II. Indications
III. Contraindications
- Clostridioides difficile
- Dysentery (toxigenic Diarrhea)
- Child under age 6 years
- Risk of respiratory depression (anoxic brain injury and death has occurred)
- Down Syndrome (risk of Atropine toxicity, even at low dose)
- Elderly (relative contraindication, risk of Atropine toxicity)
IV. Mechanism
- Diphenoxylate is typically combined with Atropine (Lomotil) for use as an antidiarrheal
- Diphenoxylate is a peripherally acting Opioid acting at gastrointestinal Opioid receptors
- Piperidine derivative similar in structure to Meperidine
- No significant central activity or Analgesic effect (retained in Gastrointestinal Tract due to insolubility)
V. Preparations
VI. Dosing: Acute Diarrhea
- Adult
- Take 2 tabs (or 10 ml) orally up to 4 times daily as needed
- Child
- Give 0.3 to 0.4 mg Diphenoxylate per kg per day in 4 divided doses
- Age 9 to 12 years (weight 23 to 55 kg): 3.5 to 5 ml orally 4 times daily
- Age 6 to 8 years (weight 17 to 32 kg): 2.5 to 5 ml orally 4 times daily
- Maximum 20 mg Diphenoxylate per day
- Give 0.3 to 0.4 mg Diphenoxylate per kg per day in 4 divided doses
VII. Safety
- Pregnancy Category C
- Safe in Lactation
VIII. Drug Interactions
-
CNS Depressants
- Diphenoxylate with Atropine may potentiate CNS Depressant effect
-
MAO Inhibitors
- Hypertension risk
-
Anticholinergic Medications
- Increased ileus risk
IX. Resources
- Diphenoxylate and Atropine, Lomotil (DailyMed)
X. References
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 96
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Related Studies
| diphenoxylate (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| DIPHENOXYLATE-ATROPINE 2.5-0.025 MG TABLET | Generic | $0.18 each |