Diphenoxylate Hydrochloride

An opioid, synthetic derivative of pethidine with little or no analgesic effect. It acts by decreasing intestinal motility and with it the frequency and fluidity of bowel movements.
Used orally every 6 hours for the symptomatic treatment of acute diarrhea.

Since the last update we did not found published data on its excretion in breastmilk.

Although the manufacturer warns that its active metabolite could be excreted in breastmilk (Pfizer 2017), several expert authors believe that excretion in breastmilk is minimal (Hale 2017 p289, Chen 2010).

In order to prevent its abuse it is often associated with atropine, which could affect breastfed children (Gattuso 1994). However, the American Academy of Pediatrics classifies atropine as compatible with breastfeeding (AAP 2001).

Its indiscriminate use in gastroenteritis is not justifiable. Most gastroenteritis does not require medication: good hydration and maintaining a normal diet is sufficient.

Until there is more published data on this drug in relation to breastfeeding, safer known alternatives may be preferable, especially during the neonatal period and in case of prematurity.

Alternatives

• Oral rehydration salt formulations (Very Low Risk)
• Loperamide Hydrochloride (Very Low Risk)
• Pectin (Very Low Risk)