Lomotil
Encyclopedia
The drug
combination diphenoxylate/atropine (trade name
Lomotil) is a popular oral anti-diarrheal in the United States
, manufactured by Pfizer
. Its UK BAN
generic name is co-phenotrope.
Its active ingredients are diphenoxylate
and atropine
. Diphenoxylate is anti-diarrheal and atropine is anticholinergic
. Diphenoxylate is chemically related to the opioid
drug meperidine. A subtherapeutic amount of atropine
sulfate is present to discourage deliberate overdosage. Atropine has no anti-diarrheal properties, but will cause tachycardia
when overused. The medication diphenoxylate
works by slowing down the movement of the intestine
s.
The inactive ingredients of Lomotil (as a liquid; it comes in pill form as well) are cherry
flavor, citric acid
, ethyl alcohol 15%, FD&C Yellow No. 6, glycerin, sodium phosphate
, sorbitol
, and water
.
Other trade names for the same therapeutic combination are Lofene, Logen,
Lomanate and Lonox, among others. In other countries, Lomotil may have other names.
In the United States, Lomotil is classified as a Schedule V
controlled substance by federal law, and is available only for a medical purpose.
s for Lomotil are:
Diarrhea
that is caused by some antibiotic
s such as cefaclor
, erythromycin
or tetracycline can worsen with Lomotil.
. Long-term use may present problems of mild drug dependency. The dosage should be reduced after 48 h.
Lomotil may cause several side-effects
, such as dry mouth, headache
, constipation
and blurred vision
. Since it may also cause drowsiness or dizziness
, Lomotil should not be used by motorists, operators of hazardous machinery, etc. It is not recommended for children under two years of age. In rare cases lomotil may cause paresthesia
.
s and symptom
s of adverse effects
may include any or several of the following: convulsion
s, respiratory depression (slow or stopped breathing), dilated eye pupils, nystagmus (rapid side-to-side eye
movements), erythema
(flushed skin), gastrointestinal constipation
, nausea
, vomiting
, paralytic ileus, tachycardia
(rapid pulse), drowsiness, coma
and hallucination
s. Symptoms of toxicity
may take up to 12 hours to appear.
Treatment of Lomotil overdose must be initiated immediately after diagnosis
and may include the following: emesis (induced vomiting), gastric lavage
, ingestion of activated charcoal, laxative
and a counteracting medication (narcotic antagonist
).
Prompt and thorough treatment of overdose leads to a favorable outcome
. After a narcotic antagonist is given, recovery is usually within 24 to 48 hours. Children are at risk of a very poor outcome and must be kept for observation.
Medication
A pharmaceutical drug, also referred to as medicine, medication or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease.- Classification :...
combination diphenoxylate/atropine (trade name
Trade name
A trade name, also known as a trading name or a business name, is the name which a business trades under for commercial purposes, although its registered, legal name, used for contracts and other formal situations, may be another....
Lomotil) is a popular oral anti-diarrheal in the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
, manufactured by Pfizer
Pfizer
Pfizer, Inc. is an American multinational pharmaceutical corporation. The company is based in New York City, New York with its research headquarters in Groton, Connecticut, United States...
. Its UK BAN
British Approved Name
A British Approved Name is the official non-proprietary or generic name given to a pharmaceutical substance, as defined in the British Pharmacopoeia...
generic name is co-phenotrope.
Its active ingredients are diphenoxylate
Diphenoxylate
Diphenoxylate is an opioid agonist used for the treatment of diarrhea that acts by slowing intestinal contractions and peristalsis allowing the body to consolidate intestinal contents and prolong transit time, thus allowing the intestines to draw moisture out of them at a normal or higher rate and...
and atropine
Atropine
Atropine is a naturally occurring tropane alkaloid extracted from deadly nightshade , Jimson weed , mandrake and other plants of the family Solanaceae. It is a secondary metabolite of these plants and serves as a drug with a wide variety of effects...
