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# Dicyclomine Hydrochloride
## Overview
Dicyclomine hydrochloride is an anticholinergic and antispasmodic agent. It works by relaxing gastrointestinal smooth muscle.
## Primary Indications
Irritable bowel syndrome (IBS) and other functional bowel disorders characterized by intestinal hypermotility.
## Adult Dosing
* **Oral:** 20 mg four times daily. Dosage may be increased to 40 mg four times daily as needed, not exceeding 80 mg per day.
* **Intramuscular (IM):** 20 mg four times daily. Not recommended for long-term use due to availability of oral formulation.
## Pediatric Dosing
* **Oral:** 6 months to 2 years: 5 mg three to four times daily.
* **Oral:** 2 years to 12 years: 10 mg three to four times daily.
* **Oral:** > 12 years: Same as adult oral dosing.
There is limited evidence supporting the efficacy and safety of dicyclomine in infants under 6 months.
## Dose Adjustments
No specific dose adjustments are routinely recommended for hepatic or renal impairment, but caution is advised due to potential accumulation.
## Contraindications
* Hypersensitivity to dicyclomine.
* Glaucoma (especially narrow-angle glaucoma).
* Gastrointestinal obstruction or atony.
* Severe ulcerative colitis.
* Myasthenia gravis.
* Infants less than 6 months of age (associated with serious adverse effects including respiratory depression, coma, and death).
## Adverse Effects
Common: Dry mouth, blurred vision, nausea, constipation, dizziness, headache, drowsiness, urinary retention.
Serious: Tachycardia, confusion, hallucinations, heat prostration, paralytic ileus, exacerbation of glaucoma.
## Key Drug Interactions
* **Anticholinergic agents (e.g., atropine, scopolamine, some antihistamines, tricyclic antidepressants):** Increased risk of anticholinergic side effects.
* **MAO inhibitors:** May potentiate anticholinergic effects.
* **Amantadine:** Additive anticholinergic effects.
* **Opioid analgesics:** Increased risk of paralytic ileus.
## Monitoring
* Monitor for signs and symptoms of anticholinergic toxicity (e.g., dry mouth, blurred vision, urinary retention, constipation, confusion, drowsiness).
* Monitor for efficacy in relieving abdominal cramping and spasms.
* In infants, close monitoring for respiratory status and neurological effects is critical.
## Clinical Pearls
* Dicyclomine crosses the blood-brain barrier and can cause CNS effects, especially in the elderly.
* Use with caution in patients with autonomic neuropathy, uncontrolled hypertension, heart failure, or arrhythmias.
* Effectiveness can vary significantly between individuals.
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*Disclaimer: This information is for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional for diagnosis and treatment, and refer to the most current prescribing information for complete details and potential updates.*
