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# Dicyclomine hydrochloride
## Overview
Dicyclomine is an antispasmodic and anticholinergic agent. It acts by directly inhibiting the action of acetylcholine at postganglionic parasympathetic receptor sites on smooth muscle and secretory glands, as well as via a direct effect on smooth muscle.
## Primary Indications
Functional bowel/irritable bowel syndrome (IBS).
## Adult Dosing
* **Initial:** 20 mg orally 4 times daily.
* **Maintenance:** May increase to 40 mg 4 times daily after one week if tolerated.
* **Maximum:** 160 mg/day (40 mg q6h). Discontinue if efficacy is not achieved after 2 weeks.
## Pediatric Dosing
* **Safety/Efficacy:** Not established for use in pediatric patients. Use is generally discouraged due to the risk of serious anticholinergic side effects (e.g., respiratory distress, CNS excitation, seizures).
## Dose Adjustments
* **Renal Impairment:** No specific manufacturer guidelines, but use caution.
* **Hepatic Impairment:** No specific manufacturer guidelines; use caution due to potential increased systemic exposure.
* **Geriatric:** Avoid in patients ≥65 years (Beers Criteria) due to high risk of anticholinergic side effects (confusion, urinary retention, sedation). If necessary, start at the lowest effective dose.
## Contraindications
* Hypersensitivity to the drug.
* Infants <6 months of age.
* Unstable cardiovascular status in acute hemorrhage.
* Myasthenia gravis.
* Obstructive disease of the GI tract (e.g., pyloroduodenal stenosis).
* Paralytic ileus or intestinal atony.
* Severe ulcerative colitis or toxic megacolon.
* Glaucoma.
## Adverse Effects
* **Common:** Dry mouth, dizziness, blurred vision, nausea, somnolence, asthenia, and nervousness.
* **Serious:** Anticholinergic psychosis (confusion, hallucinations), tachycardia, urinary retention, and heat stroke (due to decreased sweating).
## Key Drug Interactions
* **Other Anticholinergics:** Additive toxicity (e.g., antihistamines, tricyclic antidepressants, antipsychotics).
* **Potassium Chloride:** Increased risk of GI mucosal lesions/ulceration with solid formulations.
* **CNS Depressants:** Enhanced sedation.
## Monitoring
* Monitor for signs of anticholinergic toxicity, particularly in the elderly.
* Assess for therapeutic efficacy; discontinue if symptoms do not improve after 2 weeks.
* Monitor bowel function for signs of ileus or constipation.
## Clinical Pearls
* Dicyclomine has minimal effect on gastric acid secretion and is not indicated for peptic ulcer disease.
* Advise patients to avoid alcohol and tasks requiring mental alertness (e.g., driving) until the effects of the medication are known.
* Patients should be cautioned to avoid high temperatures or exercise, as dicyclomine inhibits perspiration, increasing the risk of heat-related illness.
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*Disclaimer: This information is for educational purposes only. Clinical practice guidelines and dosing recommendations may vary by institution or clinical context. Always consult the official FDA-approved prescribing information and your institution's specific protocols before prescribing or administering medication.*
