# Diphenoxylate & Atropine



## okies (Jul 18, 2004)

Has any one ever had this medicine. How long did it take befor th D let up?


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## peardrops (Jan 3, 2004)

Do you mean Lomotil? Lomotil has those two drugs in it. It's about the only drug that helps me with D. I don't take it every day, just when I've got to go somewhere and really don't want to have an attack. Some people say it's addictive but I've never had a problem with it. Side effects for me are, dry mouth and sometimes a headache. Everyone is different and what works for one person might not work for another.


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## bushja1 (Apr 23, 2003)

I've never had a problem with either. I've taken it 4 or 5 times a week for over 5 years. It works great for me. I question the addictive nature of it. I've quit for more than a week at a time and felt no withdrawal symptoms. My doctor never even said anything about dependance. From what I've read it can only become addictive in high doses.


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## Tabitha (Jun 1, 2004)

This drug has been very beneficial to me.It has been the only one which has worked. Initially I was taking very high doses.I travel a lot for work, and I needed to stop the "D". I was able to dradually lower the dose, and am not taking any at the moment.I do carry it with me, however







I agree with the other posters; I have never had any trouble stopping using it.My personal POV is that if you aren't actually abusing the drug, it isn't addictive.I would be more concerned about Ativan.It worked beautifully for me, but I also felt "high", like I'd had a few cocktails. I told my G.P. and he said I shouldn't take it. (I have quite a high incidence of alcoholism in my family, and I'm very aware that it runs in families).Tibby


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## Albion (Feb 14, 2001)

Next to Opium Tincture, Lomotil has been the only drug that has been effective in controlling my IBS-D.Lomotil is very safe; however, it can be habit-forming. It is related to Demerol (meperidine). It is a Schedule V controlled substance. The risk of becoming dependent on the drug is minimal, so long as you stay within the recommended dose range. The DEA is alarmed at the rate at which Lomotil is becoming a drug of abuse given diphenoxylate's long half-life and ability to produce an intense "high" at relatively low doses -- 10 to 20 tablets at once.Lomotil is diphenoxylate (2.5mg) and atropine (25 micrograms). The atropine has no therapeutic effect at that dose level; it is added solely to prevent abuse of diphenoxylate, which is a potent opioid. Atropine, even in small doses, can have undesirable side effects if taken over a long period of time, as is the case with all belladonna alkaloids. The dry mouth associated with atropine can lead to tooth decay, gum disease, etc. There are other probelms with atropine as well.The maximum recommended dose of Lomotil is 8 tablets a day. If you are considering taking Lomotil for an extended period of time, I would ask you doctor if he or she would be willing to prescribe Motofen instead of Lomotil. Motofen contains difenoxin (1mg) and atropine sulfate (25 micrograms). Difenoxin is the active metabolite of diphenoxylate and is effective at one-fifth the dosage of diphenoxylate. Thus, each Motofen tablet twice as strong as Lomotil with the same amount of atropine. So if you're taking 4 Lomotil tablets a day, you would have to take only 2 Motofens. Plus, you would be ingesting only 50 micrograms of atropine daily, instead of 100.Lomotil and Motofen are the strongest antidiarrheals before moving up to the more "serious" opiates-- codeine, morphine or opium.If your physician is willing, opium tincture is very effective for intractable fulminant diarrhea. Obviously, opium is habit-forming in high doses, but the usual dose for IBS-D is .6cc two to four times a day. That's about 1/10th of a teaspoon for each dose. The side effects are almost nil at that dose level.


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## jlrscoop (Apr 17, 2004)

My doctors have never mentioned these drugs to me - how do these drugs work to stop the D? I feel like I've tried everything else, with no real help. I'm very interested in how they help and are these everyday drugs or to be used on the worst of worst days? Thanks for the info!!!


