ance the use of diphenoxylate hydrochloride and atropine sulfate tablets should be accompanied by appropriate fluid and electrolyte therapy, when indicated. if severe dehydration or electrolyte imbalance is present, diphenoxylate hydrochloride and atropine sulfate tablets should be withheld until appropriate corrective therapy has been initiated. drug-induced inhibition of peristalsis may result in fluid retention in the intestine, which may further aggravate dehydration and electrolyte imbalance. gastrointestinal complications in patients with infectious diarrhea diphenoxylate hydrochloride and atropine sulfate tablets are contraindicated in patients with diarrhea associated with organisms that penetrate the gi mucosa (toxigenic e. coli, salmonella, shigella), and pseudomembranous enterocolitis (clostridium difficile) associated with broad-spectrum antibiotics (see contraindications). antiperistaltic agents, including diphenoxylate hydrochloride and atropine sulfate, slow gastrointestinal motility and may enhance bacterial overgrowth and the release of bacterial exotoxins. diphenoxylate hydrochloride and atropine sulfate has been reported to result in serious gi complications in patients with infectious diarrhea, including sepsis, prolonged and/or worsened diarrhea. prolonged fever and the delay in the resolution of stool pathogens were reported in study of shigellosis in adults who used diphenoxylate hydrochloride and atropine sulfate vs. placebo. toxic megacolon in patients with acute ulcerative colitis in some patients with acute ulcerative colitis, agents that inhibit intestinal motility or prolong intestinal transit time have been reported to induce toxic megacolon. consequently, patients with acute ulcerative colitis should be carefully observed and diphenoxylate hydrochloride and atropine sulfate therapy should be discontinued promptly if abdominal distention occurs or if other untoward symptoms develop. interaction with meperidine hydrochloride since the chemical structure of diphenoxylate hydrochloride is similar to that of meperidine hydrochloride, the concurrent use of diphenoxylate hydrochloride and atropine sulfate tablets with monoamine oxidase (mao) inhibitors may, in theory, precipitate hypertensive crisis. hepatorenal disease diphenoxylate hydrochloride and atropine sulfate tablets should be used with extreme caution in patients with advanced hepatorenal disease and in all patients with abnormal liver function since hepatic coma may be precipitated. interaction with cns depressants diphenoxylate hydrochloride may potentiate the action of other drugs that cause dizziness or drowsiness, including barbiturates, benzodiazepines and other sedatives/hypnotics, anxiolytics, and tranquilizers, muscle relaxants, general anesthetics, antipsychotics, other opioids, and alcohol. therefore, the patient should be closely observed when any of these are used concomitantly.

tial control of diarrhea has been achieved. clinical improvement of acute diarrhea is usually observed within 48 hours. dosage after initial control of diarrhea after initial control has been achieved, the diphenoxylate hydrochloride and atropine sulfate dosage may be reduced to meet individual requirements. control may often be maintained with as little as two diphenoxylate hydrochloride and atropine sulfate tablets daily. duration of treatment if clinical improvement of chronic diarrhea after treatment with the maximum recommended daily dosage is not observed within 10 days, discontinue diphenoxylate hydrochloride and atropine sulfate tablets as symptoms are unlikely to be controlled by further administration.

bdominal discomfort. the following adverse reactions related to atropine sulfate are listed in decreasing order of severity, but not of frequency: hyperthermia, tachycardia, urinary retention, flushing, dryness of the skin and mucous membranes.