Bitter Pills:Medicines & The Third World Poor | Page 106

LOMOTIL
But poor people are even less likely to be told that, apart from not being particularly
helpful to their children, these comforting products also have hidden dangers.
In the case of Lomotil (which contains diphenoxylate hydrochloride and atropine
sulphate) the manufacturers warn British doctors that "Lomotil should be used
with caution in young children", because "accidental overdosage may produce
unconsciousness with respiratory depression, particularly in children, or atropine
poisoning, or both". (30) These toxic reactions can be fatal. (3I)
One doctor explains that the indiscriminate use of antidiarrhoeals in prolonged
attacks of diarrhoea can run the risk of their acting as a "blindly harmful
stopcock". |32) Lomotil stops diarrhoea from coming out, but to do that it also
prevents the body from getting rid of the organism causing the infection. So
Lomotil can make the infection last longer. (33) Although the child's body stops
expelling fluid and vital electrolytes, these are not necessarily absorbed and may just
be accumulating in the paralysed gut. This means that Lomotil can hide the seriousness
of a child's condition, because it "can mask the signs of dehydration".(34> The dangers
are potentially so great that experts urge doctors treating children to "avoid the
potentially dangerous use of Lomotil for the treatment of diarrhoea". (35)
In recent years Third World prescribers have not been given the same warnings
as British and American doctors. Since 1973 the US regulatory agency has stopped
its use in children under two. (36) In Britain Lomotil is sold only on prescription,
and Searle advises doctors that it' 'should not be given to children under one year
old". (37) But in Third World countries, where there are no effective prescription
controls, the manufacturers have recommended dosages for babies under a year
old. The London-based action research unit, Social Audit, carried out an in-depth
case-study and found that Lomotil has been recommended in India for babies
"aged up to 3 months", and for Brazilian babies weighing "only 3kg (or some
6'/2 lbs) - a low-to-average birth weight". (38)
Lomotil has also been sold in poor countries without any warnings that it can
be harmful to children. For example, in 1980 in North Yemen we bought packs
of Lomotil with neomycin freely over the counter. Those packs, manufactured
in High Wycombe, England, in May 1979, gave no precautions for use in children.
This combination product with neomycin is even more expensive than Lomotil
alone. Moreover, both WHO and the British National Formulary (1981) advise
against the use of neomycin in treating diarrhoea. (39) Lomotil is also widely sold
in Central America. The label of a small bottle purchased by OXFAM staff in
the Dominican Republic in 1980 does give a warning in Spanish that the drug should
be used "delicately". It also advises that in the event of an overdose the patient
should be admitted to hospital. But there are no recommended maximum doses
on the label.
In September 1981 Searle made the encouraging announcement that "in response
to concerns expressed by Social Audit, Searle has decided to revise its product
labelling to indicate clearly that Lomotil should be used for the adjunctive treatment
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