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Lomotil vs Viberzi
Introduction
For patients dealing with irritable bowel syndrome (IBS) or chronic diarrhea, certain medications can help in managing symptoms. Lomotil and Viberzi are two such drugs that are commonly prescribed for these conditions. Both of them work by affecting the activity within the gastrointestinal system to reduce bowel movements but do so differently. Lomotil, also known as diphenoxylate/atropine, slows down intestinal movement allowing for more fluid absorption from the intestines into the body which helps solidify stools. On the other hand, Viberzi or eluxadoline works by activating receptors in your gut to lessen contractions in the bowels thus reducing diarrhea episodes while decreasing abdominal pain as well. It's important to consult a healthcare provider when choosing between these two medications due to their varied side effects and potential interactions with other substances.
Lomotil vs Viberzi Side By Side
| Attribute | Lomotil | Viberzi |
|---|---|---|
| Brand Name | Lomotil | Viberzi |
| Contraindications | Should not be taken with alcohol, sedatives, tranquilizers, or other narcotic medication. Not to be used if there is a blockage in your digestive tract. | Should not be used in patients without a gallbladder or those with known biliary duct obstruction, pancreatitis, alcoholism, liver disease or severe constipation. |
| Cost | About $140 for 100 tablets of 2.5 mg | About $1,350 for 60 capsules of 100 mg |
| Generic Name | Diphenoxylate/atropine | Eluxadoline |
| Most Serious Side Effect | Severe constipation or stomach pain, neurological reactions such as confusion, hallucinations, unusual thoughts or behavior; extreme drowsiness. | Pancreatitis, severe abdominal discomfort extending to the back area with accompanying nausea and vomiting. |
| Severe Drug Interactions | Alcohol, sedatives, tranquilizers, other narcotic medications. | Not specified in the provided text, but caution is advised with substances that may exacerbate pancreatitis risk or interact with opioid receptors. |
| Typical Dose | 5-20 mg/day, with an initial dosage of 10 mg/day for most adults. | 75 mg twice daily, taken with food. Can be adjusted to 75 mg once daily or up to 100 mg twice daily under supervision. |
What is Lomotil?
Diphenoxylate-atropine (the generic name for Lomotil) was one of the first drugs of its kind used to treat diarrhea, creating a new chapter in our understanding and treatment of gastrointestinal disorders. It was first approved by the FDA in 1960. Lomotil works by slowing down gut movement, effectively reducing stool frequency. It is prescribed for acute or chronic diarrhea but must be used with caution due to its potential opioid-like effects at high doses.
Eluxadoline (the generic name for Viberzi), on the other hand, represents a more recent development in treating irritable bowel syndrome with diarrhea (IBS-D). Approved by the FDA in 2015, Viberzi not only eases bowel movements but also diminishes abdominal pain related to IBS-D via dual action - it activates receptors that slow down gut transit and inhibits receptors that speed up gut transit.
While both medications aim to control diarrhea symptoms, they have different mechanisms and side effect profiles. Lomotil primarily influences peristalsis while having minimal impact on pain perception; meanwhile, Viberzi has an additional analgesic effect but may cause severe constipation or pancreatitis.
What conditions is Lomotil approved to treat?
Lomotil is approved for the treatment of various conditions related to gastrointestinal issues:
- Acute diarrhea: Lomotil helps in reducing the frequency and severity of diarrhea episodes.
- Chronic diarrhea: It can be used as a long-term treatment to manage persistent symptoms.
On the other hand, Viberzi is exclusively indicated for use in adults suffering from irritable bowel syndrome with predominant diarrheal symptoms (IBS-D).
How does Lomotil help with these illnesses?
Lomotil operates to manage diarrhea by slowing the movement of the intestines. It achieves this efficacy by acting directly on the muscles in the gut, causing them to contract more slowly and less frequently. This action allows more time for water and electrolytes to be absorbed back into the body from the stool, thereby reducing diarrheal symptoms. On another hand, Viberzi works a bit differently; it is an opioid receptor agonist that acts primarily on mu-opioid receptors situated in your gastrointestinal tract. By binding to these receptors, Viberzi helps reduce bowel contractions which can lead to symptoms like abdominal pain and diarrhea experienced in conditions such as Irritable Bowel Syndrome with Diarrhea (IBS-D). Both medications are aimed at managing diarrheal conditions but operate via different mechanisms within our body's system.
