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# Dicyclomine hydrochloride
## Overview
Dicyclomine hydrochloride is an anticholinergic and antispasmodic medication. It works by relaxing smooth muscle in the gastrointestinal tract.
## Primary Indications
* Treatment of infantile colic.
* Symptomatic relief of functional bowel distress and irritable bowel syndrome (spastic colon).
## Adult Dosing
* **Usual dose:** 10-20 mg orally four times daily, 30 minutes before meals and at bedtime.
* **Maximum dose:** Up to 40 mg orally four times daily if symptoms persist.
## Pediatric Dosing
* **Infantile colic:** 5 mg orally three or four times daily. Dosing may be adjusted based on weight or healthcare provider recommendations.
* **Note:** Due to potential for severe adverse effects, including respiratory depression and central nervous system effects, the use in infants under 6 months is generally avoided or used with extreme caution under strict medical supervision. Some sources contraindicate use in children under 6 months.
## Dose Adjustments
No specific adjustments are necessary for hepatic or renal impairment based on current widely available information. However, caution is advised in patients with conditions that could be exacerbated by anticholinergic effects.
## Contraindications
* Hypersensitivity to dicyclomine.
* Glaucoma (angle-closure glaucoma is a specific concern).
* Obstructive uropathy.
* Gastrointestinal obstruction or atony.
* Myasthenia gravis.
* Infants less than 6 months old (absolute contraindication by some sources due to increased risk of serious adverse events like respiratory depression).
* Unstable cardiovascular collapse.
## Adverse Effects
Common adverse effects include dry mouth, blurred vision, dilated pupils, constipation, urinary retention, drowsiness, dizziness, and confusion. Less common but serious effects can include respiratory depression, central nervous system effects (especially in infants), tachycardia, and heat prostration.
## Key Drug Interactions
* **Other Anticholinergics:** Additive effects can increase risk of anticholinergic side effects.
* **CNS Depressants:** May increase sedative effects.
* **Antacids:** May decrease absorption of dicyclomine. Administer dicyclomine at least 1 hour before or after antacids.
* **MAO Inhibitors:** May potentiate anticholinergic effects.
## Monitoring
* Monitor for efficacy in relieving gastrointestinal spasms and symptoms.
* Assess for anticholinergic side effects (dry mouth, blurred vision, urinary retention, constipation, dizziness, confusion).
* In infants, monitor closely for signs of respiratory depression, sedation, or other CNS effects.
## Clinical Pearls
* Dicyclomine should be taken 30 minutes before meals to be most effective.
* Due to potential for serious adverse events, especially in infants, careful patient selection and close monitoring are crucial.
* The risk-benefit profile should be carefully considered, particularly in vulnerable populations.
*Please verify current prescribing information with the latest official drug compendium or manufacturer's product monograph as recommendations can change.*
