Diphenoxylate/Atropine: Complete Guide to Diarrhea Treatment & Dosage

Summary of Key Points

Diphenoxylate/atropine is a prescription medication used to manage diarrhea and other gastrointestinal conditions. It works by slowing down bowel movements and reducing fluid loss. This antidiarrheal medication is generally prescribed for short-term use and should be taken exactly as directed by your healthcare provider. Common side effects of diphenoxylate include drowsiness, dry mouth, and dizziness. Always consult your doctor before adjusting your dose or if you experience any unusual symptoms.

Names of Medication

US Brand Name: Lomotil

Generic Name: Diphenoxylate/atropine

The generic name refers to the active ingredients in the medication, which are listed in parentheses next to the brand name.

Pharmacologic Category

Antidiarrheal

Opioid agonist (Diphenoxylate)

Anticholinergic (Atropine)

Dosing Guidelines for Diphenoxylate/Atropine

Diphenoxylate/atropine is used to treat various gastrointestinal conditions, including diarrhea, irritable bowel syndrome (IBS), and related disorders. Below are typical dosing guidelines for adults. Always consult your healthcare provider before making any changes to your medication regimen. If you need assistance, you can schedule a telemedicine appointment with one of our providers.

Diarrhea (Acute and Chronic)

Initial Dose: 2 tablets (or 10 mL of liquid) four times daily.

Maintenance Dose: Once symptoms improve, the dose may be reduced to 1 tablet (or 5 mL of liquid) as needed, up to a maximum of 8 tablets (or 40 mL) per day.

Length of Treatment: Typically short-term, until diarrhea is controlled. Consult your doctor if symptoms persist beyond 48 hours.

Irritable Bowel Syndrome (IBS)

Initial Dose: 2 tablets (or 10 mL of liquid) four times daily.

Maintenance Dose: Once symptoms improve, the dose may be reduced to 1 tablet (or 5 mL of liquid) as needed, up to a maximum of 8 tablets (or 40 mL) per day.

Length of Treatment: Short-term, based on symptom control. Consult your doctor for long-term management strategies.

Traveler’s Diarrhea

Initial Dose: 2 tablets (or 10 mL of liquid) four times daily.

Maintenance Dose: Once symptoms improve, the dose may be reduced to 1 tablet (or 5 mL of liquid) as needed, up to a maximum of 8 tablets (or 40 mL) per day.

Length of Treatment: Typically short-term, until diarrhea resolves. Contact your healthcare provider if symptoms persist beyond 48 hours.

Gastroenteritis

Initial Dose: 2 tablets (or 10 mL of liquid) four times daily.

Maintenance Dose: Once symptoms improve, the dose may be reduced to 1 tablet (or 5 mL of liquid) as needed, up to a maximum of 8 tablets (or 40 mL) per day.

Length of Treatment: Short-term, based on symptom control. Consult your doctor if symptoms persist.

Inflammatory Bowel Disease (IBD)

Initial Dose: 2 tablets (or 10 mL of liquid) four times daily.

Maintenance Dose: Once symptoms improve, the dose may be reduced to 1 tablet (or 5 mL of liquid) as needed, up to a maximum of 8 tablets (or 40 mL) per day.

Length of Treatment: Short-term, based on symptom control. Discuss long-term management with your healthcare provider.

Colitis

Initial Dose: 2 tablets (or 10 mL of liquid) four times daily.

Maintenance Dose: Once symptoms improve, the dose may be reduced to 1 tablet (or 5 mL of liquid) as needed, up to a maximum of 8 tablets (or 40 mL) per day.

Length of Treatment: Short-term, based on symptom control. Consult your doctor for long-term treatment options.

Diverticulitis

Initial Dose: 2 tablets (or 10 mL of liquid) four times daily.

Maintenance Dose: Once symptoms improve, the dose may be reduced to 1 tablet (or 5 mL of liquid) as needed, up to a maximum of 8 tablets (or 40 mL) per day.

