Dicyclomine is used to treat functional bowel or irritable bowel syndrome.
Dicyclomine may also be used for purposes not listed in this medication guide.
Warnings
Many drugs can affect dicyclomine. Tell your doctor about all your current medicines.
Before taking this medicine
You should not use dicyclomine if you are allergic to it, or if you have:
glaucoma;
a bladder obstruction or other urination problems;
a blockage in your digestive tract (stomach or intestines);
severe ulcerative colitis;
gastroesophageal reflux disease (GERD);
a serious heart condition and active bleeding;
myasthenia gravis; or
if you are breastfeeding a baby.
Not approved for use by anyone younger than 18 years old. Dicyclomine should never be given to a child younger than 6 months old.
Tell your doctor if you have ever had:
heart problems or high blood pressure;
a stroke;
ulcerative colitis;
an ileostomy or colostomy;
an enlarged prostate; or
liver or kidney disease.
Older adults may be more sensitive to the effects of dicyclomine.
Tell your doctor if you are pregnant.
Do not breastfeed.
Dicyclomine Uses:
Gastrointestinal motility disorders and irritable bowel:
It is indicated for the treatment of functional bowel disorders like irritable bowel syndrome.
Other drugs recommended for the treatment of IBS include:
Lubiprostone (Amitiza) for the treatment of IBS with constipation.
Linaclotide (Linzess) for the treatment of chronic constipation and IBS with constipation.
Zelnorm (Tegaserod) – a 5 HT-4 agonist for the treatment of IBS with constipation.
Dicyclomine Dose in the treatment of Gastrointestinal motility disorders and irritable bowel:
Initial treatment:
20 mg orally four times a day for seven days.
The dose may be increased to 40 mg four times a day after one week.
Discontinuation of therapy:
If no improvement is noted within 2 weeks or if less than 80 mg per day is used because of intolerable adverse effects, the treatment should be discontinued.
The safety of the drug at doses exceeding 80 mg per day for greater than 2 weeks has not been established.
IM: 10 to 20 mg four times a day for a day or two and then convert to oral treatment as soon as possible.
Dicyclomine Dose in the treatment of Gastrointestinal motility disorders and irritable bowel syndrome:
Infants ≥6 months and Children <2 years:
5 to 10 mg orally three or four times a day administered 15 minutes before feeding.
Children 2 years of age or older.
10 mg orally three or four times a day.
Adolescents:
10 to 20 mg orally thrice or four times a day.
If no improvement is noted within 2 weeks, the treatment should be discontinued.
Pregnancy Risk Category: B
It has not been shown to have adverse teratogenic effects on fetal outcomes in the first trimester when used at the usual doses.
Other medications are recommended for treatment of irritable intestinal syndrome during pregnancy.
Use of dicyclomine during breastfeeding
It is excreted from breastmilk and contraindicated for lactating mothers.
Lactation may be affected by anticholinergic drugs.It can also cause severe adverse effects in infants and should be avoided by lactating mothers.
Dose in Kidney Disease:
Use with caution in patients with renal impairment. There are no dosage adjustments provided in the manufacturer’s labeling as it has not been studied in patients with kidney disease.
Dose in Liver Disease:
Use with caution in patients with liver disease. There are no dosage adjustments provided in the manufacturer’s labeling as it has not been studied in patients with liver disease.
Common Side Effects of Dicyclomine :
Central nervous system:
Dizziness
Gastrointestinal:
Xerostomia
Nausea
Ophthalmic:
Blurred vision
Less Common Side Effects of Dicyclomine:
Central nervous system:
Drowsiness
Nervousness
Neuromuscular & skeletal:
Weakness
Contraindications to Dicyclomine :
Obstructive diseases of gastrointestinal tract
Grave ulcerative colitis
Reflux esophagitis
Patients with acute hemorhage have unstable cardiovascular status
Obstructive Uropathy
Glaucoma
Myasthenia gravis
Breastfeeding women
Infants under 6 months old
Canadian labeling: Additional contraindications not in US labeling
Hypersensitivity to any drug component or drug ingredient
Warnings and precautions
CNS effects
Blurred vision and mental impairment may result from the use of this drug.People who are required to be alert for driving or operating heavy machinery should be aware of the dangers.
Diarrhea
Diarrhea patients who experience diarrhea should stop taking the medication as this could indicate incomplete intestinal obstruction.
Heat prostration
You should use extreme caution when exercising in hot conditions or when the drug is being administered.In hot weather, heat prostration can occur.
Psychosis and Delirium:
Patients who are sensitive to anticholinergic drugs (such as those with preexisting mental illnesses or elderly patients) may experience psychosis and delirium if they take too many anticholinergic medications.
