Dicyclomine%252525252520hydrochloride

# Dicyclomine hydrochloride ## Overview Dicyclomine is an antispasmodic and anticholinergic agent that acts directly on smooth muscle to relieve spasms in the gastrointestinal (GI) tract. ## Primary Indications Treatment of functional bowel/irritable bowel syndrome (IBS). ## Adult Dosing * **Initial:** 20 mg PO four times daily. * **Maintenance:** May increase to 40 mg PO four times daily after one week if tolerated. * **Maximum:** 160 mg/day. ## Pediatric Dosing * **Safety and efficacy have not been established in infants or children.** * **WARNING:** Dicyclomine is contraindicated in infants <6 months of age due to reports of fatalities, respiratory distress, seizures, and syncope post-administration. ## Dose Adjustments * **Renal/Hepatic Impairment:** No specific dosing guidelines provided by the manufacturer; use with extreme caution as anticholinergic effects may be exacerbated. * **Geriatric:** Use the lowest effective dose; high risk of confusion, urinary retention, and constipation (Beers Criteria). ## Contraindications * Hypersensitivity to dicyclomine. * Infants (<6 months). * Unstable cardiovascular status in acute hemorrhage. * Myasthenia gravis. * Glaucoma (narrow-angle). * Obstructive GI disease (e.g., paralytic ileus, severe ulcerative colitis, megacolon). * Obstructive uropathy. ## Adverse Effects * **Common:** Dry mouth, dizziness, blurred vision, nausea, lightheadedness, drowsiness, nervousness, and asthenia. * **Serious:** Tachycardia, palpitations, urinary retention, psychotic symptoms (confusion, hallucinations), and heat prostration (due to decreased sweating). ## Key Drug Interactions * **Anticholinergics:** Additive side effects; avoid concomitant use with other antimuscarinics (e.g., oxybutynin, diphenhydramine). * **CNS Depressants:** Enhanced sedation. * **Digoxin:** Dicyclomine may increase digoxin serum concentrations by slowing GI motility. * **Potassium Chloride:** Increased risk of GI mucosal ulceration due to prolonged transit time. ## Monitoring * Monitor for signs of anticholinergic toxicity (e.g., urinary retention, severe constipation, altered mental status). * Assess efficacy in symptom relief; discontinue if no improvement after 2 weeks. ## Clinical Pearls * Dicyclomine is generally considered a second-line agent for IBS due to its side effect profile compared to safer alternatives that target specific gut receptors. * Advise patients to avoid operating heavy machinery until the effect of the drug on alertness is known. * Patients should be cautioned against physical exertion in hot environments, as dicyclomine inhibits perspiration and increases the risk of heatstroke. *** *Disclaimer: This information is for educational purposes only. Drug dosing, contraindications, and interaction profiles evolve. Always verify current prescribing information via official institutional protocols, the FDA label, or reliable clinical databases (e.g., Lexicomp/Micromedex) before prescribing or administering medication.*