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# Dicyclomine Hydrochloride
## Overview
Dicyclomine is an antispasmodic and anticholinergic agent that acts as a competitive antagonist at muscarinic acetylcholine receptors. It exerts a direct relaxant effect on smooth muscle of the gastrointestinal tract.
## Primary Indications
* Management of functional bowel or irritable bowel syndrome (IBS).
## Adult Dosing
* **Initial:** 20 mg orally 4 times daily.
* **Maintenance:** May increase to 40 mg 4 times daily after 1 week if tolerated. If no clinical improvement is observed after 2 weeks, discontinue therapy.
* **Maximum:** 160 mg/day (40 mg 4 times daily).
## Pediatric Dosing
* **Under 6 months:** Contraindicated.
* **6 months and older:** Safety and efficacy are not established. Dicyclomine is generally considered inappropriate for use in pediatric patients due to reports of serious respiratory and neurologic adverse events (e.g., respiratory failure, seizures, tachycardia) in infants.
## Dose Adjustments
* **Renal Impairment:** No specific guidelines exist; use with caution.
* **Hepatic Impairment:** No specific guidelines exist; use with caution.
* **Geriatric:** Not recommended for use in patients ≥65 years (Beers Criteria) due to high risk of anticholinergic side effects, including confusion, urinary retention, and constipation.
## Contraindications
* Infants <6 months of age.
* Unstable cardiovascular status in acute hemorrhage.
* Myasthenia gravis.
* Obstructive disease of the GI tract (e.g., pyloroduodenal stenosis, achalasia, paralytic ileus).
* Severe ulcerative colitis or toxic megacolon.
* Glaucoma.
* Obstructive uropathy.
## Adverse Effects
* **Common:** Dry mouth, dizziness, blurred vision, nausea, nervousness, somnolence, and constipation.
* **Serious:** Tachycardia, urinary retention, confusion/hallucinations (particularly in the elderly), and anaphylaxis.
## Key Drug Interactions
* **Anticholinergics:** Concurrent use with other antimuscarinics (e.g., atropine, TCAs) increases the risk of additive anticholinergic toxicity.
* **Potassium Chloride:** Increased risk of GI mucosal ulceration when using solid dosage forms of potassium with anticholinergics.
* **Digoxin:** Anticholinergics may decrease gastric motility and increase the absorption and serum concentrations of digoxin.
## Monitoring
* Monitor for signs of anticholinergic toxicity (e.g., hyperthermia, confusion, tachycardia, urinary retention).
* Assess for therapeutic efficacy at 2 weeks.
## Clinical Pearls
* **Cognitive Burden:** Use with extreme caution in the elderly due to significant cognitive impairment potential.
* **Heat Sensitivity:** Because dicyclomine inhibits sweating, patients should avoid vigorous physical activity or excessive heat exposure to prevent heatstroke.
* **Sedation:** Warn patients about potential drowsiness; caution against operating machinery or driving until effects are known.
* **Administration:** May be taken with or without food.
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**Disclaimer:** This information is for educational purposes only. Always verify current prescribing information, contraindications, and dosing guidelines via institutional protocols or official drug monographs (e.g., Lexicomp, FDA-approved labeling) before clinical use.
