Lomotil toxicity


  • Mixture of diphenoxylate/atropine used to treat diarrhea
  • Children are especially sensitive to toxicity (death reported after ingestion of <5 tablets)

Mechanism of toxicity

Clinical Features

  • Atropine effects
    • Lethargy, agitation, flushing, dry mucous membranes, mydriasis, ileus, tachycardia
  • Opioid effects
    • Miosis, coma, respiratory depression, respiratory arrest

Differential Diagnosis

Sedative/hypnotic toxicity

Anticholinergic toxicity Causes


  • Diagnosis is based on history and signs of toxicity


  • Maintain airway and support ventilation, if needed
  • Naloxone 1-2mg IV for apnea, coma, or lethargy (may require repeat dosing)
  • Activated charcoal should be given promptly if available
  • No evidence for utility of physostigmine


  • Pediatric patients should be observed in the ICU for 24 hours given risk of sudden respiratory arrest

See Also


  • Olson, K. Poisoning and Drug Overdose Clinical Manual. 2004
  1. Dawson AH, Buckley NA. Pharmacological management of anticholinergic delirium – theory, evidence and practice. Br J Clin Pharmacol. 2015;81(3):516-24.
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