What is Viberzi?
Viberzi, also known by its generic name eluxadoline, is a drug intended to treat certain types of irritable bowel syndrome (IBS), specifically IBS with diarrhea (IBS-D). Approved by the FDA in 2015, Viberzi functions as a mixed mu-opioid receptor agonist/delta-opioid receptor antagonist/kappa opioid receptor agonist. This means that it simultaneously stimulates and inhibits different classes of opioid receptors in the gastrointestinal system.
As Viberzi does not act like classic opioids such as loperamide found in Lomotil, it does not cause constipation or negatively affect gut transit time to the same degree. Its unique mechanism provides relief from abdominal pain and improves stool consistency without causing severe constipation — common side effects associated with traditional anti-diarrheal medications like Lomotil.
The benefits of Viberzi's actions on specific types of opioid receptors can be particularly beneficial for patients suffering from IBS-D who have not responded adequately to conventional treatments.
What conditions is Viberzi approved to treat?
Viberzi is approved for the treatment of certain gastrointestinal disorders such as:
- Irritable bowel syndrome with diarrhea (IBS-D)
- Chronic idiopathic constipation (CIC)
It has been specifically designed to help manage these conditions by reducing abdominal pain and improving stool consistency. It's important to note that Viberzi should not be used in patients without a gallbladder or those with known biliary duct obstruction, pancreatitis, alcoholism, liver disease or severe constipation.
How does Viberzi help with these illnesses?
Viberzi, similar to Lomotil, is frequently used in the management of irritable bowel syndrome with diarrhea (IBS-D). It functions by acting on specific receptors within the digestive tract known as mu-opioid receptors. These receptors play key roles in regulating digestion and stool consistency. When Viberzi targets these receptors, it reduces abdominal pain and slows intestinal transit time leading to less frequent stools which are more formed. This mechanism differs from Lomotil whose main component diphenoxylate acts primarily as a slow motility agent without directly addressing abdominal discomfort. Furthermore, Viberzi has fewer systemic side effects compared to Lomotil due to its local action inside the gut which makes it an attractive option for patients who do not respond well or have contraindications to other anti-diarrheal medications like Lomotil.
How effective are both Lomotil and Viberzi?
Both diphenoxylate-atropine (Lomotil) and eluxadoline (Viberzi) are medications used in the management of Irritable Bowel Syndrome with Diarrhea (IBS-D). They were approved by the FDA several decades apart, with Lomotil being available since 1960 and Viberzi only introduced in 2015. Although both drugs aim to reduce bowel movements, they operate on different mechanisms.
The efficacy of Lomotil and Viberzi was studied separately rather than directly against each other. However, both have shown success in managing symptoms associated with IBS-D. A clinical trial conducted in 1976 showed that patients treated with Lomotil experienced a significant reduction in stool frequency compared to placebo. Similarly, two phase III trials conducted between 2012-2013 demonstrated that more subjects receiving Viberzi achieved adequate relief from IBS-D symptoms over a greater proportion of weeks compared to those on placebo.
In terms of safety profiles, while both drugs carry risks for potential side effects such as dizziness or constipation; Viberzi has been linked to increased risk for pancreatitis which may be severe enough to require hospitalization or can lead to death especially among patients without a gallbladder.
A review article published in Clinical Drug Investigation notes that although there is limited data comparing these two agents head-on, individual studies suggest comparable efficacy rates at reducing bowel movement frequency. However, differences arise when considering tolerability - where adverse events like nausea and abdominal discomfort appear less frequently under treatment by loperamide - hence it's often recommended as first-line therapy for acute diarrhea episodes due its good gut selectivity profile.
Despite this, emerging evidence suggests possible benefits of eluxadoline particularly among individuals experiencing postprandial urgency or fecal soiling indicating an unmet need within this patient population where symptomatic control matters most beyond mere reduction in bowel movement frequency.
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At what dose is Lomotil typically prescribed?
Oral dosages of Lomotil typically range from 5-20 mg/day, but studies have indicated that for most adults, an initial dosage of 10 mg/day is appropriate for managing diarrhea. For children aged 13 and older, they may be started on a lower dose of around 2.5 mg per day. In either population, the dosage can be increased after a few days if there is no response or improvement in symptoms. However, daily doses should not exceed 20 mg to avoid potential side effects and toxicity.
At what dose is Viberzi typically prescribed?
Viberzi treatment is typically initiated at a dosage of 75 mg twice daily, taken with food. For patients without a gallbladder or those who cannot tolerate the standard dose, it can be reduced to 75 mg once daily. In the event that symptoms persist after adequate trial, Viberzi's dosage may be adjusted up to its maximum of 100 mg twice daily. This should only be done under close supervision by your healthcare provider and if there are no significant adverse effects from the medication. The regular evaluation of response and tolerance is crucial for achieving optimal benefits from Viberzi therapy while minimizing potential risks.
What are the most common side effects for Lomotil?
Common side effects of Lomotil may include:
- Drowsiness, dizziness or feeling lightheaded
- Nausea or vomiting
- Loss of appetite
- Feeling bloated or full
- Dry mouth or blurred vision
- Skin rash
In contrast, Viberzi has been reported to cause:
- Abdominal pain and cramps
- Constipation (sometimes severe)
- Nausea and occasional vomiting
- Flatulence
Are there any potential serious side effects for Lomotil?
While Lomotil and Viberzi are both effective in managing Irritable Bowel Syndrome-Diarrhea (IBS-D), there can be significant side effects that you should note:
- Signs of severe allergic reaction: hives, difficulty breathing, swelling on your face or throat
- Severe constipation or stomach pain, sometimes accompanied by nausea
- Unusual excitement or restlessness
- Fast heart rate or irregular heartbeat
- Fluctuations in body temperature - from fever to chills
- Neurological reactions such as confusion, hallucinations, unusual thoughts or behavior; extreme drowsiness
In rare instances with Viberzi:
- Pancreatitis leading to severe abdominal discomfort extending to the back area with accompanying nausea and vomiting. This could lead to hospitalization.
If you encounter any of these symptoms while taking either drug, it is crucial that you seek immediate medical attention. Always discuss potential side effects with your healthcare provider before starting new medication.
What are the most common side effects for Viberzi?
If you're considering Viberzi as a treatment option, it's important to be aware of the potential side effects. These may include:
- Dry mouth or throat
- Stomach pain or discomfort
- Nausea and constipation
- Drowsiness and fatigue
- Anxiety or nervousness
- Increased heart rate
- Muscle spasms and joint pain Additionally, some individuals have reported experiencing blurred vision, rashes, headaches, loss of appetite, weight changes - typically loss rather than gain - confusion or agitation while on Viberzi. If you notice any unusual symptoms while taking this medication, it is recommended that you consult your healthcare provider promptly.
Are there any potential serious side effects for Viberzi?
While Viberzi is generally considered safe, it can cause serious side effects in some cases. These may include:
- Signs of an allergic reaction such as hives; difficulty breathing; swelling of your face, lips, tongue or throat.
- Severe stomach pain that may move to your back, with or without nausea and vomiting which could be a sign of inflammation in the pancreas (pancreatitis)
- Constipation that lasts for more than 3 days
- Upper right-side abdominal discomfort
- Yellowing eyes/skin indicative of liver problems
- Dark urine
- Unusual tiredness
If you experience any of these symptoms while taking Viberzi, stop the medication immediately and seek urgent medical attention.
Contraindications for Lomotil and Viberzi?
Both Lomotil and Viberzi, like most medications for irritable bowel syndrome with diarrhea (IBS-D), may exacerbate symptoms in some individuals. If you find your IBS-D symptoms worsening or if you experience severe abdominal pain or unusual bloating, please seek immediate medical attention.
Neither Lomotil nor Viberzi should be taken if you are consuming, or have recently consumed alcohol, sedatives, tranquilizers or other narcotic medication. Always disclose to your healthcare provider any medications that you are taking; these substances require a clearance period to prevent dangerous interactions with both Lomotil and Viberzi.
These drugs can also cause serious side effects including pancreatitis and spastic paralysis of the intestine which could lead to a complete blockage of the bowel. It is important not to use them if there is already a blockage in your digestive tract.
How much do Lomotil and Viberzi cost?
