New Scoop on the Poop

[SoCalGal]

Hi friends,

GOOD NEWS - saw my gastro guy last week, (did another stool culture to rule out any cooties as opposed to side effects) and I've been on a new anti-poop medicine called LOMOTIL. So far, IT WORKS!

Boy do I wish I tried it about 3 years ago. I have no idea what the down side is, don't even care at this point, good will outweigh bad, and am happily taking this tiny but mighty pill 2 - 3 times a day. Feeling my usual tired, well, exhausted but am pushing thru. (On Friday did my herceptin, perjeta, avastin, zometa and am hoping that my markers slide down to ground zero).

For people who are struggling with pooperia, I highly recommend asking your doc about LOMOTIL.

As a good friend of mine always says, "that's the pooperton, scooperton".

[BonnieR]

I have always loved me some Lomotil when traveling. It also is a relaxant in general. I notice it always made me hungry.
Glad you found it
Keep the faith

[Laurel]

You can buy that stuff over the counter in Mexico, Flori! Lomotil is a restricted drug here, but does wonders! Glad to hear things are looking up for a change.

[CoolBreeze]

I'm so happy you found something that works!

Just be very very careful. Lomotil and c-diff do not go together! I've been freaked about c-diff since I got it so forgive me for mentioning it. If you aren't taking probiotics, I recommend them. Especially whatever is in florastor (which I can never remember how to spell so I use one of the brand names)

C-diff is all over hospitals and you don't want to make yourself susceptible. *hugs*

[NanaJoni]

I have some ongoing gastro issues and always have Lomotil on hand. When I was doing chemo and it was really bad, my gastroenterologist told me to take Lomotil AND immodium at the same time - I worried about it but they assured me the chemistry worked differently and it wouldn't stop me from ever having another bowel movement (aren't these lovely topics for discussion) and it didn't. I also take a drug called Entocort which is a steroid that works in the bowel. All good options for a poopy problem.

[BonnieR]

Yes, about Mexico. That's where I have gotten it OTC when needed for travelers diarrhea. Three times a day will probably make you pretty tired. Don't drive!
Keep the faith

[jaykay]

Yes, Lomotil is wonderful. Had a bad bout with d after my last chemo that Imodium wouldn't touch. After too many days of poop, my onc wrote for Lomotil. Within 24 hours, felt 100% better. But it did make me sleepy, as Bonnie said.

Glad it helped both of us!

Best
Janis

[Lani]

Lomotil I believe, is an opioid, like morphine. A side effect of morphine, vicodin, demerol and other opiods is constipation. In the case of Lomotil, it is its desired function rather than a side effect. That is probably why it makes you sleepy. It is also why it is not over the counter in the US from what I can gather.

[chrisy]

well, hallelujah my dear!!!!!!

[CoolBreeze]

Lomotil is diphenoxylate hydrochloride and atropine sulfate. It is not an opiate. It does not have the same action as an opiate and doesn't have any pain relieving properties

Both of the drugs in lomotil are used to slow bowel motility, same as immodium, and yes, many opiates can also slow bowel motility. Side effects of many drugs include tiredness. And, you should drink a lot of water while on these drugs as being dehydrated can increase the feeling of tiredness.

I know way too much about poop since c-diff! LOL.

[Laurel]

Hey, Cool Breeze, we all have to be an "authority" on something!!! LOL.

On a serious note, has your C-Diff been successfully whacked? That stuff is as nasty as it gets.

[fullofbeans]

Socalgirl glad you found something and thanks for the tip I may use it myself..as my new drug is giving me hell since yesterday. and I am developing anal fissure because of it and it can become crazily painful.

I also noted that having a wrmth bath or putting a hot water bottle on my belly/intestine seems to help quite a bit.

