Lomotil (diphenoxylate and atropine)

Lomotil is a drug used to reduce diarrhoea. It contains two active ingredients: diphenoxylate and atropine.

Diphenoxylate slows down the movements of the bowel. Atropine is present in a very small amount and helps discourage misuse of the drug.

Lomotil is not an antibiotic. It does not get rid of the germs that cause diarrhoea.

How does Lomotil work?

Normally the bowel moves digested food and fluids along at a certain speed. During diarrhoea the bowel contents can move quickly and a lot of water can be lost in the stool.

Lomotil slows down the movements of the bowel and gives more time for water to be absorbed from the bowel.

In this way the number of stools and how watery they are can lessen.

However, less diarrhoea does not mean that the disease causing it has healed.

When is it used?

Acute diarrhoea

In some cases of diarrhoea that start suddenly, if the doctor thinks it suitable, it can be used to control the symptoms for a short time.

However, a large share of acute diarrhoea gets better on its own. The priority in treatment is replacing the water and minerals that have been lost.

In diarrhoea with fever or blood, or diarrhoea caused by certain bacteria, using Lomotil can be harmful.

Chronic diarrhoea

In some types of long-lasting diarrhoea, after the underlying cause has been investigated, it can be used to reduce the number of stools.

However, the cause of chronic diarrhoea may be coeliac disease, medicines, bile acid malabsorption or another bowel disease.

For this reason, Lomotil is not a substitute for investigating the cause of chronic diarrhoea.

Inflammatory bowel diseases

Some patients with Crohn’s disease or ulcerative colitis can have diarrhoea.

However, in active and especially severe ulcerative colitis, drugs that slow the bowel can cause serious complications.

For this reason, people with inflammatory bowel disease should not use Lomotil without a doctor’s advice.

How is Lomotil taken?

Lomotil is taken by mouth as a tablet.

The common tablet form contains 2.5 mg of diphenoxylate hydrochloride and 0.025 mg of atropine sulphate. The contents and licensing conditions of the products should be checked for each country.

The dose and length of use are decided according to the patient’s age and the cause and severity of the diarrhoea.

• Do not go over the dose your doctor recommends.
• Take in enough fluid and minerals while you have diarrhoea.
• If the drug does not work well enough, do not increase the dose on your own.
• If you feel drowsy or dizzy, do not drive.
• Keep the drug out of the reach of children.

Lomotil does not replace making up for lost fluid and electrolytes.

What are the side effects of Lomotil?

Lomotil can cause side effects in some patients.

Possible side effects

• Nausea
• Abdominal discomfort
• Constipation
• Dizziness
• Drowsiness
• Dry mouth

More serious side effects

Rarely, a marked change in consciousness, excessive slowing of the bowel, conditions resembling bowel obstruction, or suppression of breathing can occur.

Taking a higher dose than recommended in particular can lead to serious poisoning.

If severe swelling of the abdomen, difficulty breathing, excessive drowsiness or a change in consciousness develops, emergency medical help is needed.

When should it not be used?

Lomotil can make some types of diarrhoea worse.

In particular, it should not be used, or should be assessed carefully by a doctor, in the following situations:

• Diarrhoea with bloody stools and high fever
• Some bacterial bowel infections
• Clostridioides difficile infection developing after antibiotic use
• Severe active ulcerative colitis
• Suspected bowel obstruction
• Serious fluid loss
• Situations in which the bile ducts are completely blocked
• Allergy to diphenoxylate or atropine

In severe ulcerative colitis in particular, a complication called toxic megacolon, in which the large bowel widens dangerously, can develop.

Can it be used in children?

Lomotil is a drug that needs particular care in children.

According to the current US product information, it must not be used in children under 6 years of age. The safety and effectiveness of the same product in treating diarrhoea have not been shown in children under 13.

In children, taking it by accident or at a high dose can cause serious suppression of breathing and be life-threatening.

Lomotil should not be given to children without a doctor’s advice.

For the current age limits of the product in Turkey, the local patient information leaflet should be followed.

Does it interact with other medicines?

Lomotil can be risky when taken with medicines that cause sleepiness or depress the nervous system.

These include some sleeping pills, sedatives and opioid painkillers.

Alcohol can also increase drowsiness and other side effects.

For this reason, do not drink alcohol during treatment, and tell your doctor about the other medicines you take.

Can it be used in pregnancy and breastfeeding?

Data on the safety of Lomotil in pregnancy are limited. The decision to use it should be made by the doctor.

Care is also needed during breastfeeding, because some of the drug’s components can pass into breast milk.

Pregnant women and breastfeeding mothers should not use it without a doctor’s advice.

Is Lomotil addictive?

Diphenoxylate is a drug with opioid properties.

When used at the recommended doses to treat diarrhoea the risk of addiction is low, but at high doses or with misuse there is a risk of addiction and serious poisoning.

For this reason, Lomotil should not be described as a completely non-addictive, harmless diarrhoea medicine.

When should I see a doctor about diarrhoea?

Medical assessment is needed in the following situations:

• Bloody or black stools
• High fever
• Severe abdominal pain
• Marked swelling of the abdomen
• Signs of fluid loss such as dry mouth, passing less urine or dizziness
• Diarrhoea that goes on or gets steadily worse
• Marked diarrhoea developing after antibiotic use

In elderly people, people with a suppressed immune system or those with significant other illnesses in particular, fluid loss can have more serious consequences.

Frequently asked questions

Does Lomotil cure diarrhoea completely?

No. It can reduce the number of stools, but it does not get rid of the disease causing the diarrhoea.

Is Lomotil an antibiotic?

No. It is not an antibiotic and does not kill the germs that cause bowel infections.

Are Lomotil and loperamide the same?

No. Both can reduce diarrhoea by slowing the bowel. But their active ingredients, side effect profiles and restrictions on use are different.

Can Lomotil be used for every kind of diarrhoea?

No. Using it is particularly inadvisable in diarrhoea that is bloody, comes with fever or is due to certain infections.

Should I drink plenty of water while taking Lomotil?

It is important to replace the water and minerals lost during diarrhoea. Where needed, oral rehydration solutions can be used.

Can Lomotil be taken for a long time?

It can be used under a doctor’s supervision in some patients with chronic diarrhoea. However, the cause of the diarrhoea should be investigated before long-term treatment.

Important: This page has been prepared to give general health information. Lomotil is not safe in every type of diarrhoea. It can carry serious risks, particularly in children, in diarrhoea caused by infection and in active ulcerative colitis. It should not be used without a doctor’s advice.