# Lactose Intolerance - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: WGO Global Guidelines Lactose Intolerance 2013 · Calcichew 500 mg Chewable Tablets SmPC sections 4.1-4.5 (eMC product 12847) · MSF Essential Drugs 2024 (colecalciferol oral monograph, prevention and treatment of vitamin D deficiency) · Lactose Intolerance - disease-level clinical article (lactose-intolerance-full.txt) - Verified date: 2026-08 ## Verified against - WGO Global Guidelines Lactose Intolerance 2013 - Calcichew 500 mg Chewable Tablets SmPC sections 4.1-4.5 (eMC product 12847) - Lactose Intolerance - disease-level clinical article (lactose-intolerance-clinical.txt) - MSF Essential Drugs 2024 (colecalciferol oral monograph, prevention and treatment of vitamin D deficiency) - Lactose Intolerance - disease-level clinical article (lactose-intolerance-full.txt) ## Treatment metadata - Lactase enzyme — oral.solid - Referral & safety-netting (no drug therapy) - Calcium carbonate — 500 mg — oral.solid - Cholecalciferol — oral.liquid ## Complete treatment card ```text LACTOSE INTOLERANCE Sources: WGO Global Guidelines Lactose Intolerance 2013 · Calcichew 500 mg Chewable Tablets SmPC sections 4.1-4.5 (eMC product 12847) · MSF Essential Drugs 2024 (colecalciferol oral monograph, prevention and treatment of vitamin D deficiency) · Lactose Intolerance - disease-level clinical article (lactose-intolerance-full.txt) Review status: REVIEWED against WGO Global Guidelines Lactose Intolerance 2013, Calcichew 500 mg Chewable Tablets SmPC sections 4.1-4.5 (eMC product 12847), Lactose Intolerance - disease-level clinical article (lactose-intolerance- clinical.txt), MSF Essential Drugs 2024 (colecalciferol oral monograph, prevention and treatment of vitamin D deficiency), Lactose Intolerance - disease-level clinical article (lactose- intolerance-full.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - Symptoms appear roughly 30 minutes to two hours after eating a lactose-containing food - Diarrhoea, bloating, and crampy abdominal pain are common complaints [abdominal distension · abdominal pain · diarrhoea] - Nausea, vomiting, a feeling of fullness, and excess flatulence are frequently reported [flatulence · nausea · vomiting] - Less often, headache, muscle or joint aches, mouth sores, urinary complaints, or poor concentration occur [headache · joint pain · mouth ulcers · poor concentration] SIGNS - what you find (1) - Exam is usually normal but can show a distended, tender, or drum-like (tympanic) abdomen on percussion TESTS (7) - A rise in breath hydrogen of more than 20 ppm from baseline after a lactose load supports malabsorption - Low stool pH from lactic acid produced by unabsorbed lactose fermentation is another clue - After 500 mL of milk, a blood glucose rise under 9 mg/dL suggests malabsorption - 50 g oral lactose with glucose checks at 0, 60, and 120 minutes; a rise under 20 mg/dL suggests intolerance, 75% sensitive and 96% specific - False negatives on the lactose tolerance test can occur with diabetes, small bowel bacterial overgrowth, or slow gastric emptying - Small bowel biopsy is invasive and rarely used, mainly to exclude coeliac disease - Genetic testing is highly sensitive and specific but is not yet widely used outside parts of Europe IF NOT THIS - what else fits (8) - Irritable bowel syndrome - Functional dyspepsia - Coeliac disease - Tropical sprue - Inflammatory bowel disease - Giardiasis - Cystic fibrosis - An intestinal neoplasm or polyp Source StatPearls "Lactose Intolerance" - disease-level clinical article Status traced to the source above Rx: Main treatment | Bone health - vitamin D alongside calcium MAIN TREATMENT - choose one, plus any add-on marked