Lomotil Dosage for Elderly Patients
For elderly patients, the recommended dose of Lomotil (diphenoxylate hydrochloride with atropine sulfate) should be reduced to 2.5 mg diphenoxylate/0.025 mg atropine (half the standard adult dose) taken 1-2 times daily, with careful monitoring for anticholinergic side effects. 1
Dosing Considerations for Elderly Patients
- The standard adult dose of Lomotil is 5 mg diphenoxylate/0.05 mg atropine (one tablet or 5 mL) 3-4 times daily, but this should be reduced in elderly patients due to increased sensitivity to anticholinergic effects 1
- Elderly patients are more susceptible to anticholinergic side effects of medications, including those containing atropine (like Lomotil) 1
- For persons aged >65 years, a reduction in dosage is generally recommended for medications with anticholinergic properties 1
- Start with 2.5 mg diphenoxylate/0.025 mg atropine (half tablet or 2.5 mL) 1-2 times daily and adjust based on response and tolerability 1
Monitoring and Precautions
- Monitor elderly patients closely for central nervous system (CNS) side effects, which may be more pronounced in this population 1
- Watch for signs of anticholinergic toxicity including:
- Urinary retention
- Constipation
- Blurred vision
- Confusion
- Dry mouth 1
- Lomotil contains atropine specifically to discourage abuse, but this component increases the risk of anticholinergic side effects in elderly patients 1
- Discontinue medication if side effects occur and consider alternative treatments 1
Special Considerations
- Patients with impaired renal function may require further dose reduction due to potential drug accumulation 1
- Avoid use in patients with severe hepatic impairment as diphenoxylate is metabolized in the liver 1
- Do not use for prolonged periods in elderly patients without careful monitoring 1
- Lomotil should not be used in infectious diarrhea where pathogen clearance is important 1
Alternative Options
- Consider loperamide as an alternative to Lomotil in elderly patients, as it has fewer central effects and anticholinergic properties 1
- Loperamide does not cross the blood-brain barrier and has less potential for CNS side effects compared to diphenoxylate with atropine 1
Common Pitfalls to Avoid
- Avoid prescribing standard adult doses to elderly patients, as this increases risk of adverse effects 1
- Do not use Lomotil for prolonged periods without reassessment 1
- Avoid combining with other medications that have anticholinergic properties, as this can lead to additive side effects 1
- Be cautious when prescribing to patients with cognitive impairment, as anticholinergic effects may worsen confusion 1