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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, leading to relaxation of the gastrointestinal tract.
## Primary Indications
* Treatment of infantile colic.
* Symptomatic relief of functional bowel distress, such as irritable bowel syndrome (IBS).
## Adult Dosing
* **Irritable Bowel Syndrome/Functional Bowel Distress:** 20 mg four times daily before meals. Doses may be increased as needed up to 40 mg four times daily. Maximum daily dose: 160 mg.
## Pediatric Dosing
* **Infantile Colic:** 5 mg three to four times daily, 15-30 minutes before feedings. Dosage may be increased to 10 mg three to four times daily if needed based on infant's response and tolerance.
* **Note:** Dicyclomine is **not recommended** for infants younger than 6 months due to the risk of serious breathing problems, including rapid breathing, shortness of breath, and respiratory arrest.
## Dose Adjustments
No specific dose adjustments are routinely recommended for renal or hepatic impairment, though caution is advised due to potential accumulation and increased anticholinergic effects.
## Contraindications
* Hypersensitivity to dicyclomine.
* Infants younger than 6 months.
* Glaucoma (angle-closure).
* Myasthenia gravis.
* Gastrointestinal obstruction or atony.
* Unstable cardiovascular status in acute hemorrhage.
* Severe ulcerative colitis or toxic megacolon.
## Adverse Effects
Common adverse effects are anticholinergic in nature and include dry mouth, blurred vision, urinary retention, constipation, drowsiness, dizziness, and confusion. Less common effects include nausea, vomiting, rash, and impotence. Severe adverse effects in infants can include respiratory depression and neurological effects.
## Key Drug Interactions
* **Anticholinergic Agents:** Additive effects with other drugs possessing anticholinergic properties (e.g., antihistamines, tricyclic antidepressants, antipsychotics, amantadine), increasing the risk of severe adverse effects.
* **Antacids:** May decrease the absorption of dicyclomine; administer dicyclomine at least 1 hour before or 2 hours after antacids.
* **Opioids:** May potentiate GI stasis and constipation.
## Monitoring
* Monitor for signs and symptoms of anticholinergic toxicity (e.g., dry mouth, blurred vision, urinary retention, constipation, dizziness, confusion).
* In infants, monitor for signs of respiratory distress.
* Assess for therapeutic efficacy.
## Clinical Pearls
* Dicyclomine can cause sedation; advise patients to use caution when driving or operating machinery.
* Due to its anticholinergic effects, use with caution in elderly patients who may be more susceptible to confusion and urinary retention.
* The efficacy and safety of dicyclomine for infantile colic have been debated, and the FDA has issued warnings regarding its use in infants. Consult local guidelines and consider alternative therapies.
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**Disclaimer:** This information is intended for healthcare professionals and does not replace the need to consult the most current prescribing information and relevant literature for definitive guidance. Always verify drug information with an up-to-date resource before patient use.
