Diphenoxylate + Atropine and Loperamide

Diphenoxylate + Atropine:

Preparation available:

• Combining 2.5 milligrams of diphenoxylate and 0.025 mg of atropine sulfate.
• When it comes to reducing gastrointestinal motility, diphenoxylate is 8–10 times more effective than morphine.
• Each oral tablet contains 2.5 mg of diphenoxylate hydrochloride and 0.025 mg of atropine sulfate.

Mechanism of action:

• Opioid receptor agonist
  • Bind to u receptor on the Myenteric Plexus of GIT.
• Stimulation of this receptor will lead to:
  • Lessen the tone of cells that make up longitudinal smooth muscles.
  • Increase the tone of circular smooth muscle cells to lengthen transit time.
  • Increase the intestine's ability and time to absorb water while inhibiting the gastric reflex.

Indication:

• Associated with inflammatory bowel disease is nonspecific diarrhea.

Dose:

• Adult:
  • 2 tabs qid untill diarrhoea is controlled.
• Child:
  • Above 6 yrs: Dosage calculated as 0.25 mg Diphenoxylate HCI per kg daily in divided doses.

Contraindication:

• Hypersensitivity to Diphenoxylate and Atropine.

Side effects:

• Sedation, tachycardia, drowsiness, restlessness, headache, dizziness, nausea, vomiting  abdominal discomfort, thrust, paralysis of ileum, dryness of skin, dryness of mucus membrane, respiratory depression, urinary retention.

Nursing considerations:

• With a full glass of water, administer medication. Encourage patients to drink enough fluids while they are taking atropine and diphenoxylate to prevent dehydration.
• Keep the medication out of reach of children. A child may die from an overdose of atropine plus diphenoxylate.
• Keep an eye on the stools' regularity and consistency. If you experience fever, bloody stools, palpitations, or any other negative side effects, call your doctor right away.
• Driving and other potentially risky activities should be avoided until the treatment reaction is determined.
• Without first seeing a doctor, avoid breastfeeding while taking this medication.
• Should not be administered along with alcohol or CNS depressants.
• Check your bowel movements for peristalsis, which can lead to paralytic ileus.

Loperamide:

Mechanism of action:

• Through the direct reduction of peristaltic activity,loperamide decreases intestinal motility. reduces the volume of the faces and modifies the colon's reabsorption of water and electrolytes.

Indication:

• Associated with inflammatory bowel disease is nonspecific diarrhea.

Dose:

• Adult: Initially 4mg followed by 2mg after each loose motion. Maximum 6mg / day

Contraindication:

• Severe liver disease, children under 2 years of age, infections diarrhoea, pseudomembranous colities.

Side effects:

• Abdominal cramps, rashes, toxic megacolon, abdominal distention, sedation, fatigue, abdominal cramping. 

Nursing considerations:

• If a patient with ulcerative colitis experiences abdominal distention or other Gl symptoms, they should contact their doctor very once.
• If diarrhea does not cease within 48 hours or if a fever appears, call your doctor.
• Observe the electrolyte and fluid balance.
• Tally the quantity and quality of stools.
• Avoid driving and other potentially risky activities.
• Without first seeing a doctor, avoid breastfeeding while taking this medication.
• Learn how to treat dry mouth by sucking hard candies and frequently rinsing your mouth with water.
• Unless specifically instructed otherwise by a doctor, avoid combining alcohol and other CNS depressants; doing so may make you drowsier.
• To keep the balance of fluids and electrolytes, encourage oral fluid intake.