Dicyclomine%25252525252525252525252525252525252520hydrochloride

# Dicyclomine hydrochloride ## Overview Dicyclomine is an antispasmodic and anticholinergic agent that acts directly on smooth muscle to relieve spasms by antagonizing acetylcholine at muscarinic receptors. ## Primary Indications Functional bowel/irritable bowel syndrome (IBS). ## Adult Dosing * **Initial:** 20 mg orally 4 times daily. * **Maintenance:** May increase to 40 mg orally 4 times daily after one week if tolerated. * **Maximum:** 160 mg per day. * *Note: If efficacy is not achieved within 2 weeks, discontinue the drug.* ## Pediatric Dosing * **Safety/Efficacy:** Not recommended for use in children due to significant risk of serious adverse effects (e.g., respiratory distress, syncope, seizures). ## Dose Adjustments * **Renal/Hepatic Impairment:** No specific manufacturer guidelines provided. Use with extreme caution in patients with hepatic or renal impairment due to potential for decreased clearance. * **Geriatric:** Avoid in patients ≥65 years (Beers Criteria) due to high risk of anticholinergic side effects (delirium, urinary retention, sedation). If necessary, use lowest possible dose. ## Contraindications * Hypersensitivity to dicyclomine. * 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, toxic megacolon). * Glaucoma (narrow-angle). * Reflux esophagitis. ## Adverse Effects * **Common:** Dry mouth, dizziness, blurred vision, nausea, drowsiness, nervousness, constipation. * **Serious:** Anticholinergic toxicity (delirium, hyperthermia, tachycardia), urinary retention, toxic megacolon, respiratory distress, and hypersensitivity reactions. ## Key Drug Interactions * **Other Anticholinergics:** Additive toxicity (e.g., antihistamines, tricyclic antidepressants, antipsychotics). * **Digoxin:** Dicyclomine may increase serum digoxin levels by decreasing GI motility/increasing absorption. * **Potassium Chloride:** Increased risk of gastrointestinal mucosal lesions/ulceration when administered with solid oral potassium formulations. ## Monitoring * Monitor for signs of anticholinergic toxicity (especially in the elderly). * Observe for signs of urinary retention or constipation. * Evaluate therapeutic efficacy; discontinue if no improvement after 2 weeks. ## Clinical Pearls * Dicyclomine is not a first-line treatment for chronic IBS. * Advise patients to avoid tasks requiring mental alertness until individual response is known, as it may cause drowsiness and blurred vision. * Use with caution in hot weather or during exercise as it may cause heatstroke or fever due to suppression of perspiration (anhidrosis). * Ensure the patient is not confusing this with other anticholinergics to avoid cumulative overdose risks. *** **Disclaimer:** This information is for educational purposes only. Always verify drug dosages, contraindications, and potential interactions against current prescribing information, institutional protocols, or reputable clinical databases (e.g., Lexicomp, Micromedex) before prescribing or administering medication.