Dicyclomine%2525252525252525252525252525252525252525252520hydrochloride

# Dicyclomine hydrochloride ## Overview Dicyclomine is an antispasmodic and anticholinergic agent that acts directly on smooth muscle to relieve gastrointestinal spasms. It inhibits the action of acetylcholine at postganglionic parasympathetic receptor sites. ## Primary Indications - Irritable Bowel Syndrome (IBS). ## Adult Dosing - **Oral:** 20 mg 4 times daily. If efficacy is not achieved within 2 weeks, increase to 40 mg 4 times daily. - **Intramuscular (IM):** 20 mg every 4 to 6 hours. (Not for IV use). - **Maximum:** 160 mg per day. ## Pediatric Dosing - **Safety and efficacy in pediatric patients have not been established.** - The use of dicyclomine is generally **contraindicated in infants under 6 months of age** due to reports of serious respiratory distress, seizures, and death. ## Dose Adjustments - **Hepatic/Renal Impairment:** No specific manufacturer guidelines. Use with caution due to the risk of anticholinergic accumulation. - **Geriatric:** Start at the lowest end of the dosing range (e.g., 10 mg). Beers Criteria lists dicyclomine as a drug to avoid in older adults due to potent anticholinergic effects. ## Contraindications - Hypersensitivity to dicyclomine. - Infants < 6 months of age. - Patients with unstable cardiovascular status in acute hemorrhage. - Myasthenia gravis. - Obstructive disease of the GI tract (e.g., pyloric stenosis, paralytic ileus). - Severe ulcerative colitis or toxic megacolon. - Obstructive uropathy. - Glaucoma. ## Adverse Effects - **Common:** Dry mouth, dizziness, blurred vision, nausea, nervousness, somnolence, and asthenia. - **Serious:** Tachycardia, urinary retention, confusion/hallucinations (particularly in the elderly), and heatstroke (decreased sweating). ## Key Drug Interactions - **Anticholinergics:** Additive effects (e.g., antihistamines, TCAs, antipsychotics) increasing risk of urinary retention and delirium. - **Potassium Chloride:** Increased risk of GI mucosal lesions (dicyclomine slows transit time). - **Digoxin:** May increase digoxin levels by decreasing GI motility. ## Monitoring - Monitor for clinical relief of IBS symptoms. - Assess for anticholinergic toxicity (e.g., tachycardia, confusion, urinary retention, dry skin/flushing). - Monitor mental status in older adults or those taking other CNS-depressant medications. ## Clinical Pearls - **Administration:** Should be taken before meals. - **Heat Sensitivity:** Patients should be advised to avoid heavy exercise or high-temperature environments, as the drug's anticholinergic effect inhibits sweating and increases the risk of heatstroke. - **CNS Depression:** Dicyclomine may cause drowsiness; use caution with machinery or driving. - **IM Injection:** Only indicated when oral administration is not feasible; switch to oral as soon as possible. *** *Disclaimer: This information is for educational purposes only. Always verify current prescribing information, contraindications, and local hospital protocols via a trusted clinical reference (e.g., Lexicomp, UpToDate) before prescribing or administering medication.*