dicyclomine

dicyclomine /di·cy·clo·mine/ (-si´klo-mēn) an anticholinergic, used as the hydrochloride salt as a gastrointestinal antispasmodic.

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dicyclomine

an anticholinergic; the hydrochloride is used as a gastrointestinal antispasmodic.

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dicyclomine (dicycloverine)

Bentyl, Bentylol (CA), Formulex (CA), Lomine (CA), Merbentyl (UK), Riva-Dicyclomine (CA)

Pharmacologic class: Anticholinergic

Therapeutic class: Antispasmodic

Pregnancy risk category B

Action

Thought to exert direct effect on GI smooth muscle by inhibiting acetylcholine at receptor sites, thereby reducing GI tract motility and tone

Availability

Capsules: 10 mg, 20 mg

Solution for injection: 10 mg/ml

Syrup: 10 mg/5 ml

Tablets: 10 mg, 20 mg

⊘Indications and dosages

➣ Irritable bowel syndrome in patients unresponsive to usual interventions

Adults: 20 mg P.O. or I.M. q.i.d.; may increase up to 160 mg/day

Contraindications

• Hypersensitivity to drug
• GI or genitourinary tract obstruction
• Severe ulcerative colitis
• Reflux esophagitis
• Unstable cardiovascular status
• Glaucoma
• Myasthenia gravis
• Breastfeeding
• Infants younger than 6 months

Precautions

Use cautiously in:
• hepatic or renal impairment, autonomic neuropathy, cardiovascular disease, prostatic hypertrophy
• elderly patients
• pregnant patients (safety not established).

Administration

• Give 30 to 60 minutes before meals; give bedtime dose at least 2 hours after evening meal.
☞ Don't administer by I.V. route.
• Don't give by I.M. route for more than 2 days.

Route	Onset	Peak	Duration
P.O., I.M.	Unknown	Unknown	Unknown

Adverse reactions

CNS: confusion, drowsiness, light-headedness (with I.M. use), psychosis

CV: palpitations, tachycardia

EENT: blurred vision, increased intraocular pressure

GI: nausea, vomiting, constipation, heartburn, decreased salivation, dry mouth, paralytic ileus

GU: urinary hesitancy or retention, erectile dysfunction, decreased lactation

Skin: decreased sweating, rash, itching, urticaria

Other: pain and redness at I.M. site, allergic reactions including anaphylaxis

Interactions

Drug-drug. Adsorbent antidiarrheals, antacids: decreased dicyclomine absorption

Cyclopropane anesthetics: increased risk of cardiovascular adverse reactions

Oral drugs: altered absorption of these drugs

Potassium (oral): increased GI mucosal lesions

Other anticholinergics (including antihistamines, disopyramide, quinidine): additive anticholinergic effects

Drug-diagnostic tests. Gastric acid secretion test: antagonism of pentagastrin and histamine (testing agents)

Patient monitoring

☞ Stay alert for anaphylaxis.
• Monitor vital signs and fluid intake and output. Ask patient about palpitations.
☞ Assess for light-headedness, confusion, and rash after I.M. injection.
• Evaluate patient's vision, particularly for blurring and other signs and symptoms of increasing intraocular pressure.
• Assess bowel pattern, particularly for signs and symptoms of paralytic ileus.

Patient teaching

• Instruct patient to take drug 30 to 60 minutes before meals and to take bedtime dose at least 2 hours after evening meal.
• Advise patient not to take antacids or adsorbent antidiarrheals within 2 hours of dicyclomine.
☞ Urge patient to promptly report rash, abdominal pain, decreased urinary output, or absence of bowel movements.
• Caution patient to avoid driving or other hazardous activities until he knows how drug affects concentration, vision, and alertness.
• Advise patient to minimize GI upset by eating small, frequent servings of healthy food and drinking plenty of fluids.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.