diphenoxylate / atropine
Lomotil (diphenoxylate / atropine) is an antidiarrheal combination medication containing diphenoxylate (an opioid) and atropine (an anticholinergic). It's used to treat diarrhea in people 13 years and older. You usually start by taking it 4 times a day until the diarrhea is under control, then switch to a lower dose. The medication is available in both brand-name and generic versions. Lomotil (diphenoxylate / atropine) is a controlled substance, so there might be specific requirements for getting it filled at the pharmacy. Side effects include sleepiness, dizziness, and nausea.
What is Lomotil (diphenoxylate / atropine)?
What is Lomotil (diphenoxylate / atropine) used for?
Add-on therapy for diarrhea for people 13 years and older
How Lomotil (diphenoxylate / atropine) works
Lomotil (diphenoxylate / atropine) is a combination of two medications that work together to treat diarrhea.
Diphenoxylate is an opioid. It works by binding to specific proteins in your gut to help control and slow down gut movement.
Atropine is an anticholinergic that's used to prevent misuse of Lomotil (diphenoxylate / atropine). It blocks the activity of a natural chemical in your body called acetylcholine, which can cause bothersome side effects like nausea if Lomotil (diphenoxylate / atropine) is taken too often.
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What are the risks and warnings for Lomotil (diphenoxylate / atropine)?
Lomotil (diphenoxylate / atropine) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Breathing problems
Risk factors: Children younger than 6 years old | Taking other medications that cause breathing problems
There have been cases of children having serious breathing problems or a coma after taking Lomotil (diphenoxylate / atropine). These effects can cause permanent brain damage or death. Children younger than 6 years old are at the greatest risk. Keep this medication safely stored and out of reach of children.
Risk factors: Taking higher doses of Lomotil (diphenoxylate / atropine)
Typical prescribed doses of Lomotil (diphenoxylate / atropine) for diarrhea don’t usually lead to addiction or misuse. However, higher doses can cause a life-threatening overdose. Symptoms include slow breathing, coma, extreme fatigue, slurred speech, and a rapid heartbeat. Slow breathing can appear up to 30 hours after taking the medication. Seek medical help immediately if you experience any of these symptoms.
Sleepiness and dizziness
Risk factors: Drinking alcohol | Taking other medications that make you sleepy
Lomotil (diphenoxylate / atropine) can make you feel sleepy or dizzy and it can lower your ability to focus, think, and react. Drinking alcohol and taking other medications that also cause sleepiness ((e.g., benzodiazepines, muscle relaxants, opioids) raises this risk. Avoid activities that require you to be alert, such as driving a car or operating machinery, until you know how this medication affects you.
Dehydration
Risk factors: Not taking in enough fluids | Severe diarrhea
Diarrhea can make you dehydrated. Make sure you get enough fluids when you have diarrhea and that you're properly hydrated when you take Lomotil (diphenoxylate / atropine). Talk to your prescriber or pharmacist if you have additional questions.
Serious bowel problems
Risk factors: Having diarrhea caused by bacteria | Ulcerative colitis (UC)
In some cases, Lomotil (diphenoxylate / atropine) can lead to serious bowel problems. Lomotil (diphenoxylate / atropine) should never be used to treat diarrhea caused by bacteria. The medication slows down your gut, which can cause bacteria to grow more in your intestines. If you have worsening diarrhea after taking Lomotil (diphenoxylate / atropine), speak with your prescriber.
People who have ulcerative colitis (UC) should also be careful when taking Lomotil (diphenoxylate / atropine). It's rare, but this medication can cause a serious, life-threatening swelling of your large intestines called toxic megacolon. Let your prescriber know if you have symptoms such as a fever, high heart rate, dehydration, or low blood pressure.
What are the side effects of Lomotil (diphenoxylate / atropine)?
Common Side Effects
- Sleepiness
- Dizziness
- Nausea
- Vomiting
- Headache
- Loss of appetite
Other Side Effects
- Restlessness
- Dry skin
- Confusion
Serious Side Effects
- Slow breathing
- Overdose: Coma, not responsive to sound or touch, extreme fatigue, slurred speech, fast heartbeat, nausea, bloating, confusion
Source:Â DailyMed
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Incidence not known
confusion
decrease in the frequency of urination
decrease in urine volume
difficulty in passing urine (dribbling)
difficulty swallowing
discouragement
dizziness
drowsiness
dry skin and mouth
extremely high fever or body temperature
false or unusual sense of well-being
fast, shallow breathing
fast, weak heartbeat
feeling of warmth
feeling sad or empty
headache
irritability
loss of appetite
loss of interest or pleasure
muscle cramps
numbness of the arms and legs
pale, clammy skin
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
redness of the face, neck, arms and occasionally, upper chest
restlessness
seeing, hearing, or feeling things that are not there
stomach cramps or pain
thirst
tightness in the chest
trouble concentrating
trouble sleeping
unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
unusual tiredness or weakness
vomiting
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
Agitation
back pain
bigger, dilated, or enlarged pupils (black part of eye)
blurred vision
difficult or troubled breathing
feeling of warmth
garbled speech
increased sensitivity of the eyes to light
irregular, fast or slow, or shallow breathing
loss of consciousness
mood or mental changes
pale or blue lips, fingernails, or skin
seizures
speech that is not understood
stiff neck
unusual tiredness or weakness
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Lomotil (diphenoxylate / atropine)
Pros
Dose can be adjusted based on your symptoms
Can be taken with or without food
Comes as a tablet and solution that you take by mouth
Available as a lower-cost generic
Cons
Need to take multiple times a day in the beginning
Can't be used if diarrhea is caused by certain bacteria
Can cause serious side effects in young children
Potentially interact with a lot of medications
Pharmacist tips for Lomotil (diphenoxylate / atropine)
Start by taking Lomotil (diphenoxylate / atropine) by mouth 4 times a day, which is the maximum dose. Once the diarrhea is under control, your prescriber will likely recommend a lower dose. Most people see improvement within 48 hours.