. Diphenoxylate is anti-diarrheal and atropine is anticholinergic
Anticholinergic
An anticholinergic agent is a substance that blocks the neurotransmitter acetylcholine in the central and the peripheral nervous system. An example of an anticholinergic is dicycloverine, and the classic example is atropine....
. Diphenoxylate is chemically related to the opioid
Opioid
An opioid is a psychoactive chemical that works by binding to opioid receptors, which are found principally in the central and peripheral nervous system and the gastrointestinal tract...
drug meperidine. A subtherapeutic amount of atropine
Atropine
Atropine is a naturally occurring tropane alkaloid extracted from deadly nightshade , Jimson weed , mandrake and other plants of the family Solanaceae. It is a secondary metabolite of these plants and serves as a drug with a wide variety of effects...
sulfate is present to discourage deliberate overdosage. Atropine has no anti-diarrheal properties, but will cause tachycardia
Tachycardia
Tachycardia comes from the Greek words tachys and kardia . Tachycardia typically refers to a heart rate that exceeds the normal range for a resting heart rate...
when overused. The medication diphenoxylate
Diphenoxylate
Diphenoxylate is an opioid agonist used for the treatment of diarrhea that acts by slowing intestinal contractions and peristalsis allowing the body to consolidate intestinal contents and prolong transit time, thus allowing the intestines to draw moisture out of them at a normal or higher rate and...
works by slowing down the movement of the intestine
Intestine
In human anatomy, the intestine is the segment of the alimentary canal extending from the pyloric sphincter of the stomach to the anus and, in humans and other mammals, consists of two segments, the small intestine and the large intestine...
s.
The inactive ingredients of Lomotil (as a liquid; it comes in pill form as well) are cherry
Cherry
The cherry is the fruit of many plants of the genus Prunus, and is a fleshy stone fruit. The cherry fruits of commerce are usually obtained from a limited number of species, including especially cultivars of the wild cherry, Prunus avium....
flavor, citric acid
Citric acid
Citric acid is a weak organic acid. It is a natural preservative/conservative and is also used to add an acidic, or sour, taste to foods and soft drinks...
, ethyl alcohol 15%, FD&C Yellow No. 6, glycerin, sodium phosphate
Trisodium phosphate
Trisodium phosphate is a cleaning agent, food additive, stain remover and degreaser. It is a white, granular or crystalline solid, highly soluble in water producing an alkaline solution....
, sorbitol
Sorbitol
Sorbitol, also known as glucitol, Sorbogem® and Sorbo®, is a sugar alcohol that the human body metabolizes slowly. It can be obtained by reduction of glucose, changing the aldehyde group to a hydroxyl group. Sorbitol is found in apples, pears, peaches, and prunes...
, and water
Water
Water is a chemical substance with the chemical formula H2O. A water molecule contains one oxygen and two hydrogen atoms connected by covalent bonds. Water is a liquid at ambient conditions, but it often co-exists on Earth with its solid state, ice, and gaseous state . Water also exists in a...
.
Other trade names for the same therapeutic combination are Lofene, Logen,
Lomanate and Lonox, among others. In other countries, Lomotil may have other names.
In the United States, Lomotil is classified as a Schedule V
Controlled Substances Act
The Controlled Substances Act was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970. The CSA is the federal U.S. drug policy under which the manufacture, importation, possession, use and distribution of certain...
controlled substance by federal law, and is available only for a medical purpose.
Contraindications
Absolute contraindicationContraindication
In medicine, a contraindication is a condition or factor that serves as a reason to withhold a certain medical treatment.Some contraindications are absolute, meaning that there are no reasonable circumstances for undertaking a course of action...
s for Lomotil are:
- AllergyAllergyAn Allergy is a hypersensitivity disorder of the immune system. Allergic reactions occur when a person's immune system reacts to normally harmless substances in the environment. A substance that causes a reaction is called an allergen. These reactions are acquired, predictable, and rapid...
to diphenoxylate or atropine - Presence of jaundiceJaundiceJaundice is a yellowish pigmentation of the skin, the conjunctival membranes over the sclerae , and other mucous membranes caused by hyperbilirubinemia . This hyperbilirubinemia subsequently causes increased levels of bilirubin in the extracellular fluid...
