Dicyclomine%252525252525252525252520hydrochloride

# Dicyclomine hydrochloride ## Overview Dicyclomine is an antispasmodic and anticholinergic agent used to treat functional bowel/irritable bowel syndrome (IBS). It exerts a dual effect: a direct musculotropic action on smooth muscle and an inhibitory effect at parasympathetic receptor sites. ## Primary Indications * Irritable bowel syndrome (IBS). ## Adult Dosing * **Initial:** 20 mg orally four times daily. * **Maintenance:** May be increased to 40 mg four times daily after one week if tolerated. * **Maximum:** 160 mg per day. * *Note:* If efficacy is not achieved within two weeks, discontinue the medication. ## Pediatric Dosing * **Safety/Efficacy:** Not established for use in children. Use is generally discouraged due to the risk of serious anticholinergic side effects (e.g., respiratory distress, seizures, syncope). ## Dose Adjustments * **Renal/Hepatic Impairment:** No specific manufacturer guidelines provided. Use with extreme caution. * **Elderly:** Use lowest effective dose. Increased sensitivity to anticholinergic effects (e.g., confusion, urinary retention) makes this drug generally inappropriate for geriatric patients per Beers Criteria. ## Contraindications * Hypersensitivity to dicyclomine. * Infants (<6 months). * Unstable cardiovascular status in acute hemorrhage. * Myasthenia gravis. * Severe ulcerative colitis or toxic megacolon. * Obstructive diseases of the GI tract. * Glaucoma (narrow-angle). * Obstructive uropathy (e.g., prostatic hypertrophy). * Reflux esophagitis. ## Adverse Effects * **Common:** Dry mouth, dizziness, blurred vision, nausea, nervousness, drowsiness. * **Serious:** Tachycardia, urinary retention, confusion, hallucinations (especially in elderly), heat prostration (decreased sweating), psychotic symptoms. ## Key Drug Interactions * **Anticholinergics:** Additive effects (e.g., antihistamines, tricyclic antidepressants, antipsychotics). * **Digoxin:** Increased serum concentration due to decreased GI motility. * **Potassium Chloride:** Risk of GI mucosal ulceration due to prolonged transit time. ## Monitoring * Monitor for signs of anticholinergic toxicity (confusion, constipation, urinary retention). * Monitor pulse (tachycardia). * Assess for therapeutic response; discontinue if symptoms do not improve within two weeks. ## Clinical Pearls * **Avoid in Elderly:** The Beers Criteria lists dicyclomine as a drug to avoid in older adults due to potent anticholinergic effects. * **Heat Sensitivity:** Advise patients to avoid extreme heat or vigorous physical exertion, as the drug's inhibition of sweating can lead to heatstroke. * **Drowsiness/Vision:** Advise patients to exercise caution when driving or operating heavy machinery until the drug's effect is known. * **Administration:** Take before meals if possible to manage postprandial spasms, though administration timing may vary based on patient tolerance of side effects (e.g., taking at bedtime). *** **Educational Disclaimer:** This information is for educational purposes only. Clinical practice and regional protocols vary. Always verify current prescribing information, contraindications, and drug-drug interactions via institutional resources (e.g., Lexicomp, Micromedex) or the official FDA-approved package insert before prescribing or administering medication.