Contraindications for Lomotil (Diphenoxylate and Atropine)
Lomotil (diphenoxylate and atropine) is contraindicated in patients with known hypersensitivity to diphenoxylate or atropine, obstructive jaundice, and diarrhea associated with pseudomembranous enterocolitis or enterotoxin-producing bacteria. 1
Absolute Contraindications
- Known hypersensitivity to diphenoxylate or atropine - Patients with allergic reactions to either component should avoid this medication 1
- Obstructive jaundice - The medication is contraindicated in patients with this condition 1
- Diarrhea associated with pseudomembranous enterocolitis - Using Lomotil in this condition can worsen outcomes by delaying clearance of toxins 1
- Diarrhea caused by enterotoxin-producing bacteria - Similar to above, antimotility agents may prolong exposure to toxins 1
Relative Contraindications and Cautions
- Severe dysentery with high fever or blood in stool - Lomotil is not recommended in these cases as it may worsen outcomes and is no more effective than placebo 2
- Children under 2 years of age - Not recommended due to risk of rare adverse central and peripheral (ileus) side effects, likely due to immature hepatic function and blood-brain barrier 2
- Pregnancy (early) - Concomitant use with other antidiarrheals should be avoided in early pregnancy 3
- Neutropenic patients - Careful risk-benefit assessment is needed as overdosage may lead to iatrogenic ileus with increased risk of bacteremia 2
- Extremely ill patients - Antidiarrheal agents including Lomotil are not recommended 3
- Evidence of intestinal obstruction or colonic dilation - These conditions are contraindications for antidiarrheal agents 3
- Patients with fever and abdominal tenderness - These symptoms may indicate conditions where antidiarrheals should be avoided 3
Safety Considerations
- Risk of dependence - Diphenoxylate has opioid properties and potential for abuse, though less than traditional opioids 4
- Pediatric toxicity concerns - Lomotil overdose in children is primarily an opioid intoxication that can cause respiratory depression, which may recur 13-24 hours after ingestion due to accumulation of difenoxine (active metabolite) 5
- Respiratory depression - This is the most threatening reaction in overdose cases, particularly in children 6
Clinical Context
- Lomotil is generally less effective than loperamide for acute diarrhea 2
- In cancer patients with therapy-associated diarrhea, Lomotil (diphenoxylate plus atropine) is considered an alternative when loperamide is ineffective, but only after infectious diarrhea has been excluded 2
- For patients with chronic diarrhea and fecal incontinence, Lomotil may provide benefit by reducing stool frequency and volume 7
When prescribing Lomotil, clinicians should carefully evaluate the underlying cause of diarrhea and consider safer alternatives like loperamide when appropriate, particularly for acute non-specific diarrhea.