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# Dicyclomine hydrochloride
## Overview
Dicyclomine hydrochloride is an anticholinergic and antispasmodic medication used to relieve smooth muscle spasms, particularly in the gastrointestinal tract.
## Primary Indications
* Irritable bowel syndrome (IBS)
* Gastrointestinal spasms
## Adult Dosing
* **Oral:**
* Initial dose: 10 mg to 20 mg, three to four times daily.
* Maximum dose: 80 mg per day. Doses may be increased gradually based on patient response and tolerance.
* **Intramuscular:**
* 10 mg to 20 mg, three to four times daily if oral administration is not feasible. Transition to oral route as soon as possible.
## Pediatric Dosing
* **Oral:**
* 6 months to < 2 years: 5 mg, three to four times daily.
* 2 years to < 12 years: 10 mg, three to four times daily.
* **Intramuscular:** Dicyclomine is generally **not recommended** for intramuscular use in pediatric patients due to potential for serious adverse events.
## Dose Adjustments
No specific dose adjustments are typically required for renal or hepatic impairment, however, caution is advised in these populations due to potential for increased anticholinergic effects.
## Contraindications
* Hypersensitivity to dicyclomine.
* Glaucoma (angle-closure glaucoma).
* Obstructive uropathy (e.g., bladder neck obstruction).
* Gastrointestinal obstruction or atony.
* Severe ulcerative colitis.
* Myasthenia gravis.
* Infants less than 6 months of age.
## Adverse Effects
Common anticholinergic effects:
* Dry mouth
* Blurred vision
* Constipation
* Urinary retention
* Drowsiness
* Dizziness
* Nausea
Additional serious adverse effects may include:
* Confusion
* Hallucinations
* Tachycardia
* Heat prostration
## Key Drug Interactions
* **Other Anticholinergics (e.g., tricyclic antidepressants, antihistamines, antipsychotics):** Increased risk of additive anticholinergic adverse effects.
* **MAO Inhibitors:** May potentiate anticholinergic effects.
* **Proton pump inhibitors (PPIs) / H2 blockers:** Dicyclomine may reduce the efficacy of these agents by increasing gastric pH.
## Monitoring
* Monitor for signs and symptoms of anticholinergic adverse effects (e.g., dry mouth, blurred vision, urinary retention, constipation, drowsiness).
* Assess for improvement in gastrointestinal symptoms.
* Monitor vital signs, particularly in IM administration.
## Clinical Pearls
* Dicyclomine is most effective when taken before meals.
* Due to anticholinergic properties, caution is advised in elderly patients.
* Risk of serious adverse events, including respiratory depression and neurological effects, is increased in infants under 6 months.
* Intramuscular administration should be a temporary measure.
This information is intended for healthcare professionals and does not substitute for professional medical advice. Always consult the current prescribing information and relevant guidelines for complete details.
