Diphenoxylate/AtropineDiphenoxylate Hydrochloride and Atropine Sulfate

About Diphenoxylate/Atropine

Diphenoxylate slows the movement of the intestines, and a small amount of atropine is added. The label approves it as an add-on treatment for diarrhea in adults and children 13 and older, accompanied by fluid and salt replacement when needed. Treatment starts at two tablets, or 10 mL of the liquid, four times a day, which is also the most allowed: 20 mg of diphenoxylate a day. Once the diarrhea is controlled the dose can be lowered, and control can often be kept with as little as two tablets a day. Acute diarrhea usually improves within 48 hours; if chronic diarrhea has not improved after 10 days at the full dose, it is stopped.

It is never given to children under 6, in whom it has caused severe slowing of breathing and coma, leading to permanent brain damage or death, and its safety and effectiveness below 13 are not established. Signs of overdose, such as slowed breathing, extreme drowsiness, fever, a fast heartbeat and seizures, can be delayed by up to 30 hours. It is not used for diarrhea caused by C. difficile (pseudomembranous enterocolitis) or other toxin-producing bacteria, because of the risk of serious bowel complications including sepsis, nor with obstructive jaundice or after an allergic reaction to either ingredient. If severe dehydration or salt imbalance is present, it is withheld until treatment for that has begun, because fluid held in a slowed bowel can make it worse. In acute ulcerative colitis, drugs that slow the bowel have brought on toxic megacolon, so a swollen belly means stopping it, and with abnormal liver function it is used with extreme caution, since it may bring on hepatic coma. Drowsiness, dizziness, confusion, headache and nausea are among its side effects.

As a Schedule V controlled substance, it has no federal refill limit: the limit of five refills within six months covers only Schedules III and IV, so the prescription carries the refills the prescriber authorizes, where state law allows. Refill information can be transferred between pharmacies only once unless they share a real-time online database. It has no boxed warning, but the label says the recommended dose should not be exceeded, since addiction is possible at high doses. The liquid contains alcohol, comes in a 60 mL bottle with a small 3 mL oral syringe, and is thrown away 90 days after opening. Lomotil liquid has been discontinued, and the oral solution sold now is a generic with no rated equivalent.

Taking Diphenoxylate/Atropine

How to take it

Exactly as prescribed, usually up to four times a day, and never more than prescribed. Drink plenty of fluids to replace what is lost. Measure the liquid with the syringe provided or another dose-measuring device, not a kitchen spoon, and ask the pharmacist how to measure your dose. Stop and call the prescriber if your belly becomes bloated, and call if you still have diarrhea after 10 days or you develop a fever.

If you miss a dose

If you take it on a schedule, take a missed dose when you remember unless the next is nearly due; then skip it. Do not take a double dose.

Storage

At room temperature, no warmer than 77°F (25°C), stored securely out of children’s reach. Throw out opened liquid after 90 days, and dispose of any medicine you no longer need.

Interactions to know about

Alcohol, opioids, benzodiazepines, barbiturates, tranquilizers, antihistamines, muscle relaxants, buspirone and antipsychotics can add to its sedating effects. MAO inhibitors are avoided because of a theoretical risk of a dangerous rise in blood pressure. Do not drive until you know how it affects you.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Diphenoxylate/Atropine differs from pharmacy to pharmacy

Generic tablets come from several makers, and a short course can be a small fill in which the dispensing fee weighs heavily. A prescription that names Lomotil and blocks substitution is priced as a brand.

Far fewer companies make the liquid than the tablets, it comes in a single 60 mL bottle size, and it has no rated equivalent, so a pharmacy may need to order it and cannot substitute another product.

Ways to pay less for Diphenoxylate/Atropine without insurance

• Ask for generic tablets, and make sure the prescription allows substitution rather than naming Lomotil only.
• If a liquid is prescribed for an adult or teenager, ask the prescriber whether tablets would suit, since many more companies make them.
• Compare more than one quote; for a short course, the dispensing fee can be much of the price.
• Settle on a pharmacy before the first fill, since refill information for a controlled substance can usually be transferred only once.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Diphenoxylate/Atropine

1. 1.How many tablets can I take a day, and when should I cut back?
2. 2.Which symptoms, such as fever or blood in my stool, mean I should call my doctor before taking it?
3. 3.Is it safe with my sleep, anxiety, pain or antidepressant medicines?
4. 4.How should I store it and get rid of what I do not use?

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