Are One or Two Dangerous? Diphenoxylate-Atropine Exposure in Toddlers

Lomotil® (Pfizer Inc., New York, NY) (diphenoxylate-atropine) is said to be potentially toxic to toddlers with exposure to as little as one to two tablets. A review of the data on diphenoxylate-atropine poisonings from the American Association of Poison Control Centers annual reports, review articles, and case series disputes this view. Fatalities associated with diphenoxylate-atropine have been reported in toddlers after repetitive or incorrect dosages. Fortunately, trends in pediatric diphenoxylate-atropine ingestions are decreasing. We review the management, trends, and current concepts regarding pediatric diphenoxylate-atropine ingestions.