Vol.

17 Issue 1

Peak Development for ...

Medication Administration

January 2016

GI Agents: Lomotil
(diphenoxylate/atropine)
Peak Development Resources
P.O. Box 13267
Richmond, VA 23225
Phone: (804) 233-3707
Fax: (804) 233-3705
Email: editor@peakdev.com

Peak Development for Medication

Administration and Competency
Assessment Tool for Medication
Administration are components of
a site license for the Peak
Development Resources
Competency Assessment System
for Medication Administration
and may be reproduced for this
individual facility only. Sharing
of these components with any
other freestanding facility within
or outside the licensees corporate
entity is expressly prohibited.

The information contained in

Peak Development for Medication
Administration is intended only as
a guide for the practice of
licensed nursing personnel who
administer medications. Every
effort has been made to verify the
accuracy of the information
herein. Because of rapid changes
in the field of drug therapy, the
reader is advised to consult the
package insert, facility pharmacist
or patients physician for relevant
information. This is particularly
important for new or seldom used
drugs. Use of professional
judgment is required in all patient
care situations. It is the readers
responsibility to understand and
adhere to policies and procedures
set forth by the employing
institution. The editor and
publisher of this newsletter
disclaim any liability resulting
from use or misuse of
information contained herein.
Copyright 2016

After completion the learner should be able to:

1. Identify appropriate indications for use of
Lomotil.
2. Relate general characteristics of Lomotil to
specific patient situations.
3. Apply nursing process considerations for
Lomotil to specific patient situations.
4. Correctly calculate dosage for Lomotil.
Diarrhea is characterized by abnormal
bowel movements that are frequent, loose and
watery. It may be associated with nausea,
bloating, blood or mucous in the stool, and
cramping or other abdominal discomfort.
Diarrhea is usually self-limiting and lasts for 1-3
days. Chronic diarrhea may signal a GI disorder
or food intolerance. Common causes of
diarrhea include:
GI disorders: Such as inflammatory bowel
disease (Crohns disease and ulcerative colitis)
and irritable bowel syndrome
Food intolerance: To substances such as
lactose or gluten
Certain substances: Such as caffeine,
heavy alcohol intake, and some artificial
sweeteners, including sorbitol and xylitol.
Infection: Due to bacteria, viruses or
parasites, such as rotavirus, norovirus, E. coli,
salmonella or giardia. Persons with reduced
immune function due to HIV, leukemia or
chemotherapy are at increased risk. Bacterial
contamination of food or water commonly
causes travelers diarrhea.
Medications: Diarrhea is an adverse effect
of many medications. Antibiotics may alter the
normal intestinal flora and cause bacterial
infection with C. difficile (pseudomembranous
colitis).
Diarrhea may cause dehydration and
electrolyte imbalance, particularly if it is severe

or ongoing. Those at increased risk are infants,

young children, the elderly and those with
impaired immune function, who need prompt
treatment to prevent these complications.
Treatment of diarrhea may include
replacement of fluid and electrolytes, either
orally or by IV, and medication to decrease
bowel motility. Lomotil is a prescription antidiarrheal medication that combines
diphenoxylate, an opioid related to meperidine,
with atropine, an anticholinergic agent.
Indications
Lomotil is indicated for the management of
diarrhea in patients two years of age and older.
Pharmacodynamics
Diphenoxylate, like other opioids, acts on
the smooth muscle of the bowel to decrease
peristalsis. The atropine in Lomotil is a subtherapeutic dose. It is added to discourage
intentional overdose and abuse of the opioid,
as the atropine causes unpleasant symptoms if
excessive amounts are taken. Despite the low
dose, adverse effects of atropine can occur in
susceptible groups, such as children, those with
Down syndrome, and the elderly.
Pharmacokinetics
Absorption: Rapidly and completely absorbed
following oral administration
Distribution: Highly protein bound; excreted in
breast milk
Metabolism: Rapid and extensive metabolism
by the liver to the active drug, difenoxine
Elimination: Via stool and urine
Major Interactions
Alcohol, barbiturates, tranquilizers and other
CNS depressants: Sedation associated with
Lomotil may be increased.
MAO inhibitors: Concurrent use may trigger
hypertensive crisis.

Adverse Effects/Toxicity
Adverse effects of Lomotil include nausea, vomiting,
anorexia, drowsiness, dizziness, delirium, flushing, urinary
retention, tachycardia, hyperthermia, and dryness of skin and
mucous membranes. Overdose may result in respiratory
depression, especially in children. A narcotic antagonist,
such as naloxone (Narcan) is used to treat respiratory
depression due to Lomotil overdose. Addiction to Lomotil
does not occur with therapeutic doses, but can occur if much
higher doses are taken.
Precautions/Contraindications
Drugs that slow peristalsis should not be used in some
types of bowel infection, such as Salmonella and E. coli, or
with pseudomembranous colitis caused by antibiotic use, as
diarrhea may worsen. Lomotil should not be used in patients
with obstructive jaundice, or in children under 2 years of age.
Severe dehydration and/or electrolyte disturbance
should be corrected before administration of Lomotil, since a
fluid shift into the bowel caused by decreased peristalsis may
worsen fluid/electrolyte imbalance. Lomotil should be used
cautiously in children age 2 years and over, and in patients
with hepatic impairment. Patients with ulcerative colitis are at
increased risk for toxic megacolon, and should immediately
stop taking the drug if abdominal distention occurs.
Nursing Process
Assessment
Determine baseline status: Prior to use of Lomotil for
treatment of diarrhea, a thorough assessment of the patients
GI status, normal and current patterns of elimination, and
typical dietary intake should be conducted. Any abnormalities,
such as abdominal pain, distention, nausea, or hypo or
hyperactive bowel sounds should be noted, as well as
frequency, amount, color and consistency of bowel
movements. Any signs of dehydration or electrolyte imbalance
should be noted, such as thirst, concentrated urine, dry
mucous membranes, muscle weakness or cramps, lethargy,
palpitations, numbness or tingling. Assessment should also
include any factors that may be causing the diarrhea, such as
food sensitivities, GI disorders or medications.
Identify risk factors: Consider young and elderly patients
at increased risk for adverse effects. A medication and
lifestyle history should be taken to assess for use of CNS
depressants that may interact with Lomotil. Also assess for
antibiotic use, which may be the cause of the diarrhea.
Age-specific considerations: FDA pregnancy category C.
Lomotil should be used by nursing mothers only if the

