What is Diphenoxylate and Atropine: Uses, Dosage, Side Effects and More

Diphenoxylate and atropine is a prescription medication that helps control diarrhea by slowing down your intestinal movement. This combination drug contains two active ingredients that work together - diphenoxylate does the main work of reducing diarrhea, while atropine is added in a very small amount to prevent misuse. You might know this medication by its brand name Lomotil, and it's commonly prescribed when other over-the-counter treatments haven't provided enough relief.

What is Diphenoxylate and Atropine?

Diphenoxylate and atropine is a controlled substance that belongs to a class of medications called antidiarrheals. The diphenoxylate component is an opioid-related compound that works specifically in your digestive system, while atropine is an anticholinergic agent added in tiny amounts primarily as a deterrent to abuse.

This medication is classified as a Schedule V controlled substance because diphenoxylate is chemically related to opioids, though it doesn't produce the same effects when used as directed. The combination comes in tablet form and requires a prescription from your healthcare provider.

Unlike simple over-the-counter antidiarrheal medications, this combination is reserved for more persistent or severe cases of diarrhea that need stronger intervention. Your doctor will typically consider this option when other treatments haven't been effective enough.

What is Diphenoxylate and Atropine Used For?

This medication is primarily prescribed to treat acute diarrhea and chronic diarrhea in adults and children over 13 years old. It's particularly helpful when you're experiencing frequent, loose, or watery bowel movements that are disrupting your daily life.

Your doctor might prescribe this medication for diarrhea caused by various conditions, including irritable bowel syndrome, inflammatory bowel disease, or infections that have persisted despite other treatments. It's also sometimes used as part of treatment for certain digestive disorders where controlling bowel movements is important for your comfort and health.

However, this medication treats the symptoms of diarrhea rather than addressing the underlying cause. Your healthcare provider will work with you to identify and treat any underlying conditions while using this medication to provide symptom relief.

It's important to note that this medication should not be used for diarrhea caused by certain types of bacterial infections, as slowing down your intestinal movement could potentially make these infections worse by preventing your body from eliminating harmful bacteria.

How Does Diphenoxylate and Atropine Work?

Diphenoxylate works by slowing down the movement of your intestines, which gives your body more time to absorb water from the stool and reduces the frequency of bowel movements. Think of it as putting gentle brakes on your digestive system's normal rhythm.

The medication binds to opioid receptors in your intestinal tract, which decreases the speed at which food and waste move through your digestive system. This slower movement allows more water to be absorbed, making your stool more formed and reducing the urgency and frequency of bowel movements.

The atropine component serves a dual purpose - it adds some additional antispasmodic effects to help calm intestinal cramping, and more importantly, it helps prevent potential misuse of the medication. The amount of atropine is carefully calculated to cause unpleasant side effects if someone were to take excessive amounts.

This is considered a moderately strong antidiarrheal medication, more potent than over-the-counter options like loperamide, but it's designed to work primarily in your digestive system rather than affecting your entire body like stronger opioid medications.

How Should I Take Diphenoxylate and Atropine?

Take this medication exactly as prescribed by your doctor, typically starting with 2 tablets initially, followed by 1 tablet after each loose stool. The maximum daily dose is usually 8 tablets in a 24-hour period, though your doctor may adjust this based on your specific situation.

You can take these tablets with or without food, but taking them with a small amount of food might help reduce any stomach upset. Swallow the tablets whole with a full glass of water - don't crush, chew, or break them as this can affect how the medication works.

It's best to take this medication at the first sign of diarrhea and continue as directed by your healthcare provider. Keep track of how many tablets you've taken each day to avoid exceeding the maximum recommended dose.

While taking this medication, make sure to stay well-hydrated by drinking plenty of clear fluids like water, clear broths, or electrolyte solutions. Avoid alcohol completely while using this medication, as it can increase the risk of serious side effects.

How Long Should I Take Diphenoxylate and Atropine For?

Most people take this medication for a few days to a week for acute diarrhea, though the exact duration depends on your specific condition and how quickly your symptoms improve. Your doctor will provide clear guidance on how long you should continue taking it.

For acute diarrhea, you'll typically stop taking the medication once your bowel movements return to normal consistency and frequency. This usually happens within 2-3 days of starting treatment, though it can take up to a week in some cases.

If you're using this medication for chronic diarrhea related to an ongoing condition, your doctor might prescribe it for longer periods. However, they'll monitor you closely and regularly reassess whether continued use is necessary and beneficial.

Never continue taking this medication longer than prescribed, and don't stop abruptly if you've been taking it for an extended period. Your doctor may need to gradually reduce your dose to prevent any withdrawal symptoms, though this is rare with normal therapeutic use.

What Are the Side Effects of Diphenoxylate and Atropine?

Like all medications, diphenoxylate and atropine can cause side effects, though many people experience only mild ones or none at all. Understanding what to expect can help you feel more prepared and know when to contact your healthcare provider.

The most common side effects you might experience include drowsiness, dizziness, dry mouth, and mild nausea. These effects are usually mild and often improve as your body adjusts to the medication over the first few days of treatment.

