Antimotility Agent Effect on Diarrhea

1. ANTIMOTILITY AGENT
EFFECT ON DIARRHEA
Brittney Dickens
Lamar University
MSNE 5356 Advanced Pharmacology
Dr. Elizabeth Long

2. DIPHENOXYLATE WITH ATROPINE
(LOMOTIL)
• Diphenoxylate with atropine (Lomotil) is an antimotility agent that is commonly
prescribed reduce the incidence of diarrhea (Wilbur, 2017).
• Lomotil decreases gastrointestinal motility within the circular and longitudinal
muscles of the intestines.

3. DIARRHEA AND HIGH ILEOSTOMY OUTPUT
• Diarrhea is classified as at least three or more loose or liquid stools in one day
(Schmelzer, 2011).
• A patient that has an ileostomy may experience “diarrhea” when their stool exceeds
1000 milliliters in output per day.
• With diarrhea, a patients intestinal contents don’t have sufficient amount of time to
in in contact with the lining of the intestinal tract resulting in the prevention of
fluid, electrolytes and nutrients from being absorbed by the intestines adequately
(Wilbur, 2017).

4. INTENDED DRUG RESPONSE
• The primary goal of the initiation of Lomotil into a patients’ medication regime is to
reduce their frequency and symptoms of diarrhea (Wilbur, 2017).
• Lomotil reduces a patients average stools per day and also reduces the average
amount of stools they may have as well (Harford et al, 1980).
• If a patient has high ileostomy output for two consecutive days in a row their
physician may implement some form of antidiarrheal agent, such as Lomotil, to
decrease their output (Schmelzer, 2011).

5. POTENTIAL INTERACTIONS
• When Lomotil and naltrexone are both administered the patient is at increased risk
of opioid withdrawal syndrome and decreased opioid effectiveness.
• Lomotil may also potentiate the effects of depressants such as alcohol, barbiturates,
or benzodiazepines patients need to be thoroughly educated on what to avoid when
taking this medication (Wilbur, 2017).
• The atropine component of Lomotil may also potentiate the effects of other agents
with anticholinergic properties such as tricyclic antidepressants, antipsychotics and
antihistamines.

6. ADVERSE DRUG REACTIONS
Cardiovascular
• Tachycardia
Dermatologic
• Flushing
• Pruritus
• Urticaria
Endocrine
• Electrolyte Imbalance
• Increased temperature
Gastrointestinal Effects
• Pancreatitis
• Paralytic Ileus
• Toxic Megacolon
Psychiatric
• Depression
• Euphoria
• Hallucinations
Respiratory
• Respiratory depression

7. SIDE EFFECTS
• The atropine component of Lomotil has an anticholinergic effect which may cause
the incidence of
• dry mouth and eyes
• urinary retention
• constipation
• blurred vision
• The diphenoxylate component of Lomotil may cause drowsiness and or dizziness in
patients.

8. PHARMACOKINETICS
• When used orally Lomotil initiates a response typically within 45 to 60 minutes and has
a peak of 2 hours (Micromedex Solutions, n.d.).
• The duration of a single dose of Lomotil is generally 3 to 4 hours, which is a reason this
drug is typically prescribed to be taken 4 times a day.
• When four 2.5 mg tablets of Lomotil is ingested it is absorbed at around 2 hours
(Micromedex Solutions, n.d.).
• Lomotil is quickly and extensively metabolized by the liver and is excreted by both the
renal system and through feces as well.
• The amount of time the human body takes to excrete the half-life of Lomotil is from 2 to
3 hours (Micromedex Solutions, n.d.).

9. DRUG BINDING ISSUES
• Lomotil is protein binding which means that the medication binds to the protein in
the patients’ blood.
• When Lomotil and naltrexone are both administered the patient is at increased risk
of opioid withdrawal syndrome and decreased opioid effectiveness (Micromedex
Solutions, n.d.).
• This is caused by both medications competition for binding at the patients’ opioid
receptors.

10. IMPROVING COMMUNICATION
• When a patient is diagnosed with diarrhea the entire multidisciplinary team must
thoroughly the patients’ medical, social and mediation history.
• The physician and the pharmacist must be in constant communication in regards to
medications to ensure that the prescribed medications and dosage are correct in
regards to the expected outcomes and potential adverse effects.
• The nurse and the pharmacist must communicate to ensure that medication and its
potential side effects are adequately explained to the patient.

11. APPLICATION TO PRACTICE SETTING
• The findings from this research about diarrhea and the use of Lomotil will help
improve how this medication is used in my practice setting by
• A better understanding of Lomotil and its possible effects
• Increasing communication between multidisciplinary team
• Improved patient education regarding medication

12. REFERENCES
Hartford, W.V., Krejs, G.J., Santa Ana, C.A. & Fordtran, J.S. (1980). Acute effect of diphenoxylate
with atropine (Lomotil) in patients with chronic diarrhea and fecal incontinence. Gastroenterlogy,
78(3). 440-443. Retrieved from http://www.gastrojournal.org/article/0016-5085(80)90853-7/abstract
Micromedex Solutions. (n.d.). Lomotil. Retrieved from
https://www.micromedexsolutions.com/home/dispatch/ssl/true
Schmelzer, M. (2011). Lower Gastrointestinal Problems. In Lewis, S.L., Dirksen, S.R., Heitkemper,
M.M., Bucher, L. & Camera, I.M. Medical-Surgical Nursing: Assessment and Management of Clinical
Problems (8th ed.). (pp. 1006-1057). St. Louis: Elsevier.
Wilbur, V.F. (2017). Constipation, Diarrhea, and Irritable Bowel Syndrome. In V. P. Arcangelo, A. M.
Peterson, V. F. Wilbur, & J. A. Reinhold (Eds.), Pharmacotherapeutics for advanced practice a
practical approach. (pp. 464-496). Philadelphia, PA: Wolters Kluwer.