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## Kathleen M. (Nov 16, 1999)

Lomotil is basically in action like Imodium with an antispasmodic added.The atropine is added more to make taking high doses uncomfortable enough you won't take the Lomotil to get high. The opiate in Lomotil can get into the body a little bit where the opiate in Imodium stays in the gut almost completely. The opiate getting to the central nervous system is what causes the risk for addiction (with Lomotil often they will enforce breaks in treatment, but some people take Lomotil daily and continuously without problems).While some people find Lomotil works better than Imodium I think that is mostly a which drug in the same class works better for you issue rather than one being inherently stronger than the other (some people do better on Imodium).If Imodium works for you it is a safer alternative than Lomotil as there is less addiction risk and no side effects from the antispasmodic atropine (dry mouth, reduced sweating/risk of overheating, increased blood pressure/heart rate). Usually for IBS the recommend taking the Imodium 2X a day (morning and evening at the regular dose...some people need less).K.


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## jason haberland (Jun 28, 2004)

Immodium works pretty well for me, but I agree with a post earlier, why hasn't my doctor prescribed Lomotil for me? He gave me Bentyl and it doesn't help


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## Kathleen M. (Nov 16, 1999)

Differnet doctors have differnet prescribing philosphies, and different clinical experiences. That influences which of the drugs they try.You can always ASK the doctor about a drug if you would like to try it. Some doctors may avoid Lomotil because of the potential addiction factor (especially if they have had patients who had a bad problem). And sometimes you have to shop around to find a doctor who will really work with you to try a bunch of different medications. Some will, some won't.K.


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## Albion (Feb 14, 2001)

My two cents-- if you're taking Imodium and it works, no need to try Lomotil or anything stronger. As Kath M. stated, Imodium is derived from an opiate, but its active ingredient (loperamide) does not cross the blood-brain barrier unless taken in extremely large doses. Plus, Imodium does not have atropine or any other active drugs besides loperamide.In the final analysis, diarrhea caused by IBS can always be controlled. You should stick to the weakest medicine possible that works, since the usual rule is, the stronger the med, the higher the likelihood of side effects (including addiction).As far as the steps to stopping diarrhea most physicians take:The first step is to use diet/behavior modification.The second step is to use non-narcotic drugs (such as Bentyl, Levsin, etc.-- mostly antispasmodics), fiber supplements, etc.The third step is to try weak narcotic based-drugs-- Imodium first, for the reasons given above, then Lomotil, and perhaps Motofen.If the "weak" narcotics don't work, then intermediate narcotics can be tried-- codeine phosphate or codeine sulfate can be tried-- 1/4 grain to 1/2 grain up to 4 times a day.If codeine doesn't work, paregoric (camphorated tincture of opium, equivalent to 2mg of morphine per 5mL) can be tried.Finally, if the intermediate narcotics don't work, then the strong narcotics should be tried -- pure tincture of opium 10% (the equivalent of 10mg of morphine per mL, or 25 times the strength of paregoric), morphine, etc. The usual starting dose for opium tincture and/or morphine is 0.6 mL (0.6cc or 10 minims) up to four times a day, but there is no ceiling. The dose can be increased gradually until symptoms are brought under control.My point is, intractable diarrhea can always be controlled, so long as the physician is willing to prescribe what it takes to bring it under control. Opium Tincture, morphine, paregoric and even codeine are fairly potent drugs. Not all physicians are sympathetic to IBS-D sufferers. Some physicians fear prescribing Schedule II drugs (which are closely monitored by the DEA) like opium and morphine. This is especially true for a "chronic" condition like IBS. The longer someone takes a narcotic, the higher the likelihood of abuse.In my case, none of the "weaker" drugs worked. I was fortunate to find a doctor willing to try stronger medications to bring my IBS-D under control. I've been prescribed opium tincture for 2 years now without having to increase the dose. It has completely stopped my D. While I used to have problems every day, now I have problems maybe once a month. As far as addiction is concerned, I'm not too worried since I haven't needed to increase the dose of opium to control my symptoms. To me, taking opium is well worth the risks. Living a normal life is something I can't put a price on.


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