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# Dicyclomine hydrochloride
## Overview
Dicyclomine is an antispasmodic and anticholinergic agent. It acts via direct effect on smooth muscle and competitive antagonism of acetylcholine at muscarinic receptor sites.
## Primary Indications
Functional bowel/irritable bowel syndrome (IBS).
## Adult Dosing
* **Initial:** 20 mg PO qid.
* **Maintenance:** May increase to 40 mg PO qid after one week if tolerated.
* **Maximum:** 160 mg/day (40 mg qid). Discontinue if efficacy is not achieved after 2 weeks.
## Pediatric Dosing
* **Safety/Efficacy:** Not established in pediatric patients. Use is generally discouraged due to the risk of serious anticholinergic side effects (e.g., seizures, respiratory depression, coma).
## Dose Adjustments
* **Renal/Hepatic Impairment:** No specific manufacturer guidelines. Use with caution; monitor closely for CNS toxicity due to potential accumulation.
* **Geriatric:** Increased susceptibility to anticholinergic side effects (Beers Criteria). Use lowest effective dose or avoid.
## Contraindications
* Hypersensitivity to dicyclomine.
* Obstructive diseases of the GI tract (e.g., paralytic ileus, pyloroduodenal stenosis).
* Severe ulcerative colitis or toxic megacolon.
* Unstable cardiovascular status in acute hemorrhage.
* Myasthenia gravis.
* Glaucoma.
* Obstructive uropathy (e.g., prostatic hypertrophy).
* Infants < 6 months old (risk of respiratory distress/seizures).
## Adverse Effects
* **Common:** Dry mouth, dizziness, blurred vision, nausea, somnolence, asthenia.
* **Serious:** Psychosis-like symptoms (confusion, hallucinations, agitation), heat prostration (decreased sweating), tachycardia, urinary retention, narrow-angle glaucoma precipitation.
## Key Drug Interactions
* **Other Anticholinergics:** Additive effects (e.g., TCAs, antihistamines, antipsychotics).
* **Potassium Chloride:** Increased risk of GI mucosal lesions (oral solid dosage forms).
* **Digoxin:** Increased digoxin serum concentrations due to decreased GI motility.
## Monitoring
* Monitor for signs of anticholinergic toxicity (CNS effects, tachycardia).
* Monitor bowel habits and abdominal symptoms.
* Assess effectiveness after 2 weeks; discontinue if ineffective.
## Clinical Pearls
* Dicyclomine is frequently overprescribed; reassess the necessity of continuing therapy regularly.
* Warn patients regarding "anticholinergic toxidrome" symptoms (dry as a bone, red as a beet, mad as a hatter, blind as a bat, hot as a hare).
* Advise patients that the medication may cause drowsiness; avoid driving or operating machinery until the effects are known.
* In hot environments, note that the drug can impair sweat production, potentially leading to heat prostration.
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*Disclaimer: This information is for educational purposes. Verify all clinical decisions, dosages, and contraindications with current prescribing information, institutional protocols, and official drug compendia (e.g., Lexicomp, Micromedex) before prescribing or administering medication.*
