Accidental and therapeutic intoxication from ingestion of Lomotil, a combination preparation intended for treatment of diarrhea, continues to occur. FDA package insert guidelines for Lomotil prohibit the use of the drug under the age of 2, but physicians continue to prescribe within this age group. Sixteen pediatric patients and nine adults are reported representing one year's experience from two poison centers. Prolonged gastric emptying with recovery of tablets 27 hours after ingestion is reported. Five patients, who were vomited shortly after exposure, demonstrated delayed onset of coma and respiratory depression. Time until onset of symptoms was greater than four hours in nine of 16 pediatric patients. One death occurred and no residual defects were noted in the survivors. A rational therapeutic outline is presented.