Atropine/diphenoxylate

Diphenoxylate/atropine, also known as co-phenotrope, is a combination of the medications diphenoxylate and atropine, used to treat diarrhea.[1] It should not be used in those in whom Clostridioides difficile infection is a concern.[2] It is taken by mouth.[1] Onset is typically within an hour.[3]

Atropine/diphenoxylate
Combination of
DiphenoxylateMu opiate receptor agonist
AtropineMuscarinic acetylcholine receptors antagonist
Clinical data
Routes of
administration		By mouth
Legal status
Legal status
  • UK: POM (Prescription only)
  • US: Schedule V
Identifiers
ChemSpider
  • none
  (verify)

Side effects may include abdominal pain, angioedema, glaucoma, heart problems, feeling tired, dry mouth, and trouble seeing.[1] It is unclear if use in pregnancy is safe and use when breastfeeding may result in side effects in the baby.[4] It works by decreasing contractions of the bowel.[1]

The combination was approved for medical use in the United States in 1960.[3] It is available as a generic medication and over the counter.[1] In the United States the wholesale cost per is dose is US$0.31.[5] In 2016 it was the 298th most prescribed medication in the United States with more than a million prescriptions.[6] It is sold under the brand name Lomotil among others.[1] The medication is in Schedule V in the United States.[2]

Contraindications

Absolute contraindications are:

Side effects

The drug combination is generally safe in short-term use and with recommended dosage. In doses used for the treatment of diarrhea, whether acute or chronic, diphenoxylate has not produced addiction.

It may cause several side-effects, such as dry mouth, headache, constipation and blurred vision. Since it may also cause drowsiness or dizziness, it should not be used by motorists, operators of hazardous machinery, etc. It is not recommended for children under two years of age.

Interactions

Interactions with other drugs:

Diarrhea that is caused by some antibiotics such as cefaclor, erythromycin or tetracycline can worsen.

Toxicity

It may cause serious health problems when overdosed. Signs and symptoms of adverse effects may include any or several of the following: convulsions, respiratory depression (slow or stopped breathing), dilated eye pupils, nystagmus (rapid side-to-side eye movements), erythema (flushed skin), gastrointestinal constipation, nausea, vomiting, paralytic ileus, tachycardia (rapid pulse), drowsiness and hallucinations. Symptoms of toxicity may take up to 12 hours to appear.

Treatment of overdose must be initiated immediately after diagnosis and may include the following: ingestion of activated charcoal, laxative and a counteracting medication (narcotic antagonist).

Mechanism of action

Diphenoxylate is anti-diarrheal and atropine is anticholinergic. A subtherapeutic amount of atropine sulfate is present to discourage deliberate overdosage. Atropine has no anti-diarrheal properties, but will cause tachycardia when overused. The medication diphenoxylate works by slowing down the movement of the intestines. In some cases it has been shown to ease symptoms of opiate withdrawal.

Society and culture

Names

The UK BAN generic name for diphenoxylate and atropine is co-phenotrope.

As of 2018, the combination drug is marketed in the US and some other countries under the following brands: Atridol, Atrolate, Atrotil, Co-Phenotrope, Dhamotil, Dimotil, Intard, Logen, Lomanate, Lomotil, Lonox, and Reasec.[8]

In the United States, it is classified as a Schedule V controlled substance by federal law, and is available only for a medical purpose.[9]

References
  1. British national formulary : BNF 76 (76 ed.). Pharmaceutical Press. 2018. p. 66. ISBN 9780857113382.
  2. "Diphenoxylate hydrochloride and atropine sulfate solution". Dailymed. Retrieved 22 March 2019.
  3. "Diphenoxylate and Atropine (Professional Patient Advice)". Drugs.com. Retrieved 22 March 2019.
  4. "Atropine / diphenoxylate Pregnancy and Breastfeeding Warnings". Drugs.com. Retrieved 3 March 2019.
  5. "NADAC as of 2019-02-27". Centers for Medicare and Medicaid Services. Retrieved 3 March 2019.
  6. "The Top 300 of 2019". clincalc.com. Retrieved 22 December 2018.
  7. "Diphenoxylate and atropine drug information". UpToDate. Retrieved 14 February 2017.
  8. "Diphenoxylate international brands". Drugs.com. Retrieved 11 May 2018.
  9. DEA, Title 21, Section 829
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