Lomotil (diphenoxylate / atropine) is used in small doses to treat diarrhea and doesn’t cause morphine-like effects or addiction when used correctly. But, taking too much for a long time can affect your nervous system and cause dangerous withdrawal symptoms if stopped suddenly, like anxiety, sweating, chills, and irritability. Get medical help if you've taken more than prescribed.
Avoid alcohol while you're taking Lomotil (diphenoxylate / atropine). Alcohol and other medications that cause drowsiness (e.g., benzodiazepines, muscle relaxants, opioids) can worsen side effects of Lomotil (diphenoxylate / atropine).
Talk to your prescriber if your diarrhea hasn't improved within 10 days of taking Lomotil (diphenoxylate / atropine) at the maximum dose. They might want to try another medication to see if it will work better for you.
More tips for Lomotil (diphenoxylate / atropine) oral solution:
Only use the plastic dropper that comes with the solution to measure the dose of the oral solution. Don't use kitchen spoons or measuring spoons to measure your dose, since these might not be accurate.
The oral solution can be stored at room temperature. Once you've opened the bottle, throw any unused medication after 90 days.
Frequently asked questions about Lomotil (diphenoxylate / atropine)
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Lomotil (diphenoxylate / atropine) dosage forms
Typical dosing for Lomotil (diphenoxylate / atropine)
Each tablet contains 2.5 mg of diphenoxylate and 0.025 mg of atropine, and the oral solution contains the same amount of each ingredient in 5 mL.
People 13 years and older: The typical starting dose is 2 tablets by mouth four times a day. Once the diarrhea is controlled, your prescriber will recommend a lower dose to manage your symptoms (e.g., 2 tablets once daily).
People 13 years and older: The typical starting dose is 10 mL by mouth four times a day. Once the diarrhea is controlled, your prescriber will recommend a lower dose to manage your symptoms (e.g., 10 mL once daily).
Interactions between Lomotil (diphenoxylate / atropine) and other drugs
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Ambenonium
- Nalmefene
- Naltrexone
- Potassium
- Safinamide
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Alfentanil
- Alprazolam
- Amifampridine
- Amphetamine
- Benzhydrocodone
- Benzphetamine
- Bromazepam
- Bromopride
- Buprenorphine
- Bupropion
- Butorphanol
- Calcium Oxybate
- Cannabidiol
- Carbinoxamine
- Cetirizine
- Clobazam
- Clopidogrel
- Clozapine
- Codeine
- Desmopressin
- Desvenlafaxine
- Dextroamphetamine
- Dihydrocodeine
- Donepezil
- Doxylamine
- Duloxetine
- Escitalopram
- Esketamine
- Fenfluramine
- Fentanyl
- Flibanserin
- Furazolidone
- Gabapentin
- Gabapentin Enacarbil
- Glucagon
- Glycopyrrolate
- Glycopyrronium Tosylate
- Granisetron
- Hydrocodone
- Hydromorphone
- Iproniazid
- Isocarboxazid
- Ketamine
- Lasmiditan
- Lemborexant
- Levocetirizine
- Levorphanol
- Linezolid
- Lisdexamfetamine
- Lithium
- Lofexidine
- Lorazepam
- Loxapine
- Macimorelin
- Magnesium Oxybate
- Meclizine
- Meperidine
- Metaxalone
- Methacholine
- Methadone
- Methamphetamine
- Methylene Blue
- Metoclopramide
- Midazolam
- Mirtazapine
- Moclobemide
- Morphine
- Morphine Sulfate Liposome
- Nalbuphine
- Ondansetron
- Oxycodone
- Oxymorphone
- Ozanimod
- Pentazocine
- Periciazine
- Phenelzine
- Potassium Oxybate
- Pregabalin
- Procarbazine
- Rasagiline
- Remifentanil
- Remimazolam
- Revefenacin
- Scopolamine
- Secretin Human
- Selegiline
- Sertraline
- Sodium Oxybate
- Sufentanil
- Tapentadol
- Tiotropium
- Tramadol
- Tranylcypromine
- Trazodone
- Vortioxetine
- Zolpidem
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Arbutamine
How much does Lomotil (diphenoxylate / atropine) cost?
Lomotil (diphenoxylate / atropine) contraindications
Children younger than 6 years old
Diarrhea caused by a bacteria
What are alternatives to Lomotil (diphenoxylate / atropine)?
What is the latest news about Lomotil (diphenoxylate / atropine)?
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References
Best studies we foundCenters for Disease Control and Prevention. (n.d). PROTECT your child: Use the right tool to give the right dose.
Department of Justice/Drug Enforcement Administration. (2020). Narcotics.
Hikma Pharmaceuticals USA Inc. (2023). Diphenoxylate hydrochloride and atropine sulfate solution [package insert]. DailyMed.
Jain, M., et al. (2024). Diphenoxylate and atropine. StatPearls.
Lannett Company, Inc. (2024). Diphenoxylate hydrochloride and atropine sulfate tablet [package insert]. DailyMed.
Skomorochow, E., et al. (2023). Toxic megacolon. StatPearls.
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