Generic Composition of Lomotil
Lomotil is the brand name for the combination of diphenoxylate hydrochloride (an opioid derivative) and atropine sulfate, available in tablet and liquid formulations. 1
Active Ingredients
- Diphenoxylate hydrochloride: The primary antidiarrheal agent, a peripherally acting opioid derivative that slows intestinal motility 2, 3
- Atropine sulfate: Added in subtherapeutic amounts to discourage abuse of the opioid component 2, 4
Available Formulations
- Tablet form: Standard oral tablets containing the diphenoxylate-atropine combination 1
- Liquid form: Available as an oral solution (diphenoxylate hydrochloride and atropine sulfate liquid) 5
Important Clinical Context
Lomotil is NOT a first-line agent and requires a prescription, unlike loperamide which is available over-the-counter and is the preferred treatment. 2, 3, 6
Why Lomotil is Second-Line
- Lower efficacy: Diphenoxylate-atropine is generally less effective than loperamide for acute diarrhea 3, 6
- More side effects: Greater risk of central nervous system effects and peripheral anticholinergic effects compared to loperamide 2, 3, 4
- Prolonged intestinal transit: Both diphenoxylate and atropine produce more prolonged effects on intestinal transit than loperamide, increasing complication risk in infectious diarrhea 2, 3
- Abuse potential: The opioid component carries risk of dependence, with documented cases of abuse 7
Critical Safety Warnings
- Contraindicated in children under 2 years: Risk of serious adverse effects including respiratory depression and toxicity 2, 6, 8
- Never use in severe dysentery: Contraindicated with high fever or bloody stools 2, 6
- Avoid in invasive bacterial infections: Should not be used with suspected Shigella, Salmonella, or STEC 6
When Lomotil May Be Considered
Lomotil is listed as a third-line alternative only for cancer patients with therapy-associated diarrhea refractory to both loperamide and octreotide, and only after infectious causes have been excluded. 1, 6