- Diarrhea associated with pseudomembranous enterocolitis, diarrhea caused by antibioticAntibioticAn antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...
treatment, or diarrhea caused by enterotoxinEnterotoxinAn enterotoxin is a protein toxin released by a microorganism in the intestine. Enterotoxins are chromosomally encoded exotoxins that are produced and secreted from several bacterial organisms. They are often heat-stable, and are of low molecular weight and water-soluble...
-producing bacteriaBacteriaBacteria are a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals...
.
Interactions
Interactions with other drugs:- SedativeSedativeA sedative or tranquilizer is a substance that induces sedation by reducing irritability or excitement....
s - BarbiturateBarbiturateBarbiturates are drugs that act as central nervous system depressants, and can therefore produce a wide spectrum of effects, from mild sedation to total anesthesia. They are also effective as anxiolytics, as hypnotics, and as anticonvulsants...
s - AntidepressantAntidepressantAn antidepressant is a psychiatric medication used to alleviate mood disorders, such as major depression and dysthymia and anxiety disorders such as social anxiety disorder. According to Gelder, Mayou &*Geddes people with a depressive illness will experience a therapeutic effect to their mood;...
s (e.g., Elavil, Prozac, Paxil) - Tranquilizers (e.g., Valium, Xanax, Klonopin)
- Monoamine oxidase inhibitors (e.g., Nardil, Parnate)
Diarrhea
Diarrhea
Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...
that is caused by some antibiotic
Antibiotic
An antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...
s such as cefaclor
Cefaclor
Cefaclor, also known as cefachlor or cefaclorum , is a second-generation cephalosporin antibiotic used to treat certain infections caused by bacteria such as pneumonia and ear, lung, skin, throat, and urinary tract infections.- Indications:Cefaclor belongs to the family of antibiotics known as the...
, erythromycin
Erythromycin
Erythromycin is a macrolide antibiotic that has an antimicrobial spectrum similar to or slightly wider than that of penicillin, and is often used for people who have an allergy to penicillins. For respiratory tract infections, it has better coverage of atypical organisms, including mycoplasma and...
or tetracycline can worsen with Lomotil.
Safety
The drug combination is generally safe in short-term use and with recommended dosageEffective dose
Effective dose may refer to:*Effective dose the dose of pharmacologic agent which will have a therapeutic effect in some fraction of the population receiving the drug...
. Long-term use may present problems of mild drug dependency. The dosage should be reduced after 48 h.
Lomotil may cause several side-effects
Adverse effect (medicine)
In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery.An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. If it results from an unsuitable or incorrect dosage or...
, such as dry mouth, headache
Headache
A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the...
, constipation
Constipation
Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation...
and blurred vision
Blurred vision
-Causes:There are many causes of blurred vision:* Use of atropine or other anticholinergics* Presbyopia -- Difficulty focusing on objects that are close. The elderly are common victims....
. Since it may also cause drowsiness or dizziness
Dizziness
Dizziness refers to an impairment in spatial perception and stability. The term is somewhat imprecise. It can be used to mean vertigo, presyncope, disequilibrium, or a non-specific feeling such as giddiness or foolishness....
, Lomotil should not be used by motorists, operators of hazardous machinery, etc. It is not recommended for children under two years of age. In rare cases lomotil may cause paresthesia
Paresthesia
Paresthesia , spelled "paraesthesia" in British English, is a sensation of tingling, burning, pricking, or numbness of a person's skin with no apparent long-term physical effect. It is more generally known as the feeling of "pins and needles" or of a limb "falling asleep"...
.
