Tablet, Oral:

Floranex: L. acidophilus and L. bulgaricus 1 million colony-forming units [contains lactose, nonfat dried milk, whey]

Kala: L. acidophilus 200 million units [dairy free, yeast free; soy based]

Tablet, chewable, Oral:

Dialyvite Probiotic: L. acidophilus and Bifidobacterium lactis 10 billion cells [orange cream flavor]

Lactinex: L. acidophilus and L. bulgaricus 1 million live cells [gluten free; contains calcium 5.2 mg/4 tablets, lactose 960 mg/4 tablets, potassium 20 mg/4 tablets, sodium 5.6 mg/4 tablets, and sucrose 500 sucrose/4 tablets; contains whey, evaporated milk, and soy peptone]

Pedia-Lax Probiotic Yums: L. reuteri 100 million organisms [dye free, gluten free, sugar free; contains milk protein; strawberry flavor]

ReZyst IM: L. acidophilus and Bifidobacterium 150 mg [3 billion lives cells; berry flavor] [DSC]

Wafer, Oral:

Generic: L. acidophilus 90 mg and L. bifidus 25 mg (100s) [provides 1 billion organisms/wafer at time of manufacture]

Brand Names: U.S.

  • Advanced Probiotic [OTC]
  • Culturelle [OTC]
  • Dialyvite Probiotic [OTC]
  • Dofus [OTC]
  • Flora-Q [OTC] [DSC}
  • Floranex [OTC]
  • Kala [OTC]
  • Lactinex [OTC]
  • Lacto-Bifidus [OTC]
  • Lacto-Key [OTC]
  • Lacto-Pectin [OTC]
  • Lacto-TriBlend [OTC]
  • Megadophilus [OTC]
  • MoreDophilus [OTC]
  • Pedia-Lax Probiotic Yums [OTC]
  • Prodigen
  • ReZyst IM [DSC]
  • Risa-Bid [OTC]
  • RisaQuad [OTC]
  • RisaQuad-2 [OTC]
  • Superdophilus [OTC]
  • Visbiome [OTC]
  • VSL #3 [OTC]
  • VSL #3-DS

Pharmacologic Category

  • Dietary Supplement
  • Probiotic

Pharmacology

Helps re-establish normal intestinal flora; suppresses the growth of potentially pathogenic microorganisms by producing lactic acid which favors the establishment of an aciduric flora.

Absorption

Oral: None

Distribution

Local, primarily colon

Excretion

Feces

Use: Labeled Indications

Dietary supplement: Probiotic to promote normal bacterial flora of the intestinal tract; probiotic supplement for breastfed or partially breastfed infants experiencing excessive crying, colic, and fussiness (Gerber Soothe Colic only).

Medical food:

Visbiome: Dietary management of pouchitis, ulcerative colitis, and irritable bowel syndrome.

VSL#3: Dietary management of an ileal pouch or ulcerative colitis.

Contraindications

OTC labeling: When used for self-medication, do not use if sensitive to milk protein (product specific).

Dosing: Adult

Dietary supplement/medical food: Oral: Dosing varies by manufacturer; consult product labeling.

Acidophilus products: 2 capsules 2 to 4 times daily or 1 to 2 wafers 2 to 4 times daily

Culturelle Digestive Health capsule and chewable tablet: 1 capsule or chewable tablet once daily; may increase chewable tablet to twice daily to alleviate digestive distress or during travel

Floranex: 4 tablets 3 to 4 times daily

Flora-Q: 1 capsule once daily

Lactinex: 1 packet or 4 tablets 3 to 4 times daily

Visbiome:

Irritable bowel syndrome: 2 to 4 capsules or ½ to 1 packet per day

Pouchitis: 2 to 4 packets/day

Ulcerative colitis (active): 4 to 8 packets/day

Ulcerative colitis (maintenance): 4 to 8 capsules or 1 to 2 packets per day

VSL #3: 1 to 8 packets or 2 to 8 capsules/day

VSL #3-DS: 1 to 4 packets/day

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Dietary Supplement: Note: Product formulations and labeling for use in pediatric patients may vary among available formulations; consult product labeling.

Culturelle (Lactobacillus rhamnosus GG): Oral:

Kids Packets: Lactobacillus rhamnosus GG 5 billion CFU/packet: Children <3 years: 1 packet once or twice daily

Kids Chewables: Lactobacillus rhamnosus GG 5 billion CFU/tablet: Children ≥3 years and Adolescents: 1 tablet once or twice daily

Digestive Health Capsule: Lactobacillus rhamnosus GG 10 billion CFU/capsule: Children and Adolescents: 1 capsule daily

Digestive Health Chewable: Lactobacillus rhamnosus GG 10 billion CFU/tablet: Children ≥3 years and Adolescents: 1 tablet once or twice daily

Gerber Soothe Probiotic Colic Drops: Lactobacillus reuteri 20 million CFU/drop: Infants: 5 drops once daily

Administration

Oral:

Acidophilus products: Administer with water or milk during a meal.

Culturelle: Do not add to warm or hot foods or beverages. Capsules may be opened and mixed in a cool beverage or sprinkled onto baby food or applesauce. Mix entire contents of packet into cool food or drink until dissolved.

Floranex: May follow administration with milk, fruit juice, or water.

Flora-Q: Administer with or without food.

Lactinex: Tablets may be chewed or swallowed; may follow with milk, fruit juice, or water. Granules may be added to cereal, food, or milk.

Visbiome: Unflavored powder packet or contents of capsule may be sprinkled on cold food or into cold noncarbonated beverages. Flavored packet may be mixed with cold noncarbonated beverage.

VSL #3, VSL #3-DS: Powder may be mixed in any noncarbonated beverage or mixed with any food such as yogurt, ice cream, or apple sauce.

Dietary Considerations

Some products may contain lactose, potassium, and/or sodium.

Storage

Store at room temperature; keep away from direct sunlight and protect from extreme heat; some preparations may need to be refrigerated; consult individual product labeling.

Visbiome: Store refrigerated at 4°C to 8°C (39°F to 46°F). May be stored at room temperature for up to 1 week.

Drug Interactions

There are no known significant interactions.

Adverse Reactions

Frequency not defined.

Gastrointestinal: Bloating (intestinal), flatulence

Warnings/Precautions

Disease-related:

• Immunocompromised patients: Use dietary supplements containing live bacteria or yeast with caution in immunocompromised patients. A fatal case of GI mucormycosis caused by the mold Rhizopus oryzae has been previously reported in a premature infant administered a dietary supplement containing 3 species of live bacteria (FDA Safety Information 2014).

Dosage form specific issues:

• Interchangeability: Significant differences may exist from one preparation compared to another with respect to biologic activity and composition.

• Lactose: Some products may contain lactose; use with caution in patients with lactose intolerance.

Other warnings/precautions:

• Dietary supplement: Probiotics are classified as dietary supplements; therefore, there are no safety reviews or approved therapeutic indications by the FDA. There is no conclusive evidence to support widespread use in the treatment of diarrhea.

Patient Education

What is this drug used for?

• It is used to keep the normal balance of bacteria in the gastrointestinal (GI) tract.

Frequently reported side effects of this drug

• Flatulence

• Nausea

• Vomiting

• Loss of appetite

• Abdominal cramps

• Dry mouth

• Headache

Other side effects of this drug: Talk with your doctor right away if you have any of these signs of:

• Dizziness

• Increased thirst

• Change in amount of urine passed

• Muscle pain

• Bone pain

• Severe loss of strength and energy

• Weight loss

• Signs of a significant reaction like wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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