[Lani]

Sorry CoolBreeze, but I took the time now to check out whether or not I remembered incorrectly. Here is the Wikipedia entry on diphenoxylate (and covers its combination with atropine as well) Here it is(with relevant areas in bold):

Diphenoxylate
From Wikipedia, the free encyclopedia

This article may contain original research. Please improve it by verifying the claims made and adding references. Statements consisting only of original research may be removed. (June 2011)

This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (June 2011)
Diphenoxylate

Systematic (IUPAC) name
ethyl 1-(3-cyano-3,3-diphenylpropyl)-4-phenylpiperidine-4-carboxylate
Clinical data
AHFS/Drugs.com monograph
Pregnancy cat. ?
Legal status Class A (UK) Schedule II (US)
Routes Oral
Pharmacokinetic data
Protein binding 74-95%
Half-life 12–14 hours
Identifiers
CAS number 915-30-0
ATC code A07DA01
PubChem CID 13505
DrugBank DB01081
ChemSpider 12919
UNII 73312P173G
KEGG D07861
ChEBI CHEBI:4639
ChEMBL CHEMBL1201294
Chemical data
Formula C30H32N2O2
Mol. mass 452.587 g/mol
SMILES[show]
InChI[show]

Diphenoxylate (R-1132) is an opioid agonist used for the treatment of diarrhea that acts by slowing intestinal contractions and peristalsis allowing the body to consolidate intestinal contents and prolong transit time, thus allowing the intestines to draw moisture out of them at a normal or higher rate and therefore stop the formation of loose and liquid stools. It is the main active ingredient in the anti-peristaltic medication Lomotil, which also contains atropine as noted below.
Diphenoxylate is the prototype of a small subfamily of opioids including difenoxin (diphenoxylic acid) (an active metabolite of diphenoxylate produced in the human body) and loperamide (which unlike the other two work exclusively in the intestines because it does not cross the blood–brain barrier). It was discovered at Janssen Pharmaceutica in 1956. It is a congener to the narcotic pethidine of which the common brand names are Dolantin and Demerol amongst others. Other somewhat more distant relatives include alphaprodine (Nisentil) and piritramide (Dipidolor).
Contents [hide]
1 Actions and use
2 Related drugs
3 Inclusion of atropine
4 Use in irritable bowel syndrome
5 Regulation
6 References
[edit]Actions and use


This section does not cite any references or sources. Please help improve this section by adding citations to reliable sources. Unsourced material may be challenged and removed. (June 2011)
Diphenoxylate works by decreasing the speed and amplitude of wave-like movements of the intestines (peristalsis) therefore allowing the body time to remove moisture from the intestinal contents and consolidate waste product into a dense solid form rather than loose and watery as is diarrhea.
Similar to loperamide and difenoxin preparations, the usual protocol is to take a loading dose (usually two tablets or the quantity of liquid containing 5 mg of diphenoxylate) and then the standard dose of one tablet every 3 to 4 hours prn over a time period not to exceed 48 hours unless so ordered by the physician. Long-term intermittent prn users should contact their physician if the need for it arises more than was usual at the outset of therapy as tolerance to diphenoxylate can occur. Those taking it in large quantities or continuously over an extended period should taper down the dose on a schedule devised by the physician and/or pharmacist.
[edit]Related drugs


This section does not cite any references or sources. Please help improve this section by adding citations to reliable sources. Unsourced material may be challenged and removed. (June 2011)
Diphenoxylate is metabolised in the body to yield difenoxin. Difenoxin is another centrally acting antidiarrhoeal that is 250 to 400 per cent the strength of diphenoxylate via the oral route and is also able to be manufactured and is distributed as Motofen, (1 mg difenoxin/25 µg atropine), which was introduced in the United States in the late 1990s after being discovered in 1970 at Janssen.
The Diphenoxylate-Loperamide subfamily of gastrointestinal drugs works directly on opioid receptors, which can be found in the intestine, brain, and spinal cord. Diphenoxylate itself crosses the blood–brain barrier. This being the case, this medication is potentially habit-forming and can generate significant tolerance if taken continuously for a protracted period. Physical dependence is most common particularly with high doses and/or long-term use. The CNS penetration of diphenoxylate makes it an agent that can cause euphoria and other psychoactive effects, which could over time lead to habituation and dependency on the drug in the user. As with other medicinal opioids, iatrogenic addiction is uncommon although physical dependence secondary to treatment of a functional bowel disorder with diphenoxylate for more than 45–90 days may very well occur; it typically requires the use of high doses to impart a morbid seek orientation for the drug in the user. Because of this, diphenoxylate is manufactured and marketed as a combination drug with atropine (Lomotil, Pfizer) as an abuse deterrent. Lomotil was used during the Apollo program, as was pethidine.[1][2]
[edit]Inclusion of atropine


