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Co-Phenotrope

Co-phenotrope Toxicity


Presentation

  • We present a series of 41 cases of opioid dependence presenting with the use of the diphenoxylate as the primary substance.[ncbi.nlm.nih.gov]
  • […] should use caution when performing tasks requiring mental alertness, including operating heavy machinery or driving Use should be accompanied by appropriate fluid and electrolyte therapy, when indicated; if severe dehydration or electrolyte imbalance present[reference.medscape.com]
  • This might seem concerning, but it's important to note that when the drug is used correctly and as prescribed, there is only a small amount of diphenoxylate present.[verywellhealth.com]
  • If severe dehydration or electrolyte imbalance is present, do not administer Lomotil until appropriate corrective therapy has been indicated (see WARNINGS ).[drugs.com]
  • Clinical presentation. Depending on the individual and the time since ingestion, manifestations may be those of primarily anticholinergic or opioid intoxication. Atropine intoxication may occur before, during, or after opioid effects.[accessmedicine.mhmedical.com]
Gastric Lavage
  • Treatment: empty stomach by emesis or by gastric lavage. Gastric lavage may be effective even after several hr due to decreased GI motility and pylorospasm. Treatment is supportive and symptomatic and monitor closely for 48 hr.[apollopharmacy.in]
Sepsis
  • […] patients with abnormal liver function; hepatic coma may be precipitated Therapy may slow GI motility and may enhance bacterial overgrowth and the release of bacterial endotoxins, which have been reported to result in serious GI complications, including sepsis[reference.medscape.com]
Pneumonia
  • 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.[medlineplus.gov]
Hypertension
  • Concomitant MAOIs may cause hypertensive crisis; avoid use.[clinicalpainadvisor.com]
  • […] of stool pathogens reported in study of Shigellosis in adults Since chemical structure of diphenoxylate hydrochloride is similar to that of meperidine hydrochloride, concurrent use with monoamine oxidase (MAO) inhibitors may, in theory, precipitate hypertensive[reference.medscape.com]
  • Lomotil Tell a doctor if any of the following conditions are currently present or have been diagnosed in the past: Asthma, chronic lung disease, or allergies Difficulty urinating Down's syndrome Glaucoma Heart disease Hiatal hernia or reflux disease Hypertension[verywellhealth.com]
  • Medical comorbidity was present in 7 patients and included asthma, hypertension, diabetes mellitus, nephrolithiasis, limb paresis, seizures, and wrist fracture in one patient each.[ncbi.nlm.nih.gov]
Jaundice
  • You should not use Lomotil if you have a bile duct disorder causing jaundice (yellowing of your skin or eyes). Keep this medicine where a child cannot reach it. An overdose can be fatal to a child.[drugs.com]
  • Contraindications Hypersensitivity to diphenoxylate or atropine Children aged Obstructive jaundice Diarrhea associated with pseudomembranous enterocolitis or infectious enterotoxin-producing bacteria Cautions Cases of severe respiratory depression and[reference.medscape.com]
  • Have liver or renal (kidney) problems or obstructive jaundice Have diarrhea associated with bacteria Have colitis Have Down’s syndrome Are dehydrated Are pregnant, plan on getting pregnant, or breastfeeding This medicine can cause side effects that may[giforkids.com]
  • They need to know if you have any of these conditions: bacterial food poisoning colitis dehydration Down's syndrome jaundice or liver disease an unusual or allergic reaction to atropine, diphenoxylate, other medicines, foods, dyes, or preservatives pregnant[hendricks.org]
  • You should not use atropine and diphenoxylate if you have a bile duct disorder causing jaundice (yellowing of your skin or eyes). Keep this medicine where a child cannot reach it. An overdose can be fatal to a child.[emedicinehealth.com]
Blister
  • NUTRITION & VITAMINS MASSAGE TABLE PRODUCTS & EQUIPMENT MEDICAL & SURGICAL INSTRUMENTS PHARMACY PILLOWS PODIATRY, ORTHOTICS & FOOTWEAR RECOVERY PUMP REHAB & CONDITIONING SPORTS FIRST AID & TEAM SUPPLIES SPORTS PERFORMANCE SRC TAPE & BANDAGES WOUNDS & BLISTER[clubwarehouse.com.au]
  • Keep your tablets in their blister pack until it is time to take them. Store below 30 C. Store away from heat, direct light and steamy or damp places. Heat or moisture may cause LOMOTIL tablets to deteriorate.[mydr.com.au]
Fracture
  • Medical comorbidity was present in 7 patients and included asthma, hypertension, diabetes mellitus, nephrolithiasis, limb paresis, seizures, and wrist fracture in one patient each.[ncbi.nlm.nih.gov]
Blurred Vision
  • Vision Confused Depression Difficult Or Painful Urination Disturbance Of Any Of The Senses Affecting The Limbs Dizzy Drowsiness Dry Mouth Dry Skin Extreme Sense Of Well Being Fast Heartbeat Fever Hallucination Head Pain Hives Inducing Of A Relaxed Easy[webmd.com]
  • Common side effects of Lomotil include: drowsiness, dizziness, headache, tiredness, restlessness, blurred vision, dry mouth, nausea, vomiting, upset stomach, loss of appetite, skin rash, or itching.[rxlist.com]
  • It may cause several side-effects, such as dry mouth, headache, constipation and blurred vision. Since it may also cause drowsiness or dizziness, it should not be used by motorists, operators of hazardous machinery, etc.[en.wikipedia.org]
Slurred Speech
  • Early overdose symptoms include weakness, blurred vision, slurred speech, feeling hot, fast heartbeats, slowed breathing, fainting, seizure, or coma. Report any early overdose symptoms to your doctor as soon as possible.[drugs.com]
Nystagmus
  • Drowsiness, miosis, hypotonia, loss of tendon reflexes, nystagmus, and seizures followed by respiratory depression and total apnoea may manifest 12-30 hr after drug ingestion. Treatment: empty stomach by emesis or by gastric lavage.[apollopharmacy.in]
  • Signs and symptoms of adverse effects may include any or several of the following: convulsions, respiratory depression (slow or stopped breathing), dilated eye pupils, nystagmus (rapid side-to-side eye movements), erythema ( flushed skin ), gastrointestinal[en.wikipedia.org]
Insomnia
  • The results when the drug was discontinued was opiate withdrawal symptoms that commonly included anxiety, aching muscles, insomnia, nausea and sweating. 8 With the death toll continuing to rise across the globe due to overdosing on antidiarrheal medications[pharmacytimes.com]