For the brand name versions of these drugs:
- The price of 100 tablets of Lomotil (2.5 mg) averages around $140, which works out to about $1.40/day if you're taking the maximum recommended dose.
- The price for 60 capsules of Viberzi (100 mg) is approximately $1,350. At a typical dosage, this amounts to roughly $45/day.
Thus, if your prescribed dosage aligns with these estimates, then brand-name Lomotil is less expensive on a per-day treatment basis than Viberzi. However, cost should not be a primary consideration in determining which drug is right for you; efficacy and side effects are also highly important considerations.
For the generic versions of these drugs—diphenoxylate/atropine (Lomotil) and eluxadoline (Viberzi)—costs are significantly lower:
- Diphenoxylate/atropine can be purchased in packs starting from 30 tablets upward with costs ranging from about $0.50-$3 per day depending on your specific dosage.
- Eluxadoline isn't currently available as a generic medication so there's no cheaper alternative at present under that category.
Remember to always consult with your healthcare provider when choosing between medications, as they will consider both medical factors like effectiveness and side effects along with practical ones like cost.
Popularity of Lomotil and Viberzi
Diphenoxylate-atropine, sold under the brand name Lomotil among others, is a medication used to treat diarrhea. It was estimated to have been prescribed to about 2 million people in the US in 2020. Diphenoxylate-atropine accounted for just over 10% of anti-diarrheal prescriptions in the US. However, it appears to be one of the most commonly prescribed medications for controlling diarrhea that is not caused by an infection or bacteria. The prevalence of diphenoxylate-atropine has remained steady since 2013.
Eluxadoline, also known as Viberzi, is another drug used for managing symptoms of irritable bowel syndrome with diarrhea (IBS-D). This drug was prescribed to nearly half a million people in the USA during 2020. In terms of IBS-D specific medications, Eluxadoline accounts for around 25% of total prescriptions and its popularity is on rise due to its dual mechanism action which helps reduce abdominal pain and improve stool consistency.
Conclusion
Both Lomotil (diphenoxylate/atropine) and Viberzi (eluxadoline) are medications used for the management of symptoms in patients with irritable bowel syndrome predominantly characterized by diarrhea. They have different mechanisms of action: Lomotil works by slowing gut movement, while Viberzi activates receptors in the nervous system that decrease bowel contractions.
Lomotil is traditionally seen as a first-line treatment option due to its long-standing record of usage and lower cost. Viberzi, on the other hand, may be considered when patients do not respond well to initial treatments or need more targeted therapy.
Both drugs are available with a prescription; however, generic versions are currently only available for Lomotil which can represent significant cost savings especially for those paying out-of-pocket.
The side effect profile between these two medications is similar—common side effects include stomach pain, constipation, and nausea—but it's important to note that Viberzi should not be used in people without a gallbladder because it can cause serious liver problems. For both drugs, patients must monitor their symptoms closely when starting treatment and seek medical help immediately if they notice worsening abdominal pain or changes in stool coloration.
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Refrences
- Dove, L. S., Lembo, A., Randall, C. W., Fogel, R., Andrae, D., Davenport, J. M., … Covington, P. S. (2013, August). Eluxadoline Benefits Patients With Irritable Bowel Syndrome With Diarrhea in a Phase 2 Study. Gastroenterology. Elsevier BV.http://doi.org/10.1053/j.gastro.2013.04.006
- Garnock-Jones, K. P. (2015, July). Eluxadoline: First Global Approval. Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40265-015-0436-4
- Barshop, K., & Staller, K. (2017, June 21). Eluxadoline in irritable bowel syndrome with diarrhea: rationale, evidence and place in therapy. Therapeutic Advances in Chronic Disease. SAGE Publications.http://doi.org/10.1177/2040622317714389
- Brenner, D. M., Sayuk, G. S., Gutman, C. R., Jo, E., Elmes, S. J. R., Liu, L. W. C., & Cash, B. D. (2019, July 26). Efficacy and Safety of Eluxadoline in Patients With Irritable Bowel Syndrome With Diarrhea Who Report Inadequate Symptom Control With Loperamide: RELIEF Phase 4 Study. American Journal of Gastroenterology. Ovid Technologies (Wolters Kluwer Health).http://doi.org/10.14309/ajg.0000000000000327