This section does not cite any references or sources. Please help improve this section by adding citations to reliable sources. Unsourced material may be challenged and removed. (June 2011)
The atropine additive strategy is designed to discourage use of the drug in a manner inconsistent with its labelling and physician and manufacturer instructions; in theory, the anticholinergic effect of atropine will produce severe weakness and nausea if standard dosage is exceeded, and at the time diphenoxylate was introduced in the United States a number of manufacturers used this strategy with oral forms of morphine, methadone (also using scopolamine), oxycodone and others. Currently, the only other narcotic produced in the United States to use this strategy is Motofen (difenoxin 1 mg with 25 µg atropine sulfate).
The 25 µg of atropine present in each 2½ mg Lomotil tablet is 1/40 of the standard therapeutic dose of atropine via the oral route for normal anticholinergic uses.
[edit]Use in irritable bowel syndrome


This section does not cite any references or sources. Please help improve this section by adding citations to reliable sources. Unsourced material may be challenged and removed. (June 2011)
Diarrhoea resulting from cyclic or diarrhoea-predominant IBS may not be optimally treated with diphenoxylate or difenoxin, and may not respond to a meaningful degree to loperamide; thus, diarrhoea and cramping which does not respond to belladonna derivatives and non-centrally-acting soothing and/or stool-desiccating agents are often treated with conservative doses of codeine, especially where paregoric and/or laudanum are not currently in general use.
Diarrhoea accompanied by significant cramping or intestinal cramping alone may benefit from either adding another smooth-muscle agent to the protocol such as dicycloverine, papaverine, or orphenadrine (which accomplishes several things at once since it is an antihistamine as noted above). Such cases may also benefit from a switch to paregoric, laudanum, powdered or granulated opium, or B&O (i.e. Belladonna & Opium) Suppositories as all of the above include many drugs which work together and have non-narcotic alkaloids like papaverine and other components like oils, waxes, resins &c. which work elsewhere in the body. Pantopon (Opium Alkaloids Hydrochlorides) and similar preparations have much of the advantages of whole opium in injectable form
[edit]Regulation


