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Pediatrics May 1991Eight pediatric accidental overdoses of diphenoxylate-atropine (Lomotil) are reported, and 28 literature cases are reviewed. This overdose is primarily an opioid... (Review)
Review
Eight pediatric accidental overdoses of diphenoxylate-atropine (Lomotil) are reported, and 28 literature cases are reviewed. This overdose is primarily an opioid intoxication, occasionally associated with atropine toxicity. Only 6 of 36 children showed signs of atropine overdose (central nervous system excitement, hypertension, fever, flushed dry skin). Contrary to popular belief, atropine effects occur before, during, or after opioid effects. Opioid overdose (central nervous system and respiratory depression with miosis) predominated or occurred without any signs of atropine toxicity in 33 cases (92%). Diphenoxylate-induced hypoxia was the major problem and was associated with slow or fast respirations, hypotonia or rigidity, cardiac arrest, and in 3 cases cerebral edema and death. Respiratory depression recurred 13 to 24 hours after the ingestion in 7 cases and was probably due to accumulation of difenoxine, an active metabolite of diphenoxylate. Recommended treatment is intravenous naloxone for depressed or inadequate respirations, followed by continuous intravenous naloxone infusion, prompt gastric lavage, repeated administration of activated charcoal, and close monitoring for 24 hours.
Topics: Atropine; Child; Child, Preschool; Diphenoxylate; Drug Combinations; Drug Overdose; Female; Gastrointestinal Agents; Humans; Male
PubMed: 2020516
DOI: No ID Found -
Journal of Psychiatric Practice Jul 2007
Topics: Adult; Antidiarrheals; Clonidine; Diphenoxylate; Dose-Response Relationship, Drug; Drug Therapy, Combination; Humans; Iran; Male; Methadone; Narcotics; Opioid-Related Disorders; Psychotherapy; Substance Withdrawal Syndrome
PubMed: 17667743
DOI: 10.1097/01.pra.0000281491.65311.c3 -
The Journal of Emergency Medicine Jan 2008Lomotil (Pfizer Inc., New York, NY) (diphenoxylate-atropine) is said to be potentially toxic to toddlers with exposure to as little as one to two tablets. A review of... (Review)
Review
Lomotil (Pfizer Inc., New York, NY) (diphenoxylate-atropine) is said to be potentially toxic to toddlers with exposure to as little as one to two tablets. A review of the data on diphenoxylate-atropine poisonings from the American Association of Poison Control Centers annual reports, review articles, and case series disputes this view. Fatalities associated with diphenoxylate-atropine have been reported in toddlers after repetitive or incorrect dosages. Fortunately, trends in pediatric diphenoxylate-atropine ingestions are decreasing. We review the management, trends, and current concepts regarding pediatric diphenoxylate-atropine ingestions.
Topics: Atropine; Child, Preschool; Diphenoxylate; Drug Combinations; Gastrointestinal Agents; Humans; Infant; Male; Poisoning; United States
PubMed: 17976801
DOI: 10.1016/j.jemermed.2007.03.051 -
Lancet (London, England) Mar 1985
Topics: Acute Disease; Atropine; Diphenoxylate; Drug Combinations; Female; Gastrointestinal Agents; Humans; Isonipecotic Acids; Middle Aged; Pancreatitis
PubMed: 2858015
DOI: 10.1016/s0140-6736(85)91287-5 -
Cureus Oct 2019Diphenoxylate-atropine (Lomotil) intoxication incidence was significantly high in the past, but seeing such cases in the present day of modern and advanced medicine,...
Diphenoxylate-atropine (Lomotil) intoxication incidence was significantly high in the past, but seeing such cases in the present day of modern and advanced medicine, hints about the gaps in the practice of medicine. In our case, a general physician maltreated an infant for diarrhea with an adult dose of diphenoxylate-atropine (Lomotil), a Food and Drug Administration (FDA) unapproved drug, which caused labored breathing and pinpoint pupils. After being maltreated, at the time of presentation to the emergency room (ER), she was being misdiagnosed as a case of dehydration until doctors noticed miosis and reached the diagnosis of diphenoxylate-atropine (Lomotil) toxicity. Her condition completely reversed with a single dose of naloxone. Hence, this case highlights the need for basic knowledge about the dosage of drugs for different age groups, especially infants, along with the importance of adherence to the evaluation protocols for accurate management.
PubMed: 31763098
DOI: 10.7759/cureus.5875 -
International Journal of Clinical and... 2015In order to investigate the effects of diphenoxylate on the metabolic capacity of cytochrome P450 (CYP) enzymes, a cocktail method was employed to evaluate the...
In order to investigate the effects of diphenoxylate on the metabolic capacity of cytochrome P450 (CYP) enzymes, a cocktail method was employed to evaluate the activities of CYP2B6, CYP2D6, CYP2C19, CYP1A2, CYP3A4, CYP2C9. The rats were randomly divided into diphenoxylate group (Low, Medium, High) and control group. The diphenoxylate group rats were given 12, 24, 48 mg/kg (Low, Medium, High) diphenoxylate by continuous intragastric administration for 7 days. Six probe drugs bupropion, metroprolol omeprazole, phenacetin, testosterone and tolbutamide were given to rats through intragastric administration, and the plasma concentrations were determined by UPLC-MS/MS. Statistical pharmacokinetics difference for omeprazole, phenacetin and tolbutamide in rats were observed by comparing diphenoxylate group with control group. Continuous 7 days-intragastric administration of diphenoxylate induces the activities of CYP2C19, CYP1A2 and CYP2C9 of rats. Induction of drug metabolizing enzyme by diphenoxylate would reduce the efficacy of other drug. Additionally, high dosage diphenoxylate may cause hepatotoxicity.
PubMed: 26770498
DOI: No ID Found