Atropine/Diphenoxylate

Antidiarrheal medications that reduce GI motility, such as loperamide, diphenoxylate/atropine, or codeine should be avoided in patients with active IBD due to the risk of precipitating acute colonic dilation (toxic megacolon). 

Diphenoxylate/atropine Adults Two tablets (5 mg) initially, then one tablet every 3-4 hours, not to exceed 20 mg in 24 hours Children 2-12 years old Oral solution (avoid tablets) 0.3 to 0.4 mg/kg per day in divided doses Do not administer to children less than 2 years of age Acute and chronic... 

HT3 antagonist, prochlorperazine for emesis (avoid corticosteroids), H2 blocker for gastritis, antidiarrheal as needed (loperamide, diphenoxylate/atropine, codeine). 

Diphenoxylate + Atropine (Lomotil, Lonox) [C V] [Opioid Antidiarrheal] Uses D Action Constipating m CTidine congener, X GI motihty Dose Adults. Initial, 5 mg PO tid—qid until controlled, then 2.5-5 mg PO bid 20 mg/d max Peds >2 y. 0.3-0.4 mg/kg/24 h (of diphenoxylate) bid-qid, 10 mg/d max Caution [C, +] Contra Obstructive jaundice, D d/t bacterial Infxn children <2 y Disp Tabs, Liq SE Drowsiness, dizziness, xCTostomia, blurred vision, urinary retention, constipation Interactions T Effects W/ CNS depressants, opioids, EtOH, T risk HTN crisis W7 MAOIs EMS Monitor for Sxs of electrolyte disturbances and hypovolemia d/t D OD May cause Szs, hypotension, and anticholinergic effects (xerostomia [dry mouth], urine retention, flushed skin) activated charcoal may be effective for OD... 

Individuals on very small amounts of heroin are prescribed diazepam for anxiety, agitation or craving, zopiclone or zolpidem for insomnia, hyoscine butylbromide (Buscopan) for stomach cramps, and diphenoxylate/atropine (Lomotil) for diarrhoea, over a seven-day period. The medication schedule provided to the user explains which drug is for which symptoms, and the maximum doses of each that can be taken in a day, which for diazepam varies during the course. The basic medication regime is included in the Appendix. 

McCarron MM, Challoner KR, Thompson GA. Diphenoxylate-atropine (Lomotil) overdose in children an update (report of eight cases and review of the literature) Pediatrics 1991 87(5) 694-700. 

Diphenoxylate-atropine has been used in the past to treat cats with diarrhea, but toxicity has limited its usefulness. Lomotil should generally be avoided in cats. 

The total dose required to reverse the effects of the opioid is highly variable and is dependent on the concentration and receptor affinity of the opioid. Some drugs (eg, propoxyphene, diphenoxylate/atropine [Lomotil], buprenorphine, pentazocine, and the fentanyl derivatives) do not respond to usual doses of naloxone. However, if no response is achieved by a total dose of 10-15 mg, the diagnosis of opioid overdose should be questioned. 

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