A fixed-dose combination tablet used for the symptomatic treatment of acute and chronic diarrhea, particularly of infectious origin. Diphenoxylate is an opioid receptor agonist that reduces intestinal motility and secretion. Atropine is added in sub-therapeutic doses to discourage abuse and overdose. Furazolidone is a nitrofuran antibacterial and antiprotozoal agent effective against common enteric pathogens like E. coli, Salmonella, Shigella, and Giardia lamblia.
Adult: Initially: 2 tablets four times daily. Maintenance: Based on response, usually 2 tablets twice or thrice daily. Maximum: 8 tablets in 24 hours. Should not exceed 2 days without medical supervision if symptoms persist.
Note: Oral administration. Can be taken with or without food. Swallow whole with water. Continue treatment for 24-48 hours after diarrhea stops. Do not crush or chew. MUST BE ACCOMPANIED BY ADEQUATE FLUID AND ELECTROLYTE REPLACEMENT (ORS).
Diphenoxylate acts on opioid receptors (primarily μ-receptors) in the myenteric plexus of the gut wall, inhibiting acetylcholine release. This reduces peristalsis, increases segmentation, and enhances fluid absorption. Atropine, an antimuscarinic agent, adds a mild inhibitory effect on intestinal secretions and motility at this dose, but its primary role is to induce unpleasant anticholinergic effects (dry mouth, blurred vision) if the tablets are taken in excess, thus deterring abuse. Furazolidone is a prodrug activated by bacterial nitroreductases, generating reactive intermediates that damage bacterial DNA and inhibit vital enzymes (e.g., monoamine oxidase). It is bactericidal against many gram-negative and some gram-positive organisms and also has antiprotozoal activity against Giardia.
Pregnancy: Category C (US FDA). Safety not established. Diphenoxylate may cause fetal harm. Use only if potential benefit justifies potential risk to the fetus, especially in first trimester. Furazolidone should be avoided near term.
Driving: May impair mental and/or physical abilities required for driving or operating machinery. Drowsiness and dizziness are common. Advise patients not to drive until effect is known.
| Monoamine Oxidase Inhibitors (MAOIs) - Phenelzine, Tranylcypromine | Risk of severe hypertensive crisis, hyperpyrexia, seizures. Contraindicated. | Contraindicated |
| Alcohol | Disulfiram-like reaction (flushing, palpitations, nausea) due to furazolidone. Enhanced CNS depression with diphenoxylate. | Major |
| Other CNS Depressants (Benzodiazepines, Barbiturates, Opioids, Sedating Antihistamines) | Additive CNS depression, sedation, respiratory depression. | Major |
| Anticholinergic Drugs (Tricyclic Antidepressants, Antipsychotics, Antiparkinsonian drugs) | Additive anticholinergic side effects (dry mouth, urinary retention, constipation, blurred vision). | Moderate |
| Sympathomimetics (Pseudoephedrine, Amphetamines) | Exaggerated pressor response due to furazolidone's MAOI activity. | Major |
| Tyramine-rich foods (Aged cheese, fermented products, cured meats) | Risk of hypertensive crisis due to furazolidone's MAOI activity. | Major |
Same composition (Atropine (0.025mg) + Diphenoxylate (2.5mg) + Furazolidone (50mg)), different brands: