Lomotil is a prescription anti-diarrhea medication that includes a compound of two medications, diphenoxylate and atropine. Diphenoxylate is an opioid that helps to slow gut motility, and atropine has anticholinergic effects that discourage misuse because of unpleasant side effects. This medication is classified as a Schedule 5 controlled substance, meaning it carries some risk for abuse and dependence. [1][2]
- Lomotil is a prescription medication that is used to treat chronic and acute diarrhea
- Lomotil works by binding to opioid receptors and slowing gut motility, reducing the urge and frequency of bowel movements
- Lomotil contains an opioid, which is an addictive substance that can cause dependence when misused or used for long periods of time
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What is Lomotil?
Lomotil is an anti-motility medication used to treat chronic and acute diarrhea. It is sometimes used off-label for other GI conditions like Crohn’s and Ulcerative Colitis. Lomotil is a combination of two drugs, diphenoxylate and atropine. [1]
Diphenoxylate is an opioid drug that helps to slow bowel movements, and atropine is an anti-cholinergic drug that can offset some of the abuse and addictive potential of this medication. [1]
Because Lomotil can still produce euphoric effects in high doses, it is considered a controlled substance, with a Schedule 5 categorization from the Drug Enforcement Administration. Schedule 5 drugs are those that carry a lower risk for abuse and dependence. [2]
What is Lomotil used for?
Lomotil is used as an anti-diarrhea medication in children and adults over the age of 13 (not used under this age range due to safety concerns). It is FDA-approved for both chronic and acute cases of diarrhea, but should not be used when an underlying bacterial infection is suspected. Because Lomotil slows gut motility, it can cause harmful bacteria and pathogens to remain in the GI tract for longer, which could increase the risk of serious complications.
Off-label uses of Lomotil include use in certain GI conditions like inflammatory bowel disease, as well as for post-surgical fecal incontinence. This medication is sometimes also used to treat diarrhea in veterinary medicine. [1][2]
How Lomotil works in the body
Lomotil is an anti-diarrhea medication that works by slowing gut motility. Diphenoxylate is one of the compounds in this medication that binds to opioid receptors, inhibiting the release of acetylcholine and helping to reduce bowel activity. [1]
Atropine is added as a second compound to reduce some of the risk for overdose, abuse, and addiction. Atropine has anti-cholinergic effects that can include nausea, dry mouth, and tachycardia. These side effects are more likely to occur when high doses are taken, which is meant to discourage misuse of Lomotil. [1][3]
Is Lomotil an opioid?
Lomotil contains the opioid medication diphenoxylate. Like other opioids, diphenoxylate can cause intoxicating and euphoric effects, especially in high doses. These effects can make it addictive, especially when used long-term or in high doses. Lomotil can also cause fatal overdose, causing people to go into respiratory depression when consuming too much of the medication. [1][3]
The inclusion of atropine helps to buffer against some of the addictive potentials and risk for misuse and overdose in patients taking Lomotil. Because atropine is an anti-cholinergic medication, it will cause uncomfortable side effects when misused, decreasing the incentive for people to overuse this medication. [1]
Dosage and administration
Lomotil is available as both a tablet and a liquid that is taken orally. Usually, liquid formulas are used in pediatric medication (although not recommended for those 12 and under, and contraindicated in those less than 6 years old), while it is more common for adults to be prescribed the tablets. Lomotil is usually prescribed as a 5mg tablet that can be taken up to four times per day, for a maximum daily dose of 20 mg. [1]
Lomotil side effects
Lomotil can cause a number of side effects. Because it contains an opioid, some people report feeling drowsy, dizzy, and even high after taking the medication. This may interfere with a person’s ability to drive, operate machinery, or do other tasks, especially if they have taken a higher dose. Because this medication is used to treat diarrhea, it can slow gut motility too much, causing constipation and cramps in some individuals. Some people also describe feeling nauseous after taking this medication.
The atropine in Lomotil can also cause side effects like dry mouth and nose, difficulty urinating, and blurred vision. Tachycardia is another possible anti-cholinergic side effect, and is more likely to be experienced when the medication is taken in high doses.[1][2][3]
Lomotil vs. Imodium (Ioperamide)
Both Lomotil and Imodium (loperamide) are anti-diarrhea medications, but they have some key differences in their pharmacological structures and mechanisms of action. Firstly, Lomotil is only available by prescription, while Imodium is largely sold over-the-counter at stores and pharmacies. This makes loperamide much more widely accessible to the general public. [1][4]
The second key difference between Lomotil and loperamide is that Lomotil contains an opioid, while loperamide does not. This also means that Lomotil has been classified by the DEA as a controlled substance, meaning it carries some risk for abuse, addiction, and overdose. While loperamide does bind to some opioid receptors in the brain, it is not a classic opioid and does not cause intoxication in standard doses. [1]
Can Lomotil be addictive?
Lomotil contains the opioid diphenoxylate, which is considered an addictive substance. Opioids work on receptors in the brain that are linked to reward pathways, which can form addictions when the drug is taken long-term, especially in high doses. The abuse potential of Lomotil is still considered lower than that of other opioid pain relievers because the medication also contains atropine, which helps to offset some of the rewarding effects. [1][5]
Lomotil is classified by the Drug Enforcement Administration (DEA) as a Schedule 5 substance. Schedule 5 substances carry some risk for abuse and dependence, although this is considered a much lower risk profile than a Schedule 1 or 2 drug. People are more likely to develop an addiction to Lomotil when they are abusing the medication, taking more than prescribed, or taking it in combination with other mind or mood-altering substances. [2]
Overdose risks and safety concerns
It is possible to overdose on Lomotil when taking more of the medication than prescribed. An overdose of Lomotil will look similar to other opioid overdoses, including some of the following signs: [5]
- Slowed or shallow breathing
- Looking pale
- Having blue fingertips or lips
- Extreme drowsiness or sedation
- Loss of consciousness
- Non-responsiveness
- Poor motor control or functioning
If a person has overdosed on Lomotil, emergency medical care is indicated. Often, a fatal opioid overdose can be reversed with the timely administration of Narcan, a drug that can help block some of the opioid effects of the medication.
In order to prevent an overdose, it is important to take Lomotil only as prescribed, without exceeding the recommended dose or schedule. Also, it is important to fully disclose any underlying medical conditions to your prescriber, as well as any other medications or illicit drugs you are taking. This can help to prevent complications, adverse effects, and accidental overdose.
Withdrawal and tapering
If you have been taking Lomotil long-term, it may be necessary to gradually taper off the medication, rather than stopping abruptly. It is possible to experience withdrawal symptoms when you stop taking this medication. Because Lomotil contains an opioid, the symptoms of withdrawal can look similar to other opioid drugs, and include flu-like symptoms, GI issues, cramping and pain, psychological distress, and cravings. Tapering slowly off the medication may help to prevent or reduce the experience of uncomfortable withdrawals. [5]
Normally, opioid withdrawals will begin within a day of stopping the medication, and can last for a week or so. While uncomfortable, the symptoms of opioid withdrawal are not medically dangerous and will pass over time. Some people experience more success with taking medications that help to prevent withdrawals, including Suboxone or Methadone. However, these are also opioids, which can cause even longer and more intense symptoms of withdrawal if you choose to discontinue them. Discussing your options with a doctor or prescribing professional is the best way to determine the best plan for you when discontinuing Lomotil. [5]
When to seek medical help
If you are taking Lomotil and experience unwanted adverse effects, discuss them with your doctor or prescribing professional. If you have taken too much Lomotil and experience signs of potential overdose, report to your nearest emergency room for immediate care. People who are struggling with addiction or dependence on opioids should also seek treatment from a certified addiction specialist, who can help to establish a working plan for recovery.
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