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# Dicyclomine Hydrochloride
## Overview
Dicyclomine hydrochloride is an anticholinergic and antispasmodic agent. It reduces the tone and amplitude of involuntary smooth muscle contractions in the gastrointestinal tract.
## Primary Indications
* Symptomatic relief of infantile colic.
* Management of irritable bowel syndrome (IBS) or other functional bowel disorders characterized by intestinal cramping and abdominal pain.
## Adult Dosing
* **Irritable Bowel Syndrome:** 10-20 mg orally four times daily before meals and at bedtime. Titrate as needed up to a maximum of 40 mg orally four times daily.
## Pediatric Dosing
* **Infantile Colic:** 5 mg orally three to four times daily. For infants older than 2 weeks and weighing less than 10 pounds, the dose is 5 mg orally once daily. For infants older than 2 weeks and weighing 10 pounds or more, the dose is 10 mg orally three to four times daily or as needed. Maximum dose is 40 mg/day. **Note:** Due to potential serious adverse events, current recommendations generally advise against routine use in infants.
## Dose Adjustments
No specific dose adjustments are typically required for hepatic or renal impairment, but caution should be exercised.
## Contraindications
* Hypersensitivity to dicyclomine.
* Glaucoma (angle-closure).
* Infants less than 2 months of age.
* Conditions where anticholinergic effects are undesirable, such as:
* Unstable cardiovascular status in acute hemorrhage.
* Myasthenia gravis.
* Pyloric or duodenal obstruction.
* Achalasia.
* Obstructive intestinal or urinary tract disease.
* Severe ulcerative colitis.
* Gastrointestinal atony.
* Toxic megacolon.
## Adverse Effects
* **Common:** Dry mouth, blurred vision, drowsiness, dizziness, constipation, urinary retention, nausea, vomiting, headache, nervousness, confusion.
* **Serious:** Tachycardia, increased intraocular pressure, heat prostration, allergic reactions. In infants, serious effects can include respiratory depression, coma, circulatory collapse, paralytic ileus, and exacerbation of infantile hypertrophic pyloric stenosis.
## Key Drug Interactions
* **Anticholinergics (e.g., tricyclic antidepressants, antihistamines, antiparkinsonian agents):** Additive anticholinergic effects, increasing the risk of dry mouth, blurred vision, constipation, urinary retention, and central nervous system effects.
* **MAO Inhibitors:** May potentiate anticholinergic effects.
* **Corticosteroids:** Increased intraocular pressure.
* **Opioid analgesics:** Increased risk of paralytic ileus.
## Monitoring
* Monitor for signs and symptoms of anticholinergic side effects (e.g., dry mouth, blurred vision, urinary retention, constipation, confusion).
* In infants, monitor closely for adverse reactions, especially respiratory distress.
* Evaluate effectiveness of treatment for pain and cramping.
## Clinical Pearls
* Dicyclomine is an older medication with a narrow therapeutic index, particularly in infants.
* The risk of serious adverse events in infants under 2 months is significant and contraindicates its use.
* Long-term safety and efficacy in infants and children are not well-established.
* Administer oral doses 30-60 minutes before meals to maximize effectiveness in reducing postprandial cramping.
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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 any treatment decisions. Dosing and recommendations may vary based on individual patient factors and local protocols.