Toxicity
Lomotil may cause serious health problems when overdosed. SignMedical sign
A medical sign is an objective indication of some medical fact or characteristic that may be detected by a physician during a physical examination of a patient....
s and symptom
Symptom
A symptom is a departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality...
s of adverse effects
Adverse effect (medicine)
In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery.An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. If it results from an unsuitable or incorrect dosage or...
may include any or several of the following: convulsion
Convulsion
A convulsion is a medical condition where body muscles contract and relax rapidly and repeatedly, resulting in an uncontrolled shaking of the body. Because a convulsion is often a symptom of an epileptic seizure, the term convulsion is sometimes used as a synonym for seizure...
s, respiratory depression (slow or stopped breathing), dilated eye pupils, nystagmus (rapid side-to-side eye
Human eye
The human eye is an organ which reacts to light for several purposes. As a conscious sense organ, the eye allows vision. Rod and cone cells in the retina allow conscious light perception and vision including color differentiation and the perception of depth...
movements), erythema
Erythema
Erythema is redness of the skin, caused by hyperemia of the capillaries in the lower layers of the skin. It occurs with any skin injury, infection, or inflammation...
(flushed skin), gastrointestinal constipation
Constipation
Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation...
, nausea
Nausea
Nausea , is a sensation of unease and discomfort in the upper stomach with an involuntary urge to vomit. It often, but not always, precedes vomiting...
, vomiting
Vomiting
Vomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose...
, paralytic ileus, tachycardia
Tachycardia
Tachycardia comes from the Greek words tachys and kardia . Tachycardia typically refers to a heart rate that exceeds the normal range for a resting heart rate...
(rapid pulse), drowsiness, coma
Coma
In medicine, a coma is a state of unconsciousness, lasting more than 6 hours in which a person cannot be awakened, fails to respond normally to painful stimuli, light or sound, lacks a normal sleep-wake cycle and does not initiate voluntary actions. A person in a state of coma is described as...
and hallucination
Hallucination
A hallucination, in the broadest sense of the word, is a perception in the absence of a stimulus. In a stricter sense, hallucinations are defined as perceptions in a conscious and awake state in the absence of external stimuli which have qualities of real perception, in that they are vivid,...
s. Symptoms of toxicity
Toxicity
Toxicity is the degree to which a substance can damage a living or non-living organisms. Toxicity can refer to the effect on a whole organism, such as an animal, bacterium, or plant, as well as the effect on a substructure of the organism, such as a cell or an organ , such as the liver...
may take up to 12 hours to appear.
Treatment of Lomotil overdose must be initiated immediately after diagnosis
Diagnosis
Diagnosis is the identification of the nature and cause of anything. Diagnosis is used in many different disciplines with variations in the use of logics, analytics, and experience to determine the cause and effect relationships...
and may include the following: emesis (induced vomiting), gastric lavage
Gastric lavage
Gastric lavage, also commonly called stomach pumping or Gastric irrigation, is the process of cleaning out the contents of the stomach. It has been used for over 200 years as a means of eliminating poisons from the stomach. Such devices are normally used on a person who has ingested a poison or...
, ingestion of activated charcoal, laxative
Laxative
Laxatives are foods, compounds, or drugs taken to induce bowel movements or to loosen the stool, most often taken to treat constipation. Certain stimulant, lubricant, and saline laxatives are used to evacuate the colon for rectal and/or bowel examinations, and may be supplemented by enemas under...
and a counteracting medication (narcotic antagonist
Antagonist
An antagonist is a character, group of characters, or institution, that represents the opposition against which the protagonist must contend...
).
Prompt and thorough treatment of overdose leads to a favorable outcome
Outcome
Outcome may refer to:* Outcome , a concept in game theory* The Outcome, a Swedish punk rock band* outcome measure in a clinical trial...
. After a narcotic antagonist is given, recovery is usually within 24 to 48 hours. Children are at risk of a very poor outcome and must be kept for observation.
External links
- Diphenoxylate and Atropin. RxList.
Source
- Lomotil overdose. MedlinePlus Medical Encyclopedia. Public domain.