Co-phenotrope

Comprehensive information about Lomotil and allied drugs is under the article Diphenoxylate.

Co-phenotrope

Combination of
Diphenoxylate	mu opiate receptor agonist
Atropine	muscarinic acetylcholine receptors antagonist
Clinical data
Pregnancy cat.	?
Legal status	POM (UK) Schedule V (US)
Routes	Oral
Identifiers
ATC code	?
ChemSpider	12919 Y
Y(what is this?)  (verify)

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 intestines.

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.^[1]

Contraindications

Absolute contraindications for Lomotil are:

• Allergy to diphenoxylate or atropine
• Presence of jaundice^{[citation needed]}
• Diarrhea associated with pseudomembranous enterocolitis, diarrhea caused by antibiotic treatment, or diarrhea caused by enterotoxin-producing bacteria.^{[citation needed]}

Interactions

Interactions with other drugs:

• Sedatives
• Barbiturates
• Antidepressants (e.g., Elavil, Prozac, Paxil)
• Tranquilizers (e.g., Valium, Xanax, Klonopin)
• Monoamine oxidase inhibitors (e.g., Nardil, Parnate)

Diarrhea that is caused by some antibiotics such as cefaclor, erythromycin or tetracycline can worsen with Lomotil.^{[citation needed]}

Safety

The drug combination is generally safe in short-term use and with recommended dosage. 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.^{[citation needed]}

Toxicity

Lomotil may cause serious health problems when overdosed. Signs and symptoms of adverse effects may include any or several of the following: convulsions, 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 hallucinations. 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.

References

1. ^ DEA, Title 21, Section 829

External links

• Diphenoxylate and Atropin. RxList.

Source

• Lomotil overdose. MedlinePlus Medical Encyclopedia. Public domain.