Its active ingredients are diphenoxylate and atropine. Diphenoxylate is anti-diarrheic and atropine is anticholinergic. Diphenoxylate is chemically related to the narcotic drug meperidine. Atropine is used to treat diarrhea that is not caused by infection with bacteria. The medication works by slowing down the movement of the intestines.

The inactive ingredients of Lomotil 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.

Contraindications

Absolute contraindications for Lomotil are:

Allergy to diphenoxylate or atropine
Presence of jaundice
Diarrhea associated with pseudomembranous enterocolitis, diarrhea caused by antibiotic treatment, or diarrhea caused by enterotoxin-producing bacteria.

Interactions

Interactions with other drugs:

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

Diarrhea that is caused by some antibiotics such as cefaclor, erythromycin or tetracycline can worsen with Lomotil.

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 cause also 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.

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), pinpoint or 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 (indiced 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.

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Radiation therapy and chronic diarrhea
From Saturday Evening Post, 7/1/04 by Cory SerVaas

Dear Dr. SerVaas:

I am wondering how many people suffer from diarrhea after having radiation therapy and what if anything can be done.

I had a complete hysterectomy in 1982 due to endometrial cancer stage 1, followed by radiation. I had diarrhea during treatment; however, it ceased after several weeks only to return a year or so later. I have now put up with this malady for almost 20 years.

I have tried controlling it by cutting out certain foods, taking Metamucil, eating no dairy foods, minimum salads, etc. Nothing works for me.

Any suggestions you can give me would certainly be appreciated. Believe me--finding out that radiation is no longer given to stage 1 patients does not make me a very happy camper!

Agnes Kermode

Cleveland, Ohio

We sent your letter to Dr. Marcus Randall, chair of radiation oncology at Indiana University. Dr. Randall explains:

"It is fairly common for people receiving external beam pelvic radiation therapy to have some diarrhea during treatment. In the vast majority of patients, this side effect goes away, as it did in your case. It is unusual for it to return as described, although some patients will continue to have certain food intolerances.

"The main device is to avoid high-fiber foods because they are hard for the gastrointestinal tract to absorb. This causes the colon to retain more fluid, leading to diarrhea. I would suggest stopping the Metamucil, maintaining a low-fiber diet (dairy products are usually okay), avoiding an osmotic load (e.g., milkshakes) and trying some medications to slow down the gastrointestinal tract. Examples of these medications are Lomotil and Immodium. These medications are very safe, even in significant doses, and they can be adjusted to the needs of the patient. It is best to determine the dose that prevents diarrhea, rather than just treating it when it occurs. There are other medications that can be added, including Kaopectate and even tincture of opium.

"Most patients are able to deal effectively with this problem. As always, it is important to see a physician experienced in the management of the specific problem to be addressed. In the situation presented, I would suggest a radiation oncologist or gastroenterologist.

"It is worth pointing out that we do continue to use radiation therapy for some patients with low-stage endometrial cancers, based on prognostic factors predictive of recurrence and the amount of surgical staging information available. However, in many cases (but not all), the radiation is given internally to treat only the upper vagina, avoiding any significant radiation to the bowel. This carries a very low risk of acute and chronic side effects."

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