This section does not cite any references or sources. Please help improve this section by adding citations to reliable sources. Unsourced material may be challenged and removed. (June 2011)
As noted below, diphenoxylate is listed in national controlled-substances and drugs laws such as pure diphenoxylate being in Annex/Schedule/List II of the Single Convention on Narcotic Drugs of 1961 and also in similarly numbered schedules of laws passed to implement the Convention such as the Canadian Controlled Substances Act and the Betäubungsmittelgesetz in Germany and the Suchtgiftverordnung of Austria. This level of regulation is also implemented in the Misuse of Drugs Act of 1971 (UK), the French opium law of 31 December 1970, and royal decrees and laws passed by practically all other countries in Europe, the Pacific Rim, South Asia and the Middle East.
In many cases, Lomotil type preparations with extra active ingredients are over the counter and/or subject to provincial and/or municipal control or minimal national oversight; the schedule numbers vary by country.
This medication is classified as a Schedule V under the United States' Comprehensive Drug Abuse Control & Prevention Act of 1970 aka Controlled Substances Act (CSA) (21 U.S.C. § 801 et. seq.) by the Food and Drug Administration (FDA) and the Drug Enforcement Administration (DEA) in the United States when used in preparations. When diphenoxylate is used alone, it is classified as a Schedule II; having one or more other active ingredients makes it Schedule V. As such, diphenoxylate/atropine tablets are under state and local control and where allowed by state law, can be obtained by signing a log book and the customer can receive up to 48 units (tablets or capsules) in any 48-hour period, much like the 4 fl. oz. limit on codeine, dihydrocodeine, dionine (ethylmorphine), and opium cough syrups and gastrointestinal drugs.
The other Schedule V narcotics, all of which may be obtained in some states without prescription as noted in this article, are cough syrups containing low amounts of codeine. Very dilute syrups of hydrocodone containing three or more other active ingredients were also Schedule V and often available without prescription until rescheduling to Schedule III circa 1990.
As for the rest of the family, in the United States difenoxin & atropine tablets are Schedule IV and therefore federally controlled and require a prescription, loperamide is unscheduled and not on prescription, and diphenoxylic acid is classified as a form of diphenoxylate. Other Schedule IV narcotics also include butorphanol nasal spray, pentazocine, propoxyphene-based mixtures and others of the same type. Unscheduled narcotics and opioid agonists include loperamide (OTC), nalbuphine (Rx), and tramadol (Rx).
As an example of the degree of regulation at the federal level, the most commonly known Schedule IV drug of any type is Valium as well as nearly all other benzodiazepines, whereas Schedule III contains Vicodin (hydrocodone bitartrate), and Schedule II contains cocaine, secobarbital, methamphetamine, methylphenidate, all forms of morphine and derivatives like Dilaudid (hydromorphone hydrochloride), oxymorphone, and oxycodone. Examples of a legitimate medical drug which are generally illegal (Schedule I) would include the morphine derivatives Vilan (nicomorphine HCl), Paramorfan (dihydromorphine HCl) and the synthetics Ketodur (ketobemidone), Dipidolor (piritramide), and Palfium (dextromoramide).
A Schedule V purchase involves the customer having to sign a dispensary log after presenting proper identification to the pharmacist; the Schedule V ledger lists transactions going back two years and must have pages that are difficult to remove and usually pre-numbered. This schedule devolves control over the drugs therein to state and local governments, so in states where it cannot be bought over the counter it may or may not require the duplicate, triplicate, or quintuplicate narcotic prescription order form defined by state law.
Narcotic preparations for gastrointestinal problems tend to be the more available of the narcotics; other narcotics for pain like the Tylenol With Codeine series, (even No. 1 and other combination products with the same quantity and therefore narcotic content number (7½ or 8 mg, i.e. 1/8 of a grain of codeine phosphate per tablet) are more restricted and therefore all Schedule III.
Lomotil is a Schedule V drug, but it is only available by prescription in the United States. Donnagel-PG: was available without prescription in some states, but has been discontinued. The stimulant pyrovalerone is another Schedule V prescription-only drug, as is Lyrica.
[edit]References

^ W. Royce Hawkins, M.D., John F. Zieglschmid, M.D., Clinical aspects of crew health
^ Apollo Medical Kits
Merlo M, Brown CH, The effect of diphenoxylate hydrochloride on diarrhea, Am J Gastroenterol. 1960 Dec;34:625-30.
Kasic AM, Treatment of diarrhea in irritable colon, including preliminary observations with a new antidiarrheal agent, diphenoxylate hydrochloride (Lomotil), Am J Gastroenterol. 1961 Jan;35:46-9.
[hide] v t e
Antidiarrheals, intestinal anti-inflammatory/anti-infective agents (A07)
Rehydration
Oral rehydration therapy

[SoCalGal]

Wow and jeez! Explains my blurryish vision and eyes that wont clearly focus at times. And sometimes now feeling dizzy when the gut "wakes up" between doses. I've experienced dizzy before when my intestines really growl around. Tonite seems particularly bad with the dizzy. Although I was at swing dance class for an hour and a half prior to the diZzy, so how sick can I be if I can dance? At least that is what I tell myself. Hope this dizzy passes by the morning.
Anyhow, thanks for the extensive info - seems like I'd better be very careful.

[PinkGirl]

Holy crap Lani ... they give this drug to pregnant cats
and now spiders are getting chemo ... I've been away too long.

[jaykay]

I guess that explains my reaction to my "loading" dose of 2 lomotil - fell asleep in my chair within 15 minutes! Nice nap, though ;-)

[SoCalGal]

Pink Girl -
anything that begins with holy crap should end with batman...you just crack me up!