Beuy Joob1, Viroj Wiwanitkit2. 1. Department of Sanitation 1 Medical Academic Center, Bangkok, Thailand. 2. Department of Sanitation, Hainan Medical University, China, University of Nis, Serbia, and Joseph Ayobabalola University, Nigeria.
Sir,The recent report on “Lomotil dependence.”[1] Mehra et al. concluded that “regulatory controls are needed to prevent escalation of use of this easily available prescription opioid.”[1] In fact, lomotil can be bought as a basic over the counter drug in many countries. Nevertheless, the concern of its dependence is not well recognized by the general practitioners.[23] Since this drug is widely sold and easily available in some settings, the patients usually have this drug as a simple drug for relieving of their diarrheal symptoms. The consideration is the frequent use of this drug can result in dependence and this will bring difficulty in management of the gastrointestinal disorder. In addition, the illegal use of this drug as narcotic and further preparation as other more potent narcotics might be expected.In Thailand, this drug is widely sold, but there has never been any report on the dependence. However, the intoxication of this drug due to excessive ingestion has been reported.[4] The common presentations of overdose intoxication include “central nervous system excitement, hypertension, fever, and flushed dry skin.”[5] As Mehra et al. noted, it should be the time to consider the restriction and control of lomotil usage.