below 1. LACTASE ENZYME [1st line] Adult 4500-9000 FCC units taken with the first bite of lactose-containing food - as needed with dairy consumption Peds Children >2 years: 2250-4500 FCC units with dairy meals Source WGO Global Guidelines Lactose Intolerance 2013 Why Enzyme replacement allows digestion of dietary lactose; sold in Egypt as combination enzyme or imported dietary supplement. Caution Dose must be taken concurrently with lactose-containing meals. Primary strategy remains dietary lactose restriction or low-lactose products. Exclude coeliac disease or secondary enteropathy if symptoms persist. Egypt RAMELACT 6000 ALU 30 TABS. RAMEDA 360.00 EGP (12.00/unit) ROTADIGEST LACTASE 9000 - 30 H.G. CAPS. LIFE SAFER INTERNATIONAL > MIRA ... 330.00 EGP LACTASE 750 15ML ORAL DROPS COPAD > FORTIS 99.00 EGP -> ? strength differs, ? different route - not oral solid LACTIMISK 15 ML ORAL DROPS DAWA EGYPT > ... 150.00 EGP -> ? strength differs, ? different route - not oral solid 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Lactose Intolerance - disease-level clinical article (lactose-intolerance-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Refer to a gastroenterologist to evaluate for alternative or concurrent GI disorders; the differential includes celiac disease, IBD, and intestinal neoplasm/polyp. 3. CALCIUM CARBONATE [add-on - not a substitute] Adult 500 mg chewable tablets, 2 to 3 tablets daily - long-term while dairy is restricted Peds The label gives the same 2 to 3 tablets daily for paediatric prevention and treatment of calcium deficiency, without an age floor; no lactose-intolerance paediatric calcium figure exists in any document held here. Source Calcichew 500 mg Chewable Tablets SmPC sections 4.1-4.5 (eMC product 12847) Why Calcium supplement added to a lactose-restricted diet, not a substitute for dietary management of lactose intolerance itself; it replaces the calcium lost when dairy is avoided, and the article asks for it - calcium and vitamin D supplements, to keep the bone healthy. The dose was put right in August 2026: the row had read 500 mg 1 to 2 times daily after food, a figure that is NOT in the label cited beside it. The label's own posology is 2 to 3 tablets daily, for preventing and for treating calcium deficiency, and one tablet carries calcium carbonate equivalent to 500 mg of calcium - so the row as it stands gives 1,000 to 1,500 mg of calcium a day rather than 500 to 1,000 mg. It matches the shin-splints calcium row, which was written from the same label. Caution Replaces the calcium intake lost when dairy is restricted. The label's own indication for Calcichew 500mg Chewable Tablets is as a chewed calcium supplement, to correct a dietary shortfall or to cover a period when the requirement is unusually high; the link to lactose intolerance comes from the disease article. The dose here is the label's - 2 to 3 tablets a day, for preventing and treating calcium deficiency. Each tablet carries calcium carbonate delivering 500mg of calcium, so 2 to 3 tablets is 1,000 to 1,500 mg of calcium daily. The tablet is taken by chewing or sucking it. CONTRAINDICATED, from section 4.3 of the label: hypersensitivity to calcium carbonate itself or to any excipient in the section 6.1 list; any disease or condition producing hypercalcaemia or hypercalciuria; severe renal failure not treated by dialysis; osteoporosis caused by immobilisation; and renal calculi. Calcium blocks the absorption of several common drugs, and the fix is timing, not stopping either one: a tetracycline 2 hours before or 4-6 hours after; a quinolone 2 hours either side; iron, zinc or strontium 2 hours either side; levothyroxine at least 4 hours apart. Taken together with the vitamin D on this card there is a risk of hypercalcaemia and milk-alkali syndrome; the label asks for serum calcium and renal monitoring, especially with cardiac glycosides or diuretics. On a thiazide, check the calcium periodically - the two together push it up. Egypt OSCASEEF 500MG 30 CAPS. SAFE PHARMA 21.75 EGP (0.72/unit) CALCIMATE 500 MG 12 CAPS. EL NASR 20.00 EGP (1.67/unit) CARIBO 500MG 50 CHEW. TABS. AL ESRAA PHAR... 18.00 EGP CALCINEX PLUS SYRUP 120 ML FAMILY PHARMA... 