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diphenoxylate

A07DA01

Forms & Strengths

Tablet: 2.5 mg diphenoxylate hydrochloride with 0.025 mg atropine sulfate
Oral liquid: 2.5 mg diphenoxylate hydrochloride with 0.025 mg atropine sulfate per 5 mL

Adult Dosing

Acute diarrhea: Initial 5 mg (two 2.5 mg tablets or 10 mL liquid) four times daily (max 20 mg/day)
Maintenance: Reduce dosage as soon as initial control is achieved; titrate to minimum effective dose

Pediatric Dosing

Children < 2 years: Contraindicated
Children 2 to 12 years: 0.3 to 0.4 mg/kg/day divided in 4 doses (use liquid formulation only)
Not recommended for chronic diarrhea in pediatric patients

Indications

Adjunctive therapy in the management of acute diarrhea

Mechanism of Action

Synthetic opioid analog structurally related to meperidine; acts on smooth muscle of the intestinal tract through opioid receptors to inhibit GI motility and peristalsis
Combined with a subtherapeutic dose of atropine to discourage deliberate overdosage

Contraindications

Hypersensitivity to diphenoxylate or atropine
Diarrhea associated with organisms that penetrate the intestinal mucosa (e.g., toxigenic E. coli, Salmonella, Shigella) or pseudomembranous colitis
Obstructive jaundice
Children under 2 years of age due to risk of severe respiratory depression

Adverse Reactions

Drowsiness, dizziness, headache, euphoria
Dry mouth, nausea, vomiting, abdominal discomfort, paralytic ileus
Tachycardia, blurring of vision, urinary retention (due to atropine component)
Respiratory depression in high doses or pediatric patients

Drug Interactions

Monoamine oxidase inhibitors (MAOIs): Risk of hypertensive crisis
Central nervous system (CNS) depressants (alcohol, barbiturates, opioids, tranquilizers): Additive CNS depression
Anticholinergic drugs: Potentiation of atropine-like side effects

Curated Content: Needs Vetting Before Put to Clinical Use