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# Dicyclomine hydrochloride
## Overview
Dicyclomine is an antispasmodic and anticholinergic agent. It acts by directly relaxing smooth muscle through a combination of anticholinergic effects and a direct effect on smooth muscle receptors.
## Primary Indications
Functional bowel/irritable bowel syndrome (IBS).
## Adult Dosing
* **Initial:** 20 mg orally four times daily.
* **Maintenance:** May increase to 40 mg four times daily after one week if tolerated.
* **Max Dosage:** 160 mg per day.
* *Note: If efficacy is not achieved within 2 weeks, discontinue use.*
## Pediatric Dosing
Dicyclomine is generally **not recommended** for infants under 6 months due to reported cases of serious respiratory and CNS side effects (seizures, syncope, tachycardia).
* **Children 6 months to 2 years:** 5–10 mg orally 3–4 times daily, 15 minutes before feedings.
*(Dosing may vary by local institutional protocol; consult current pediatric references like the Harriet Lane Handbook.)*
## Dose Adjustments
* **Renal/Hepatic Impairment:** No specific manufacturer guidelines, but exercise extreme caution due to potential drug accumulation and anticholinergic toxicity. Use the lowest effective dose.
* **Geriatric Patients:** Use with caution (Beers Criteria). Higher risk for cognitive impairment, confusion, urinary retention, and falls.
## Contraindications
* Infants < 6 months old.
* Unstable cardiovascular status in acute hemorrhage.
* Myasthenia gravis.
* Obstructive disease of the GI tract (e.g., paralytic ileus, pyloric stenosis).
* Severe ulcerative colitis or toxic megacolon.
* Glaucoma (narrow-angle).
* Urinary tract obstruction (e.g., prostatic hypertrophy).
## Adverse Effects
* **Common:** Dizziness, somnolence, dry mouth, blurred vision, nausea, nervousness, asthenia.
* **Serious:** Tachycardia, palpitations, urinary retention, confusion/hallucinations (often in elderly), heat prostration (due to decreased sweating).
## Key Drug Interactions
* **Anticholinergics:** Additive toxicity (e.g., antihistamines, tricyclic antidepressants, antipsychotics).
* **Digoxin:** Increased serum concentrations due to decreased GI motility.
* **Potassium Chloride:** Increased risk of GI mucosal lesions (delayed transit time).
## Monitoring
* Monitor for anticholinergic side effects, particularly mental status changes and urinary retention.
* Monitor heart rate if tachycardia is a concern.
* Evaluate patient response/IBS symptoms; discontinue if no improvement after 2 weeks.
## Clinical Pearls
* **Heat Stroke:** Advise patients to avoid extreme heat or vigorous exercise, as dicyclomine inhibits sweating.
* **Driving:** Warn patients regarding potential drowsiness or blurred vision affecting the ability to operate machinery.
* **Formulations:** Available as capsules, tablets, and oral syrup.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical practice varies; always verify current prescribing information in a trusted clinical resource (e.g., Lexicomp, UpToDate) and adhere to institutional protocols prior to prescribing or administering medication.
