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# Dicyclomine Hydrochloride
## Overview
Dicyclomine is an antispasmodic and anticholinergic agent. It acts by direct relaxation of smooth muscle in the gastrointestinal tract and by inhibiting the muscarinic actions of acetylcholine.
## 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.
* **Maximum:** 160 mg per day.
* *Note:* If therapeutic efficacy is not achieved within two weeks or side effects are significant, discontinue use.
## Pediatric Dosing
* **Safety/Efficacy:** Not recommended for use in pediatric patients due to the risk of serious adverse reactions (e.g., respiratory distress, seizures, syncope).
* **Infants:** The FDA recommends avoiding use in infants under 6 months due to reports of fatal respiratory distress associated with dicyclomine use.
## Dose Adjustments
* **Renal/Hepatic Impairment:** No specific manufacturer guidelines exist. Use with caution; monitor for increased anticholinergic toxicity as clearance may be reduced.
* **Geriatric:** Avoid in patients ≥65 years (Beers Criteria) due to high risk of anticholinergic side effects (confusion, urinary retention, dizziness, falls).
## Contraindications
* Hypersensitivity to dicyclomine.
* Infants <6 months.
* Unstable cardiovascular status in acute hemorrhage.
* Myasthenia gravis.
* Obstructive uropathy (e.g., prostatic hypertrophy).
* Obstructive disease of the GI tract (e.g., achalasia, paralytic ileus).
* Severe ulcerative colitis or toxic megacolon.
* Glaucoma.
## Adverse Effects
* **Common:** Dry mouth, dizziness, blurred vision, nausea, nervousness, somnolence, and asthenia.
* **Serious:** Anticholinergic psychosis, tachycardia, confusion, urinary retention, seizure, and anaphylaxis.
## Key Drug Interactions
* **Other Anticholinergics:** Additive effects (e.g., antihistamines, tricyclic antidepressants, antipsychotics).
* **Potassium Chloride:** Increased risk of GI mucosal lesions (dicyclomine slows GI motility).
* **Digoxin:** Dicyclomine may increase serum digoxin concentrations by slowing GI motility, leading to increased absorption.
## Monitoring
* Monitor for signs of anticholinergic toxicity (tachycardia, confusion, urinary retention).
* Assess therapeutic response (improvement in IBS symptoms) within two weeks to determine if continued therapy is warranted.
## Clinical Pearls
* Dicyclomine causes significant cognitive impairment in elderly patients; it is generally considered inappropriate for this population.
* Advise patients to avoid alcoholic beverages and to exercise caution when driving or operating machinery, as the drug may cause drowsiness or blurred vision.
* Use with extreme caution in hot weather or during exercise; dicyclomine can suppress sweating (anhidrosis), increasing the risk of heatstroke.
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**Educational Disclaimer:** This information is for educational purposes and does not constitute medical advice. Always verify current prescribing information, contraindications, and dosing protocols through official sources or your institution's clinical pharmacy department before prescribing or administering medication.
