diphenoxylate with atropine (Rx)
Generic: Diphenoxylate with atropine
Brand: Lomotil, Lonox
(dye-fen-ox'i-late)
Pharmacological Action
Inhibits gastric motility by acting on mucosal receptors responsible for peristalsis
Therapeutic outcome: Decreased loose stools
Uses
Acute nonspecific and acute exacerbations of chronic functional diarrhea
Contraindications
Hypersensitivity, pseudomembranous colitis, child <2 yr, severe electrolyte imbalances, diarrhea associated with organisms that penetrate intestinal mucosa
Precautions: Pregnancy C, breastfeeding, hepatic disease, ulcerative colitis, severe hepatic disease, substance abuse, dehydration
Dosage & Routes
diphenoxylate/atropine
Adult: PO 5 mg qid, titrated to patient response, max 8 tabs/24 hr Child 2-12 yr: PO (liquid only) 0.3-0.4 mg/kg/day in 4 divided doses difenoxin/atropine
Adult: PO initially 2 tabs, then 1 tab after each loose stool or q3-4 hr prn, max 8 tabs/day
Available forms: diphenoxylate/atropine: tab 2.5 mg diphenoxylate/0.025 mg atropine; liq 2.5 mg diphenoxylate/0.025 mg atropine/5 ml; difenoxin/atropine: tabs 1 mg difenoxin/0.025 atropine
Implementation • Give for 48 hr only; tabs may be given with food, crushed and mixed with fluids; liquid should be measured accurately
Adverse Effects
CNS: Dizziness, drowsiness, light-headedness, headache, fatigue, nervousness, insomnia, confusion
EENT: Blurred vision, burning eyes
GI: Nausea, vomiting, dry mouth, epigastric distress, constipation, paralytic ileus, toxic megacolon
MISC: Anaphylaxis, angioedema
RESP: Respiratory depression
Pharmacokinetics
Absorption: Well absorbed
Distribution: Unknown
Metabolism: Liver, active metabolite
Excretion: Kidneys
Half-life: 2½ hr
Pharmacodynamics
Onset: 45-60 min
Peak: 2 hr
Duration: 3-4 hr
Interactions
Individual drugs
Alcohol: increased action of alcohol Amantadine, amoxapine, diphenhydrAMINE, clemastine, cloZAPine, cyclobenzaprine, disopyramide, loperamide, maprotiline, olanzapine: decreased GI motility, possible toxic megacolon
Drug classifications
Anticholinergics: increased anticholinergic effect Antimuscarinics, phenothiazines, tricyclics: decreased GI motility, possible toxic megacolon
Barbiturates: increased action of barbiturates CNS depressants: increased action of CNS depressants
MAOIs: hypertensive crisis; do not use together
Opiates: increased action of opioids
Nursing Considerations
Assessment • Monitor electrolytes (potassium, sodium, chloride) if on long-term therapy; fluid status, skin turgor • Assess bowel pattern before, during treatment; check for rebound constipation after termination of medication; check bowel sounds • Check response after 48 hr; if no response, product should be discontinued and other treatment initiated • Assess for abdominal distention and toxic megacolon, which may occur in ulcerative colitis • Assess hepatic function if on long-term therapy
Patient/family education • Advise patient to avoid alcohol and OTC products unless directed by prescriber; may cause increased CNS depression • Caution patient not to exceed recommended dosage; that product may be habit forming • Advise patient that product may cause drowsiness; to avoid hazardous activities until response to product is determined • Teach patient that dry mouth can be decreased by frequent sips of water, hard candy, sugarless gum
Evaluation
Positive therapeutic outcome: Decreased diarrhea
Reference
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