Lomotil overdose

Lomotil contains two medicines that can be harmful in large amounts. They are:

• Atropine
• Diphenoxylate (an opioid)

Medicines with these names contain atropine and diphenoxylate:

• Lofene
• Logen
• Lomanate
• Lomotil
• Lonox

Other medicines may also contain atropine and diphenoxylate.

Symptoms of a Lomotil overdose include:

• Slow breathing, or breathing stops
• Pounding heartbeat (palpitations)
• Rapid heartbeat
• Slowdown or stoppage of the bowels
• Coma (decreased level of consciousness, lack of responsiveness)
• Constipation
• Seizures (convulsions)
• Drowsiness
• Dry mucous membranes in the mouth
• Eye changes in pupil size (may be small, normal-sized, or large)
• Eyes move quickly from side to side
• Flushed skin
• Hallucinations (seeing or hearing things that aren't there)
• Restlessness
• Urination difficulty
• Vomiting

Note: Symptoms may take up to 12 hours to appear.

Seek medical help right away. Do not make a person throw up unless poison control or a health care provider tells you to.

Have this information ready:

• Person's age, weight, and condition
• Name of the product (ingredients and strength, if known)
• Time it was swallowed
• Amount swallowed
• If the medicine was prescribed for the person

Your local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. This national hotline will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

Take the container to the hospital with you, if possible.

The provider will measure and monitor the person's vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated.

Tests that may be done include:

• Blood and urine tests
• Chest x-ray
• Electrocardiogram (ECG)

• Fluids through a vein (by IV)
• Laxative
• Activated charcoal
  
• Medicine to reverse the effect of atropine
• Medicine to reverse the effect of the diphenoxylate
• Breathing support, including tube through the mouth and connected to a breathing machine (ventilator)

Some people may need to stay in the hospital to be monitored.

How well someone does depends on how much medicine was swallowed and how quickly treatment is received. The faster medical help is given, the better the chance for recovery.

A hospital stay may be needed for more doses of the medicines that reverse the effects of the drug. Complications, such as pneumonia, muscle damage from lying on a hard surface for a prolonged period of time, or brain damage from lack of oxygen may result in permanent disability. However, unless there are complications, long-term effects and death are rare.

People who quickly receive medicine to reverse the effect of the opioid usually get better within 24 to 48 hours. However, children do not do as well.

Diphenoxylate with atropine overdose; Atropine with diphenoxylate overdose

Aronson JK. Atropine. In: Aronson JK, ed. Meyler's Side Effects of Drugs. 16th ed. Waltham, MA: Elsevier; 2016:754-755.

Cole JB. Cardiovascular drugs. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 142.

Nikolaides JK, Thompson TM. Opioids. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 151.

Updated by: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.