Length of Treatment: Short-term, based on symptom control. Consult your doctor if symptoms persist.

Food Poisoning

Initial Dose: 2 tablets (or 10 mL of liquid) four times daily.

Maintenance Dose: Once symptoms improve, the dose may be reduced to 1 tablet (or 5 mL of liquid) as needed, up to a maximum of 8 tablets (or 40 mL) per day.

Length of Treatment: Short-term, until symptoms resolve. Contact your healthcare provider if symptoms persist beyond 48 hours.

Antibiotic-Associated Diarrhea

Initial Dose: 2 tablets (or 10 mL of liquid) four times daily.

Maintenance Dose: Once symptoms improve, the dose may be reduced to 1 tablet (or 5 mL of liquid) as needed, up to a maximum of 8 tablets (or 40 mL) per day.

Length of Treatment: Short-term, until diarrhea resolves. Consult your doctor if symptoms persist.

Functional Diarrhea

Initial Dose: 2 tablets (or 10 mL of liquid) four times daily.

Maintenance Dose: Once symptoms improve, the dose may be reduced to 1 tablet (or 5 mL of liquid) as needed, up to a maximum of 8 tablets (or 40 mL) per day.

Length of Treatment: Short-term, based on symptom control. Consult your doctor for long-term management options.

Dosage Forms and Strengths

Tablets: 2.5 mg diphenoxylate/0.025 mg atropine

Liquid (Oral Solution): 2.5 mg diphenoxylate/0.025 mg atropine per 5 mL

Contraindications for Diphenoxylate/Atropine

A contraindication is a specific situation or condition where a particular medication should not be used because it could cause harm. If you have any of the following conditions, avoid taking diphenoxylate/atropine:

1. Hypersensitivity to diphenoxylate or atropine: If you are allergic to either ingredient, taking this medication could cause a severe allergic reaction, including rash, swelling, or difficulty breathing.
2. Obstructive jaundice: This condition blocks bile flow from the liver. Diphenoxylate/atropine can worsen this by further impairing bile flow.
3. Diarrhea caused by certain infections: If your diarrhea is due to a bacterial infection like Clostridium difficile (C. diff) or other organisms that cause colitis, this medication may worsen your condition by slowing the removal of harmful bacteria from your intestines.
4. Severe liver disease: Diphenoxylate is metabolized in the liver. If you have severe liver disease, the medication may not be processed properly, leading to toxic levels in your body.
5. Children under 6 years of age: This medication is not recommended for young children due to the risk of serious side effects, including respiratory depression (slowed breathing).

Drug to Drug Interactions

Diphenoxylate/atropine, commonly known as Lomotil, can interact with other medications, potentially increasing side effects or reducing the effectiveness of either drug. It is important to inform your healthcare provider about all medications you are taking, including over-the-counter drugs and supplements. Key drug interactions to be aware of include:

1. Barbiturates (e.g., phenobarbital): These medications can amplify the sedative effects of diphenoxylate, which may lead to excessive drowsiness or respiratory depression.
2. Benzodiazepines (e.g., diazepam [Valium], lorazepam [Ativan]): When combined with diphenoxylate/atropine, these drugs can increase sedation and raise the risk of respiratory depression.
3. Opioid pain medications (e.g., oxycodone [OxyContin], hydrocodone [Vicodin]): Taking opioids with diphenoxylate can significantly heighten the risk of severe drowsiness, respiratory depression, and other serious side effects.
4. Anticholinergic drugs (e.g., diphenhydramine [Benadryl], amitriptyline [Elavil]): Since atropine has anticholinergic properties, using it alongside other anticholinergic medications can increase the likelihood of side effects such as dry mouth, constipation, and blurred vision.
5. MAO inhibitors (e.g., phenelzine [Nardil], tranylcypromine [Parnate]): These antidepressants can interact with diphenoxylate/atropine, potentially causing dangerous increases in blood pressure or other severe side effects.