Workup

Torsades De Pointes
  • Severe cardiac arrhythmias including QTc prolongation were also commonly seen. 4 Today, loperamide holds a Black Box Warning for reports of Torsades de Pointes and sudden death when used in higher than recommended doses. 7 Unlike loperamide, CYP enzyme[pharmacytimes.com]

Treatment

  • Materials and Methods: This retrospective chart review was conducted at the Drug De-addiction and Treatment Centre of PGIMER, Chandigarh, India.[ncbi.nlm.nih.gov]
  • Treatment: empty stomach by emesis or by gastric lavage. Gastric lavage may be effective even after several hr due to decreased GI motility and pylorospasm. Treatment is supportive and symptomatic and monitor closely for 48 hr.[apollopharmacy.in]
  • The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.[pennstatehershey.adam.com]
  • Lomotil is a combination product containing diphenoxylate and atropine that is prescribed commonly for symptomatic treatment of diarrhea.[accessmedicine.mhmedical.com]
  • A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions.[leehealth.org]

Prognosis

  • Outlook (Prognosis) 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.[ufhealth.org]

Prevention

  • Another way to prevent abuse is good communication with physicians.[pharmacytimes.com]
  • Take only as prescribed and record the time that each dose is taken to prevent taking too much Do not take diphenoxylate and atropine (Lomotil ) if you have an active intestinal infection with a certain type of bacteria known as Clostridium difficile,[chemoexperts.com]
  • In order to prevent abuse of diphenoxylate for its mood-elevating effects, atropine is combined with diphenoxylate in small quantities.[medicinenet.com]
  • Regulatory controls are needed to prevent escalation of use of this easily available prescription opioid.[ncbi.nlm.nih.gov]

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