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# Dicyclomine hydrochloride
## Overview
Dicyclomine hydrochloride is an anticholinergic and antispasmodic medication. It works by blocking the action of acetylcholine on smooth muscle, which reduces spasms in the gastrointestinal tract.
## Primary Indications
Dicyclomine hydrochloride is primarily indicated for the relief of symptoms of irritable bowel syndrome (IBS), also known as spastic colon.
## Adult Dosing
* **Oral:** 20 mg four times daily, usually 30-60 minutes before meals and at bedtime.
* **Maximum Dose:** 80 mg per day.
* Dose may be adjusted based on patient response and tolerance.
## Pediatric Dosing
* **Oral:** Use in children under 6 months of age is generally not recommended due to potential for serious side effects.
* **Children 6 months to 2 years:** 5 mg three or four times daily.
* **Children 2 to 12 years:** 10 mg three or four times daily.
* Titrate dosage to lowest effective level.
## Dose Adjustments
No specific dose adjustments are required for renal or hepatic impairment. However, caution is advised in elderly patients due to increased risk of anticholinergic side effects.
## Contraindications
* Hypersensitivity to dicyclomine hydrochloride.
* Gastrointestinal obstruction or atony.
* Uncontrolled narrow-angle glaucoma.
* Myasthenia gravis.
* Infants less than 2 months of age.
* Severe ulcerative colitis or toxic megacolon.
## Adverse Effects
Common adverse effects include dry mouth, blurred vision, constipation, urinary retention, drowsiness, dizziness, and nausea. Less common but serious effects can include confusion, hallucinations, fever, and cardiovascular effects (tachycardia, hypotension, hypertension).
## Key Drug Interactions
* **Anticholinergic Agents:** Additive anticholinergic effects (e.g., with tricyclic antidepressants, antihistamines, antiparkinsonian agents, MAO inhibitors).
* **Adrenergic Agents:** May potentiate CNS stimulant effects.
* **Potassium Chloride:** May increase risk of gastrointestinal ulceration and bleeding when used concurrently.
## Monitoring
Monitor for therapeutic response and adverse effects, particularly anticholinergic side effects such as dry mouth, constipation, urinary retention, and cognitive impairment.
## Clinical Pearls
* Dicyclomine is most effective when taken before meals.
* It provides symptomatic relief of abdominal cramps and spasms; it does not treat the underlying cause of IBS.
* Onset of action is typically within 30-60 minutes.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making prescribing decisions.*