Diphenoxylate/atropine in Pregnancy

Is it safe to take Diphenoxylate/atropine during pregnancy?

Diphenoxylate/atropine is classified as a Category C medication by the FDA for use during pregnancy. This means that while no well-controlled studies have been conducted in pregnant women, animal studies have shown some risk to the fetus. However, in certain situations, the potential benefits of using this antidiarrheal medication during pregnancy may outweigh the risks. It is essential to discuss this with your healthcare provider. If you are pregnant or planning to become pregnant, consult with one of our telemedicine providers to determine the best course of action for managing your symptoms.

Diphenoxylate/atropine while Breastfeeding

Is it safe to take Diphenoxylate/atropine while breastfeeding?

Diphenoxylate/atropine is not recommended while breastfeeding. The medication can pass into breast milk and may cause serious side effects in a nursing infant, including respiratory depression, drowsiness, and irritability. If you are breastfeeding, it is important to discuss alternative treatments for diarrhea with your healthcare provider. Our telemedicine providers are available to help you find a safer option for managing your symptoms while breastfeeding.

Estimated Cost of Diphenoxylate/atropine

The estimated cost of a 30-day supply of Diphenoxylate/atropine (typically 60 tablets) without insurance is approximately $15 to $25 when using a GoodRx coupon. Prices may vary depending on your location and the pharmacy you use. Be sure to check GoodRx or other discount programs to find the best price available for this prescription diarrhea medication.

Possible Alternatives to Diphenoxylate/atropine

If Diphenoxylate/atropine is not suitable for you, there are other treatment options and lifestyle changes that may help manage your symptoms. Always consult with your healthcare provider before making any changes to your treatment plan. You can also schedule a telemedicine appointment with one of our providers to discuss these alternatives.

1. Diarrhea: Over-the-counter options like loperamide (Imodium) may be effective. Dietary changes, such as avoiding fatty or spicy foods, can also help manage symptoms.
2. Irritable Bowel Syndrome (IBS): Antispasmodic medications like dicyclomine (Bentyl) or lifestyle changes, including stress management and dietary adjustments (e.g., a low FODMAP diet), may help.
3. Gastroenteritis: Staying hydrated and using oral rehydration solutions (ORS) is crucial. In some cases, probiotics may help restore gut balance.
4. Inflammatory Bowel Disease (IBD): Medications like mesalamine (Asacol) or biologics may be prescribed. Dietary changes and stress management are also important.
5. Traveler’s Diarrhea: Bismuth subsalicylate (Pepto-Bismol) or antibiotics like ciprofloxacin may be recommended, depending on the severity of symptoms.
6. Colitis: Treatment may include anti-inflammatory medications or corticosteroids. Avoiding trigger foods and managing stress can also help.
7. Diverticulitis: Antibiotics and a temporary liquid diet may be recommended during flare-ups. Long-term management includes a high-fiber diet.
8. Food Poisoning: Staying hydrated and resting are key. In some cases, antibiotics may be necessary if a bacterial infection is confirmed.
9. Antibiotic-associated Diarrhea: Probiotics and discontinuing the offending antibiotic (under a doctor’s guidance) may help resolve symptoms.
10. Functional Diarrhea: Dietary changes, stress management, and medications like loperamide may be effective in managing symptoms.

Recent Updates on Diphenoxylate/atropine Research

Recent studies have focused on the long-term safety of Diphenoxylate/atropine, particularly in individuals with chronic gastrointestinal conditions. Researchers are also exploring the potential for this medication to be used in combination with other therapies for more effective symptom management in conditions like IBS and IBD. As of now, no major changes in the recommended use of Diphenoxylate/atropine have been made, but ongoing studies may provide further insights into its safety and efficacy in the future. If you have questions about the latest research, our telemedicine providers are available to discuss how this may impact your treatment plan.

James Kingsley

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