Diphenoxylate-Atropine

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Oct 20, 2022

Warnings

Diphenoxylate-Atropine Warnings, Risks, and Complications

Diphenoxylate-atropine can cause serious adverse reactions in some people. Talk to your doctor about other treatment options for diarrhea if you are at a high risk of complications from this medicine. Some of the risks of diphenoxylate-atropine use include:

SEVERE RESPIRATORY DEPRESSION: Opioids are CNS depressants (they slow down activity in the central nervous system). Diphenoxylate, an active ingredient in Lomotil, is an opioid. As a result, the use of Lomotil (diphenoxylate and atropine), especially in young children, can lead to severe respiratory depression (breathing difficulties). CNS depression complications can lead to permanent brain damage, coma, or death. Children younger than 6 years of age are at increased risk as well as people taking other medications that can also cause breathing problems. Lomotil tablets should not be given to children under 13 years of age. The oral solution should not be used in children younger than 2 years of age. Be sure to monitor breathing carefully, especially if a young child is taking Lomotil (diphenoxylate and atropine).
SEVERE DROWSINESS AND DIZZINESS: Diphenoxylate and atropine can cause severe drowsiness and dizziness in some people. This can lead to a decreased ability to react, think, and focus. Avoid activities like driving or operating machinery that require your full attention until you know how this medicine affects you. Drinking alcohol and taking other medications that also make you drowsy can make these side effects worse.
DEHYDRATION: Diarrhea can lead to dehydration. People who have severe diarrhea, those who are not drinking enough water, and those taking water pills (diuretics) are at increased risk of becoming dehydrated. Be sure to drink enough fluids and replace electrolytes when you have diarrhea.
SERIOUS GASTROINTESTINAL COMPLICATIONS: Diphenoxylate and atropine can lead to serious gastrointestinal problems. This medicine should not be used to treat infectious diarrhea or bloody diarrhea caused by bacteria such as Clostridium difficile (enterotoxin producing bacteria). This is because the medication affects gut activity. Slowed gut activity can lead to bacterial overgrowth in the intestines (uncontrolled growth of bacteria causing diarrhea). People who have chronic or acute ulcerative colitis should use this medication with caution. Rarely, taking diphenoxylate and atropine can lead to toxic megacolon, a potentially life-threatening swelling of the large intestine. Contact your healthcare provider without delay if your diarrhea doesn't improve, you have worsening diarrhea, or you develop swelling of the abdomen while on this medicine.

Precautions Before Starting Diphenoxylate-atropine

Tell your doctor if you have had an allergic reaction to diphenoxylate, atropine, any of the active or inactive ingredients in diphenoxylate-atropine tablets or liquid solution, or any other drugs. Your pharmacy can give you a list of ingredients.

Give your healthcare professional a complete medical history. Diphenoxylate-atropine may not be right for people with certain medical conditions like bloody diarrhea, infectious diarrhea, diarrhea due to antibiotic use, fever and diarrhea, abdominal cramps, mucus in the stool, and jaundice (yellowing of the eyes or skin). If you have a medical condition such as Down syndrome or ulcerative colitis, discuss the risks versus benefits of this medicine with your doctor. Also, tell your doctor if you have kidney disease or liver disease.

Give your doctor or pharmacist a complete list of your medications, including prescription medications, over-the-counter medications, vitamins, supplements, and herbal products. This can help avoid possible interactions between diphenoxylate and atropine and your other medicines.

Tell your doctor if you are pregnant, could be pregnant, planning a pregnancy or breastfeeding.

Precautions During Use of Diphenoxylate-atropine

Keep all appointments with your healthcare professional while on diphenoxylate and atropine treatment. Your doctor will want to decrease the dose of this medicine once your diarrhea symptoms improve.

Tell your doctor if you become pregnant while on diphenoxylate and atropine.

Lomotil (diphenoxylate and atropine) can make you drowsy and dizzy. Drinking alcohol can make these side effects worse. Avoid driving, operating machinery, or doing anything that requires your full focus until you know how this medicine affects you.

Diphenoxylate-Atropine Drug Interactions

The drug combination of diphenoxylate and atropine and certain other medications can affect how the medicines work. Possible drug interactions between diphenoxylate and atropine and your other medicines can increase the risk of severe adverse reactions. Your doctor may change the dose of your medications or monitor you carefully for side effects if there are known interactions between diphenoxylate and atropine and your other medicines.

There can be possible interactions between diphenoxylate and atropine and the following medications:

Antihistamines
Medications that contain alcohol, such as Nyquil and elixirs
Skeletal muscle relaxants like cyclobenzaprine (Amrix)
Sedative-hypnotics like barbiturates (for example, phenobarbital, pentobarbital (Nembutal), and secobarbital (Seconal))
CNS depressants including benzodiazepines (for example, alprazolam (Xanax), diazepam (Diastat, Valium), clonazepam (Klonopin), chlordiazepoxide (Librium), lorazepam (Ativan), estazolam, flurazepam, oxazepam, triazolam (Halcion), and temazepam (Restoril))
Medications used to treat mental illness
Anxiety medications such as buspirone
Other medications that contain opioids, such as meperidine (Demerol)
Tranquilizers, sedatives, and sleeping pills

Be sure to tell your doctor or pharmacist if you are taking or have taken within the last two weeks medications called monoamine oxidase inhibitors (MAO inhibitors) such as linezolid (Zyvox), isocarboxazid (Marplan), methylene blue, selegiline (Zelapar, Emsam, Eldepryl), phenelzine (Nardil), and tranylcypromine (Parnate).

Give your doctor or pharmacist a complete list of your medications, including prescription medications, over-the-counter drugs, dietary supplements, and herbal remedies. Also, tell your healthcare provider if you smoke, consume alcohol, or use recreational drugs because some of these substances can cause serious health complications when used with prescription and non-prescription medicines.

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