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# Dicyclomine Hydrochloride
## Overview
Dicyclomine hydrochloride is an anticholinergic and antispasmodic medication used to relieve smooth muscle spasms. It acts directly on smooth muscle and blocks the action of acetylcholine at parasympathetic sites.
## Primary Indications
* Irritable bowel syndrome (IBS)
* Gastrointestinal (GI) spasms
## Adult Dosing
* **Oral:** Typically initiated at 10 mg four times daily, increased as needed and tolerated. Usual maintenance dose is 20 mg four times daily. Maximum dose is 80 mg daily.
* **Intramuscular (IM):** 20 mg every 4-6 hours. Do not exceed 80 mg daily. IM route is generally reserved for situations where oral administration is not feasible.
## Pediatric Dosing
* **Oral:** Generally not recommended for infants under 6 months due to risk of serious adverse effects including respiratory depression, central nervous system (CNS) depression, coma, and death. For children 6 months and older, doses vary, and specific dosing should be guided by clinical judgment and potentially local protocols. A common starting point for children over 6 months is 5 mg three to four times daily.
## Dose Adjustments
No specific dose adjustments are typically required for hepatic or renal impairment, but caution is advised due to potential for increased anticholinergic effects.
## Contraindications
* Hypersensitivity to dicyclomine.
* Glaucoma (especially angle-closure glaucoma).
* Obstructive uropathy (e.g., bladder neck obstruction).
* Obstructive GI disease (e.g., achalasia, pyloric stenosis).
* Severe ulcerative colitis.
* Myasthenia gravis.
* Infants less than 6 months of age.
## Adverse Effects
Common adverse effects include dry mouth, constipation, blurred vision, drowsiness, dizziness, and urinary retention. Less common but serious effects include confusion, hallucinations, tachycardia, and dysuria.
## Key Drug Interactions
* **Anticholinergic agents:** Additive anticholinergic effects (e.g., other antimuscarinics, some antihistamines, some antidepressants).
* **CNS depressants:** Increased CNS depressant effects (e.g., alcohol, benzodiazepines, opioids).
* **Medications affecting GI motility:** May antagonize effects of prokinetic agents.
## Monitoring
* Assess for relief of GI symptoms.
* Monitor for anticholinergic side effects (dry mouth, constipation, urinary retention, blurred vision, confusion).
* Evaluate mental status, especially in elderly patients.
## Clinical Pearls
* Dicyclomine can exacerbate symptoms in patients with severe ulcerative colitis.
* Use with caution in patients with autonomic neuropathy, hepatic disease, renal disease, or known or suspected prostatic hypertrophy.
* Avoid activities requiring mental alertness or coordination until response to medication is known, as it can cause drowsiness and blurred vision.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and patient-specific factors before making clinical decisions.*