benefits outweigh the risks. The drug should not be used in

children under age 2, and should be used very cautiously in
children. Elderly patients may be more sensitive to adverse
effects of Lomotil, such as delirium.
Planning and Analysis
The goal of therapy with Lomotil is to relieve diarrhea and
its associated symptoms.
Intervention
Medication administration: Lomotil is administered orally,
and is available in tablet and liquid forms. It can be taken
without regard to meals. The liquid form should be used for
patients age 12 years and younger. The drug is initially taken
four times daily until improvement occurs, usually within 48
hours. The dosage may then be reduced.
Diarrhea may cause breakdown of the skin around the
anus. Instruct the patient to clean the area very gently and
thoroughly, using a gentle skin cleanser and protectant after
each bowel movement. This care should be provided if the
patient is unable.
Observe for therapeutic effects: Relief of diarrhea is
assessed by the patients report of improved comfort and
firmer, less frequent bowel movements.
Observe for adverse effects: Monitor the patient for
signs such as drowsiness, nausea/vomiting, anorexia,
flushing and confusion. Continue to monitor for signs of
dehydration and electrolyte imbalance.
Patient/Family teaching:
Take the drug exactly as prescribed; do not exceed the
recommended dose.
Avoid alcohol, tranquilizers and other sedating drugs.
Dizziness and drowsiness may occur. Change positions
slowly and use care to prevent falls. Avoid driving or
operating equipment until drug effects are known.
Contact the prescriber if diarrhea worsens or does not
improve within 48 hours, or if other symptoms develop or
worsen, such as abdominal distention, thirst, weakness,
or decreased urination.
Avoid foods or other substances suspected of contributing
to the diarrhea.
Clean the skin around the anus gently and thoroughly
after each bowel movement, and pat dry.
Evaluation
The nurses role in assessment, monitoring and effective
patient education promotes the successful use of Lomotil,
along with other appropriate measures, for management of
diarrhea.

Peak Development for Medication Administration

GI Agents: Lomotil (diphenoxylate/atropine)

Page 2

Peak Development for ...

Medication Administration
Competency Assessment Tool

Vol. 17 Issue 1
January 2016

GI Agents: Lomotil
(diphenoxylate/atropine)
NAME:

DATE:

UNIT:

Directions: Place the letter of the one best answer in the space provided.
_____1. Diarrhea is most commonly caused by all of the following EXCEPT:
A. medication use
B. dehydration
C. food intolerance
D. infection
_____2. Pseudomembranous colitis is caused primarily by:
A. antibiotic use
B. contaminated food or water (travelers diarrhea)
C. Crohns disease
D. excessive caffeine or alcohol intake
_____3. Lomotil contains atropine for the purpose of:
A. decreasing peristalsis
B. removing fluid from the intestine
C. discouraging abuse of the drug
D. reducing opioid adverse effects
_____4. Patient groups who are at increased risk for adverse effects of atropine include:
A. children
B. those with Down syndrome
C. the elderly
D. all of the above
_____5. There is a significant risk of addiction with therapeutic doses of Lomotil.
A. True
B. False

_____6. A serious overdose of Lomotil is most commonly treated with:

A. an osmotic laxative, such as polyethylene glycol (Miralax)
B. a drug to reverse anticholinergic effects, such as physostigmine
C. a sedating agent, such as diazepam (Valium)
D. an opioid antagonist, such as naloxone (Narcan)
_____7. Which of the following patients should not receive Lomotil for treatment of diarrhea:
A. Mr. V, who has diarrhea caused by lactose intolerance
B. Mrs. U, who has ulcerative colitis
C. Mr. A, who has pseudomembranous colitis
D. Mrs. P, who has irritable bowel syndrome
_____8. Education for a patient taking Lomotil should include all of the following EXCEPT:
A. do not drive or operate machinery until drug effects are known
B. let the doctor know if diarrhea does not improve in 48 hours
C. avoid alcohol, tranquilizers and other sedating drugs while taking Lomotil
D. take the drug on an empty stomach, 1 hour before or 2 hours after meals
_____9. Drug order: Lomotil liquid 5 mg (diphenoxlyate) PO four times daily
Drug label: Lomotil liquid 2.5 mg (diphenoxylate) per 5 ml
Give:
A. 10 ml
B. 15 ml
C. 25 ml
D. 30 ml
_____10. The recommended pediatric dosage of Lomotil is 0.3 to 0.4 mg/kg daily total, divided into
four doses. A child weighing 88 lb is prescribed Lomotil liquid 3 mg (diphenoxylate) four
times daily. This dose falls within the recommended dosage guidelines.
A. True
B. False

Competency Assessment Tool

GI Agents: Lomotil (diphenoxylate/atropine)

Page 2

Month: January 2016

Issue:
GI Agents: Lomotil
(diphenoxylate/atropine)

Peak Development for ...

Medication Administration

Group Tracking Log

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GI Agents: Lomotil (diphenoxylate/atropine)

January 2016
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