Diphenoxylate and Atropine

(dye-fen-ox-ih-late, at-ruh-peen)

Trade/other name(s): Lomotil, Lonox

Why would this drug be used?

Diphenoxylate with atropine is used to help stop diarrhea. It is sometimes used for other purposes.

How does this drug work?

Diphenoxylate with atropine combination, a synthetic opiate-like drug, works by slowing the normal forward movement (known as peristalsis) of the intestines, so that they can better absorb water from the liquid stool. This help make the stool more solid.

Before taking this medicine

Tell your doctor…

• If you are allergic to anything, including medicines, dyes, additives, or foods.
• If you have any medical conditions such as kidney disease, liver disease (including hepatitis or jaundice), heart disease, diabetes, underactive or overactive thyroid, gallstones or gallbladder problems. These conditions may require that your medicine dose, regimen, or timing be changed.
• If you have hiatal hernia, or glaucoma. These conditions may be worsened or complicated by diphenoxylate and atropine.
• If you use alcohol, opioid pain medicines, muscle relaxers, tranquilizers, sleeping medicines, antihistamines, barbiturates, anti-seizure medicines or other substances that can cause sleepiness. This medicine may add to their effects and cause unconsciousness or even death.
• If you have asthma, emphysema, bronchitis, sleep apnea, lung disease, or other breathing problem. This medicine can worsen breathing.
• If you have trouble passing urine, overflow incontinence, or an enlarged prostate. Diphenoxylate and atropine can worsen this problem.
• If your diarrhea is from an infection such as salmonella, shigella, or is related to taking antibiotics. Diphenoxylate and atropine can make them worse or make the diarrhea last longer.
• If you have fever, blood or mucus in your stools, ulcerative colitis, or stools that look like black tar. You may have a more serious problem than diarrhea, and this medicine could make it worse.
• If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. There may be an increased risk of harm to the fetus if a woman takes this drug during pregnancy.
• If you are breast-feeding. This drug may pass into breast milk and affect the baby.
• About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

Medicines or substances that slow down the brain or nervous system, such as these, can cause worse side effects if taken with diphenoxylate and atropine:

• anti-anxiety drugs (tranquilizers or sedatives)
• sleeping pills
• muscle relaxers
• barbiturates
• anti-seizure medicines
• other opioid drugs
• anesthetics
• antidepressants such as amitriptyline, desipramine, doxepin, imipramine, nortriptyline
• anti-psychotic drugs
• certain anti-nausea medicines
• alcohol

Some of these can cause slowed breathing, low blood pressure, extreme sleepiness, coma, brain damage, or even death if taken with diphenoxylate and atropine.

Serious side effects may result if antidepressants of the older MAO inhibitor type such as phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan), or selegiline (Emsam) are taken within 2 weeks of diphenoxylate and atropine.

Check with your doctor, nurse, or pharmacist about whether other medicines, vitamins, herbs, and supplements can cause problems with this medicine.

Interactions with foods

There are no known serious interactions with food at this time. Check with your doctor, nurse, or pharmacist about whether foods may be a problem. Diphenoxylate with atropine may be taken with food to keep it from upsetting your stomach.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Diphenoxylate with atropine is available as a pill or liquid. The liquid comes in a bottle which includes a special dropper used to measure the dose exactly. A dose is typically given after each loose stool, but don't take more than 4 doses a day unless your doctor tells you to do so. Your doctor will adjust the dose and how often it is given depending on how severe the diarrhea is.

Take this drug exactly as directed by your doctor. If you do not understand the instructions, ask your doctor or nurse to explain them to you. Talk to your doctor or nurse if you still have diarrhea after 48 hours of taking the medicine as directed.

Store the medicine in a tightly closed container away from heat and moisture and out of the reach of children and pets.

Precautions

Diarrhea can cause dehydration and deplete the body of important minerals. It is very important to drink plenty of liquids while you are being treated for diarrhea. Try to drink at least 2 to 3 quarts of fluid each day. Check with your doctor if your diarrhea does not stop after two days or if you notice dizziness, lightheadedness, low urine output, dry mouth, unusual thirst, or dry, loose skin.

Before having any kind of surgery, dental surgery, or emergency treatment, tell the doctor or dentist in charge that you are taking this medicine.

Diphenoxylate with atropine can cause drowsiness and lightheadedness. Do not drive, operate machinery, or perform other activities until you know how this medicine affects you.

Diphenoxylate and atropine can make you feel dizzy or faint, and increase your risk of falling. Be careful getting up, changing position, or walking. Get up slowly and hold onto something or someone to keep you steady. Have a responsible adult with you until you have adjusted to the medicine.

Call your doctor or nurse if you notice bloating, constipation, stomach pain or cramping, nausea or vomiting, loss of appetite.

Stop the drug and call your doctor or nurse right away if you get a rash, itching, hives (skin welts) or swelling of the face. This may be an allergic reaction, which can be serious.

To help decrease the diarrhea, try to eat small, frequent meals that are warm or at room temperature. Try to avoid foods that cause gas (such as broccoli or beans), fatty foods (such as bacon or cheeses), citrus fruits and juices. Avoid high lactose-foods (such as milk or ice cream) if they upset your stomach or make diarrhea worse. Instead eat foods high in sodium and potassium (such as soups or sports drinks), and foods high in soluble fiber (such as rice or bananas). Stay away from foods high in insoluble fiber (such as cereal or nuts). To add calories without worsening diarrhea, dilute fruit juice with water.

If you think you or someone else may have taken an overdose, get emergency help right away. Symptoms of overdose may include blurred vision, confusion, severe nervousness or restlessness, extreme dizziness, severe drowsiness, very dry mouth, fast heart beat, warm or flushed skin, or shortness of breath or troubled breathing.

This is a controlled substance, and may be habit-forming. You can become physically dependent on this drug. (This is not the same thing as addiction.) If you have been taking it for several weeks or more, do not stop taking it without checking with your doctor. He or she may want you to gradually cut down the amount you are using, to reduce the chance of withdrawal effects. Check with your doctor if you notice muscle cramps, stomach cramps, upset stomach, vomiting, and shivering or trembling, when you stop taking the drug.

Possible side effects

Should you have any of these side effects talk to your doctor or nurse. They can help you understand these side effects and help you deal with them

Common

• nausea*
• dry mouth
• sleepiness*

Less common

• vomiting*
• restlessness
• bloated belly*
• loss of appetite
• dizziness*
• tiredness (fatigue)
• trouble sleeping

Rare

• intestines stop moving altogether (paralytic ileus)*
• headache
• numbness and tingling in hands and/or feet
• blurred vision
• allergic reaction with rash, itching, or swelling of the face*

*See "Precautions" section for more detailed information.

There are some other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved before 1984 (FDA cannot verify dates of drugs approved before 1984).

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.