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# Dicyclomine Hydrochloride
## Overview
Dicyclomine is an anticholinergic/antispasmodic agent that acts directly on smooth muscle to relieve spasms by antagonizing acetylcholine at muscarinic receptors. Its efficacy in treating functional bowel/irritable bowel syndrome (IBS) is supported, though it does not affect digestive secretions.
## Primary Indications
* Irritable Bowel Syndrome (IBS).
## Adult Dosing
* **Oral:** Initial dose is 20 mg four times daily.
* **Maintenance:** May be increased to 40 mg four times daily after one week if tolerated.
* **Intramuscular (IM):** 20 mg every 4 to 6 hours. (Not for IV use).
* **Maximum:** 160 mg per day.
## Pediatric Dosing
* **Safety and efficacy are not established.** Use is generally discouraged in pediatric patients due to reported serious adverse events, including respiratory distress, seizures, and syncope.
## Dose Adjustments
* **Renal/Hepatic Impairment:** No formal dosage adjustments provided; use with caution.
* **Geriatrics:** Dose lower; increased sensitivity to anticholinergic side effects (e.g., delirium, urinary retention, sedation).
## Contraindications
* Infants < 6 months of age.
* Unstable cardiovascular status in acute hemorrhage.
* Myasthenia gravis.
* Obstructive uropathy or gastrointestinal disease (e.g., paralytic ileus, severe ulcerative colitis, GI obstruction).
* Glaucoma (narrow-angle).
* Reflux esophagitis.
## Adverse Effects
* **Common:** Dry mouth, dizziness, blurred vision, nausea, drowsiness, nervousness, asthenia.
* **Serious:** Anticholinergic toxicity (tachycardia, confusion, hallucinations), urinary retention, paralytic ileus, heatstroke (due to decreased sweating).
## Key Drug Interactions
* **Other Anticholinergics:** (e.g., diphenhydramine, TCAs) May significantly increase the risk of adverse effects.
* **Potassium Supplements:** May increase the risk of GI mucosal lesions (dicyclomine slows GI motility).
* **Digoxin:** Anticholinergics may increase digoxin levels by slowing GI motility, leading to increased absorption.
## Monitoring
* Monitor for signs of anticholinergic toxicity, particularly in elderly patients.
* Monitor bowel function and urinary output.
* Assess for CNS effects (confusion, delirium).
## Clinical Pearls
* **Not for IV use:** Never administer dicyclomine intravenously; severe reactions may occur.
* **Cognitive Burden:** Use with extreme skepticism in patients over 65 (Beer's Criteria).
* **Heat Sensitivity:** Advise patients to avoid high environmental temperatures, as the medication inhibits sweating, increasing the risk of pyrexia and heatstroke.
* **Driving:** Warn patients regarding potential blurred vision and drowsiness.
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*Disclaimer: This information is for educational purposes only. Always verify dosing, contraindications, and drug interactions against institutional protocols and the manufacturer's official prescribing information (package insert) before prescribing or administering medication.*