Here are the more frequently reported side effects that affect some people:

• Drowsiness or feeling tired
• Dizziness or lightheadedness
• Dry mouth
• Nausea or stomach discomfort
• Headache
• Blurred vision
• Constipation (especially if diarrhea stops completely)

These common side effects are generally manageable and temporary. Staying hydrated, moving slowly when changing positions, and avoiding driving until you know how the medication affects you can help minimize these effects.

Some people may experience less common but more concerning side effects that require medical attention. These include severe constipation that lasts more than a few days, severe abdominal pain or swelling, difficulty urinating, or signs of an allergic reaction.

Rare but serious side effects can occur, particularly if you take too much medication or have certain underlying health conditions:

• Severe constipation with abdominal pain and swelling
• Difficulty breathing or slowed breathing
• Severe drowsiness or confusion
• Rapid heartbeat or irregular heart rhythm
• Severe allergic reactions with rash, swelling, or difficulty breathing
• Signs of toxic megacolon (severe abdominal pain and swelling)

If you experience any of these serious side effects, seek immediate medical attention. While these complications are uncommon when the medication is used as prescribed, it's important to be aware of them and act quickly if they occur.

Who Should Not Take Diphenoxylate and Atropine?

Several groups of people should avoid this medication or use it only under very careful medical supervision. Your doctor will review your medical history and current health status to determine if this medication is safe for you.

You should not take this medication if you have certain types of diarrhea, particularly those caused by bacterial infections like Salmonella, Shigella, or E. coli. Slowing down your intestinal movement in these cases could trap harmful bacteria in your system and make the infection worse.

People with certain medical conditions need to avoid this medication entirely:

• Severe liver disease
• Severe kidney disease
• Myasthenia gravis (a muscle weakness condition)
• Glaucoma (increased pressure in the eyes)
• Severe ulcerative colitis or other inflammatory bowel diseases during acute flares
• Intestinal blockage or obstruction
• Known allergy to diphenoxylate, atropine, or related medications

This medication is also not recommended for children under 13 years old, as they're more sensitive to its effects and may experience serious complications even with normal doses.

Pregnant and breastfeeding women should generally avoid this medication unless the potential benefits clearly outweigh the risks. If you're pregnant, planning to become pregnant, or breastfeeding, discuss alternative treatment options with your healthcare provider.

People with a history of drug or alcohol abuse should use this medication with extreme caution, as it contains an opioid-related compound that could potentially be habit-forming, even though the atropine component makes abuse less likely.

Diphenoxylate and Atropine Brand Names

The most well-known brand name for this medication combination is Lomotil, which has been available for many years and is widely recognized by both healthcare providers and patients. This brand name version contains the same active ingredients in the same concentrations as generic versions.

Generic versions of diphenoxylate and atropine are also available and contain identical active ingredients to the brand name product. These generic options are typically less expensive while providing the same therapeutic effects and safety profile.

Whether you receive the brand name or generic version often depends on your insurance coverage, pharmacy preferences, and cost considerations. Both versions are equally effective when used as prescribed by your healthcare provider.

Diphenoxylate and Atropine Alternatives

Several alternative medications can help control diarrhea, and your doctor might consider these options based on your specific situation, medical history, and how well you tolerate different treatments.

Loperamide (Imodium) is the most common over-the-counter alternative that works similarly by slowing intestinal movement. It's often tried first for mild to moderate diarrhea because it's readily available and has fewer restrictions than prescription options.

Other prescription alternatives your doctor might consider include:

• Bismuth subsalicylate (Pepto-Bismol) for mild diarrhea and stomach upset
• Cholestyramine for diarrhea caused by bile acid malabsorption
• Rifaximin for certain types of bacterial overgrowth
• Probiotics as supportive therapy to restore healthy gut bacteria
• Specific medications targeting underlying conditions like inflammatory bowel disease

The choice of alternative depends on what's causing your diarrhea, how severe your symptoms are, and what other medical conditions you might have. Your healthcare provider will work with you to find the most appropriate and effective treatment option.

Is Diphenoxylate and Atropine Better Than Loperamide?

Both medications work by slowing down intestinal movement, but they have some important differences that make each more suitable for different situations. The choice between them depends on the severity of your diarrhea and your individual medical needs.

Diphenoxylate and atropine is generally considered stronger than loperamide and is typically reserved for more severe or persistent diarrhea that hasn't responded well to over-the-counter treatments. It requires a prescription and closer medical supervision.

Loperamide has some advantages - it's available over-the-counter, has fewer drug interactions, and doesn't carry the controlled substance restrictions. It's often the first choice for mild to moderate diarrhea and can be very effective for many people.

However, diphenoxylate and atropine may be more effective for severe diarrhea or when loperamide hasn't provided adequate relief. The addition of atropine can also help with cramping and abdominal discomfort that sometimes accompanies severe diarrhea.

Your doctor will consider factors like the severity of your symptoms, underlying causes, other medications you're taking, and your medical history when deciding which option is better for your specific situation.