Drug Facts

How The Drug Works

Difenoxin and diphenoxylate, related to the narcotic pain reliever meperidine, act on intestinal tract muscles and slow intestinal motility. Atropine is present to discourage deliberate misuse of these drugs.

Uses

To relieve diarrhea.

Pregnancy: Adequate studies have not been done in pregnant women. Use only if clearly needed and potential benefits outweigh the possible hazards to the fetus.

Breastfeeding: Difenoxin and diphenoxylate may appear in breast milk.

Atropine appears in breast milk. Because of the potential for serious side effects in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

Children: Do not use difenoxin tablets or diphenoxylate liquid in children under 2 years of age. Do not use diphenoxylate tablets in children under 13 years of age. Safety and effectiveness of difenoxin tablets have not been established in children under 12 years of age. Use with caution in children with Down syndrome due to presence of atropine.

Drug Interactions

Tell your doctor or pharmacist if you are taking or if you are planning to take any over-the-counter or prescription medications or dietary supplements with antidiarrheals containing difenoxin, diphenoxylate, or atropine sulfate. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. The following drugs and drug classes interact with antidiarrheals containing difenoxin, diphenoxylate, or atropine sulfate.

Side Effects

Every drug is capable of producing side effects. Many antidiarrheal users experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy, and individual susceptibility. Possible side effects include:

Both: Nausea; vomiting; dizziness; drowsiness; headache.

Difenoxin Only: Constipation; lightheadedness; dry mouth; stomach pain.

Diphenoxylate Only: Stomach ache; appetite loss; toxic megacolon; paralyticileus; pancreatitis; restiessness; confusion; depression; exaggerated sense of well-being; itching; hives; swelling of gums; numbness of arms or legs; general body discomfort; allergic reaction.

Atropine Only: Dry skin; flushing; fever; fast heartbeat; urinary retention.

Guidelines for Use

• Difenoxin - Starting dose in adults is 2 mg by mouth, then 1 mg after each loose stool or 1 mg every 3 to 4 hours as needed. Total dose in any 24-hour period should not exceed 8 mg.
• Diphenoxylate - Initial dosage in adults is 2 tablets by mouth 4 times daily or 10 ml (2 tsp) of liquid 4 times daily (20 mg/day). Once control of diarrhea is achieved, reduce the dose to the lowest possible level (eg, 2 tablets daily) to maintain control.
• Do not use tablets for children under 13 years of age. Only use the plastic dropper included with the liquid to measure doses for children. Doses for children must be carefully determined. Talk to your doctor or pharmacist about the correct dose for your child.
• If clinical improvement of acute diarrhea is not observed within 48 hours, do not continue the medication. If improvement of chronic diarrhea is not seen within 10 days of using diphenoxylate (with a maximum daily dose of 20 mg), symptoms are unlikely to be controlled by further administration.
• Do not take more than the prescribed dose.
• Appropriate fluid and electrolyte therapy should be used in conjunction with diphenoxylate therapy in the treatment of diarrhea in children.
• Avoid alcohol and other sedatives that may cause drowsiness.
• May cause drowsiness or dizziness. Use caution when performing tasks requiring alertness, coordination, or physical dexterity.
• May cause dry mouth. Chew sugarless gum or suck sugarless hard candies if desired.
• Keep out of reach of children because accidental overdose may result in severe, even fatal, breathing problems.
• Notify your doctor if diarrhea persists or if fever, rapid heart rate, or stomach swelling occur.
• Store at room temperature (59^o to 86°F) in a child resistant container.
• Protect diphenoxylate from light.

How the Drug Works

Ovulation predictor kits test for the presence of luteinizing hormone (LH) in the urine. The pituitary gland increases LH production 12 to 16 days before menstruation begins. This “LH surge” causes an ovarian follicle to rupture and releases a mature egg in 1 to 1.5 days (24 to 40 hours). The onset of the LH surge (and therefore ovulation) can be estimated by using the ovulation predictor tests for several days. An egg survives for 12 to 24 hours after ovulation. If the egg and sperm are not united shortly after ovulation, conception will not occur.

It is possible the LH surge and ovulation will not occur during every menstrual cycle. Onset of menstrual bleeding does not always mean ovulation has occurred.

Uses

To aid in planning pregnancy; to determine fertile time of menstrual cycle.

Menopause: Women entering menopause may have high LH levels during their entire menstrual cycle.

Day for beginning testing is determined by the approximate length of the menstrual cycle, the first day being the onset of bleeding (even spotting), the last being the day before bleeding onset. Test kits vary regarding the date to begin testing. Follow manufacturers’ instructions carefully.

Specimen collection and handling: Collect urine in the urine cup from the kit or in a clean, dry container. If testing cannot be done in 3 to 4 hours after collecting the urine specimen, cover and refrigerate immediately. Let it return to room temperature before testing. Do not freeze specimen. For best results, do the test the same day as the urine was collected.

Time: Allow enough time to complete the test.

Drug Interactions

Tell your doctor or pharmacist if you are taking or if you are planning to take any over-the-counter or prescription medications or dietary supplements while testing for LH surge (ovulation). The following drugs and drug classes may interact with the test to cause questionable results:

1. Thyroid stimulating hormone (eg, Thyrogen)
2. HCG injection (eg, APL., Profasi HP)
3. Menopropins (eg, Pergonal)
4. Steroids (eg, prednisone)

Guidelines for Use of Ovulation Predictor Kits

• Do not use as a contraceptive aid. Results cannot guarantee that pregnancy will not occur.
• Follow the directions on the label exactly.
• Results may not be accurate during menopause, pregnancy, in the presence of ovarian cysts, or after an abortion.
• Not all women ovulate during every menstrual cycle.
• Drinking large quantities of water before the test may dilute the urine and interfere with the results.
• Have all the materials you need on hand before beginning the test: Test kit, timer (second hand and 30-minute timer), clean dry container, and pen or pencil for dating test. Be near a cold water faucet.
• Do test at the same time in the same room with the same lighting each day, if possible. It is best to test in the mid-morning (10 a.m.).
• Color vision is needed to properly read the test results. Have someone else confirm results if in doubt.
• Look for the FIRST noticeable change in color, not the darkest.