59.00 EGP -> ? strength differs, ? different route - not oral solid BONE HEALTH - VITAMIN D ALONGSIDE CALCIUM - give alongside 4. CHOLECALCIFEROL [add-on - not a substitute] Adult 600 IU once daily as the preventive dose; where deficiency is established, 6,000 IU once daily for 3 months or 300,000 IU as a single dose, then continue the preventive dose Peds Under 12 months: Prevention: 400 IU once daily. Established deficiency: under 3 months, 2,000 IU once daily for 3 months; 3 to under 12 months, 2,000 IU once daily for 3 months or 50,000 IU as a single dose. 12 months and over: Prevention: 600 IU once daily. Established deficiency, 12 months to under 12 years: 3,000 to 6,000 IU once daily for 3 months or 150,000 IU as a single dose. (MSF preventive dosing: child under 12 months, 400 IU once daily; child 12 months and over, 600 IU once daily. For established deficiency MSF gives child under 3 months 2,000 IU once daily for 3 months; 3 to under 12 months 2,000 IU once daily for 3 months or 50,000 IU single dose; 12 months to under 12 years 3,000 to 6,000 IU once daily for 3 months or 150,000 IU single dose.) Source MSF Essential Drugs 2024 (colecalciferol oral monograph, prevention and treatment of vitamin D deficiency) Why The card already carried calcium carbonate as an adjunct, but the disease article recommends calcium AND vitamin D together to maintain bone health in patients avoiding dairy - so half the article's bone-health pairing was missing. MSF Essential Drugs indicates colecalciferol for the prevention and treatment of vitamin D deficiency and gives the doses. The link from lactose intolerance to that indication comes from the disease article, not from MSF: MSF names rickets and osteomalacia, not lactose intolerance. Named Cholecalciferol rather than the MSF spelling Colecalciferol because that is how the Egyptian register spells it (184 products); the two are the same molecule. Caution Do not administer to patients with hypercalcaemia, hypercalciuria, calcic lithiasis, severe renal impairment. Stop treatment if signs of overdosage occur: headache, anorexia, nausea, vomiting, increased thirst, polyuria. Avoid combination with thiazide diuretics, e.g. hydrochlorothiazide (decreased urinary calcium excretion). Do not exceed 600 000 IU yearly. The MSF indication is prevention and treatment of vitamin D deficiency (rickets, osteomalacia); it does not name lactose intolerance, and that link comes from the disease article. Egypt UR-D 200 I.U./ML ORAL DROPS 25 ML HI-PHARM 21.60 EGP D3 BOX DROPS 15 ML ORGANIX INDUS... 22.00 EGP VIDROP 2800 I.U./ML ORAL DROPS 15 ML MUP 26.00 EGP ONEFEROL BONE 2800 I.U./ML ORAL DROPS 30 ML PHARMAZAD > PHARMA ONE 46.00 EGP CHILDAL ORAL DROPS 30 ML BRAND PHARMA ... 60.00 EGP CHOLETRIX-D3 400 IU ORAL DROPS 30ML COPAD EGYPT > IBM PHARMA 75.00 EGP VITAMIN D 2000IU 30ML ORAL DROPS ORGANIX > SOU... 165.00 EGP KIDDO 3 ORAL DROPS 10 ML PRO-BIO PHARMA > 300.00 EGP D3-TAG 1000 IU/ML ORAL DROPS 30ML > TAG PHARMA 27.00 EGP -> ? strength differs, ? different route - not oral liquid PEDYANO D SYRUP15ML ORGANIX > PED... 35.00 EGP -> ? strength differs, ? different route - not oral liquid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)