From the Guidelines
Diphenoxylate should be used with caution to treat diarrhea, as it has potential for dependence and is less effective than loperamide, according to the most recent evidence 1. The use of diphenoxylate, also known as Lomotil, is generally not recommended as a first-line treatment for diarrhea due to its potential for dependence and abuse.
Key Points to Consider
- Diphenoxylate is a synthetic opioid medication that works by slowing intestinal motility through binding to opioid receptors in the gut, reducing the frequency of bowel movements.
- The standard adult dosage is typically 2.5-5 mg (1-2 tablets) taken 3-4 times daily until diarrhea is controlled, with a maximum daily dose of 20 mg.
- Treatment should be short-term, usually 2-3 days, as prolonged use can lead to dependence.
- Common side effects include constipation, drowsiness, dizziness, and dry mouth.
- This medication should be used cautiously in patients with liver disease, and is contraindicated in children under 2 years, patients with obstructive jaundice, diarrhea associated with pseudomembranous colitis, or diarrhea caused by antibiotic use.
- As a controlled substance (Schedule V), diphenoxylate has potential for dependence, so it should be used only as directed and discontinued once diarrhea resolves.
Comparison with Other Treatments
- Loperamide is a peripherally acting opiate that is devoid of abuse potential and is more effective than diphenoxylate for acute diarrhea, as shown in studies 1.
- Other treatments, such as antimicrobial agents, may be more effective for certain types of diarrhea, such as traveler's diarrhea, and should be considered based on the individual patient's needs and medical history.
Patient Education
- Patients should be educated on the proper use of diphenoxylate, including the recommended dosage and duration of treatment.
- Patients should also be informed of the potential risks and side effects of diphenoxylate, including dependence and abuse.
- Alternative treatments, such as loperamide, should be discussed with patients and considered based on their individual needs and medical history.
From the FDA Drug Label
DIPHENOXYLATE HYDROCHLORIDE AND ATROPINE SULFATE IS NOT RECOMMENDED FOR CHILDREN UNDER 2 YEARS OF AGE Diphenoxylate hydrochloride and atropine sulfate may be used as an adjunct to the treatment of diarrhea but should be accompanied by appropriate fluid and electrolyte therapy, if needed.
The use of Diphenoxylate (Lomotil) is as an adjunct to the treatment of diarrhea, and it should be accompanied by appropriate fluid and electrolyte therapy if needed 2. It is not recommended for children under 2 years of age 2 2.
From the Research
Use of Diphenoxylate (Lomotil)
- Diphenoxylate is used in the treatment of diarrhea, including acute and chronic diarrhea [ 3 ].
- It is a synthetic anti-diarrheal that can help improve the consistency of the stool and reduce the frequency of bowel movements [ 3 ].
- Diphenoxylate is often used in combination with atropine, and this combination is known as Lomotil [ 4 ].
- Lomotil can be used to treat chronic diarrhea and fecal incontinence, and it has been shown to reduce stool frequency and stool weight [ 5 ].
- Diphenoxylate can also be used to treat travelers' diarrhea, and it is recommended as an antimotility drug for mild cases [ 6 ].
- However, diphenoxylate may have side effects, particularly central nervous system effects, and it may be less effective than other treatments, such as loperamide, in some cases [ 7 ].
Comparison with Other Treatments
- Diphenoxylate has been compared to other treatments, such as loperamide and codeine, in the treatment of chronic diarrhea [ 7 ].
- Loperamide and codeine were found to be more effective than diphenoxylate in relieving urgency and producing a solid stool [ 7 ].
- However, diphenoxylate was found to be as effective as loperamide in the treatment of acute noninfectious diarrhea in critically ill patients [ 4 ].