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# Dicyclomine Hydrochloride
## Overview
Dicyclomine is an anticholinergic (antispasmodic) agent that acts by direct relaxation of smooth muscle in the gastrointestinal tract and antagonism of acetylcholine at muscarinic receptors.
## Primary Indications
* Treatment of functional bowel/irritable bowel syndrome (IBS).
## Adult Dosing
* **Initial:** 20 mg orally four times daily.
* **Maintenance:** May increase to 40 mg orally four times daily after one week, if tolerated.
* **Maximum:** 160 mg per day.
* *Note:* Discontinue if efficacy is not observed after 2 weeks of treatment at the maximum tolerated dose.
## Pediatric Dosing
* **Children (6 months – 2 years):** 5-10 mg orally 3-4 times daily (Safety and efficacy data are limited; use caution).
* **Children (2-12 years):** 10 mg orally 3-4 times daily.
* *Note:* Generally discouraged in infants < 6 months due to reported serious respiratory and CNS adverse effects.
## Dose Adjustments
* **Renal/Hepatic Impairment:** No specific manufacturer guidelines, but exercise caution in patients with hepatic or renal disease due to potential for cumulative toxicity.
* **Geriatric:** Avoid if possible (Beers Criteria). If necessary, use lowest effective dose due to increased sensitivity to anticholinergic side effects (e.g., confusion, urinary retention, constipation).
## Contraindications
* Infants < 6 months of age.
* Unstable cardiovascular status in acute hemorrhage.
* Myasthenia gravis.
* Glaucoma (narrow-angle).
* Obstructive uropathy or GI tract (e.g., paralytic ileus, severe ulcerative colitis).
* Severe inflammatory bowel disease (risk of toxic megacolon).
## Adverse Effects
* **Common:** Dry mouth, dizziness, blurred vision, nausea, drowsiness, nervousness.
* **Serious:** Tachycardia, palpitations, urinary retention, confusion (especially in elderly), hypersensitivity reactions.
## Key Drug Interactions
* **Anticholinergics/Antimuscarinics:** Additive anticholinergic effects (e.g., atropine, antihistamines, tricyclic antidepressants).
* **GI Motility Agents:** Antagonizes the effects of prokinetic drugs (e.g., metoclopramide).
* **Digoxin:** Potential for increased digoxin levels due to decreased GI motility.
## Monitoring
* Monitor for signs of anticholinergic toxicity (tachycardia, urinary retention, constipation, altered mental status).
* Monitor GI symptoms for therapeutic response.
## Clinical Pearls
* Dicyclomine is not recommended for the treatment of infant colic despite historical off-label use due to safety concerns.
* Advise patients to avoid operating machinery or driving until effects are known, as dizziness and blurred vision are common.
* Counsel patients to drink adequate fluids to manage dry mouth and constipation.
* If symptoms do not improve, reconsider the diagnosis; dicyclomine is ineffective for structural GI causes.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical practice is subject to individual judgment and local institutional protocols. Always verify current prescribing information, contraindications, and drug-drug interactions via official resources (e.g., FDA-approved labeling, Lexicomp, or Micromedex) before prescribing or administering medication.