Cardiovascular disease
The drug should not be used by patients with heart disease, hypertension, or coronary artery disease.
Before administering the drug, monitor pulse rate and check for tachycardia.
Hepatic impairment
Patients with liver impairment should be cautious.
Hyperthyroidism
Hyperthyroid patients should be cautious when taking the drug.
Neuropathy
Patients suffering from autonomic neuropathy must be cautious when taking the drug.
Prostatic hyperplasia
Patients with suspected or known prostatic hyperplasia must be cautious when taking the drug.
Renal impairment
Patients with impaired renal function should be cautious when taking the drug.
Salmonella dysentery
Anticholinergic drugs should not be used by patients with salmonella dysentery due to the increased risk for toxic intestinal dilation or perforation.
Ulcerative colitis
Patients with severe ulcerative colitis should be avoided.It should be avoided by patients with mild-moderate ulcerative colitis.
Dicyclomine : Drug Interaction
Note: Drug Interaction Categories:
Risk Factor C: Monitor When Using Combination
Risk Factor D: Consider Treatment Modification
Risk Factor X: Avoid Concomitant Use
Risk Factor C (Monitor therapy).
Acetylcholinesterase inhibitors
Anticholinergic Agents may have a decreased therapeutic effect.Anticholinergic Agents can decrease the therapeutic effects of Acetylcholinesterase inhibitors.
Amantadine
Anticholinergic Agents may have an enhanced anticholinergic effect.
Anticholinergic Agents
Other Anticholinergic Agents may have an adverse/toxic effect.
Botulinum Toxin-Containing Product
Anticholinergic Agents may have an enhanced anticholinergic effect.
Cannabinoid-Containing Product
Anticholinergic agents may increase the tachycardic effects of Cannabinoid -Containing products.Cannabidiol is an exception.
Chloral Betaine
Anticholinergic Agents may have an adverse/toxic effect.
Gastrointestinal Agents (Prokinetic).
Anticholinergic Agents can reduce the therapeutic effects of Gastrointestinal Agents (Prokinetic).
Glucagon
Anticholinergic agents may increase the toxic/adverse effects of Glucagon.Particularly, there may be an increase in the likelihood of gastrointestinal adverse reactions.
Itopride
Itopride’s therapeutic effects may be diminished by anticholinergic agents.
Mianserin
Anticholinergic Agents may have an enhanced anticholinergic effect.
Mirabegron
Anticholinergic agents may increase the toxic/adverse effects of Mirabegron.
Nitroglycerin
The absorption of Nitroglycerin may be decreased by anticholinergic agents.Anticholinergic Agents may reduce the dissolution sublingual nitroglycerin tablet, which could impair or slow down nitroglycerin absorbtion.
Opioid Agonists
Opioid Agonists can have an adverse/toxic effect that may be exacerbated by anticholinergic agents.This combination may increase the likelihood of constipation or urinary retention.
Ramosetron
Ramosetron’s constipating effects may be enhanced by anticholinergic agents.
Thiazide and Thiazide – Like Diuretics
Anticholinergic Agents can increase serum Thiazide or Thiazide-Like Diuretics.
Topiramate
Topiramate’s toxic/adverse effects may be exacerbated by anticholinergic agents.
Risk Factor D (Consider therapy modifications)
Pramlintide
Anticholinergic Agents may have an enhanced anticholinergic effect.These effects are only for the GI tract.
Secretin
Secretin’s therapeutic effects may be diminished by anticholinergic agents.Concomitant use: Secretin and anticholinergic agents should be avoided.Stop using anticholinergic drugs for at least five half-lives before administering secretin.
Sincalide
Sincalide may be less effective if drugs that affect gallbladder function are taken.Management: Before Sincalide is used to stimulate the gallbladder, discontinue any drugs that affect gallbladder motility.
Risk Factor X (Avoid Combination)
Aclidinium
Anticholinergic Agents may have an enhanced anticholinergic effect.
Cimetropium
Cimetropium may have an anticholinergic effect that can be enhanced by the use of anticholinergic agents.
Eluxadoline
Eluxadoline may cause constipation by using anticholinergic agents.
Oral Inhalation
Anticholinergic agents may increase the anticholinergic effects of Glycopyrrolate (Oral inhalation).
Glycopyrronium (Topical).
Anticholinergic Agents may have an enhanced anticholinergic effect.
Oral Inhalation with Ipratropium
Anticholinergic Agents may have an enhanced anticholinergic effect.
Levosulpiride
Anticholinergic Agents can reduce the therapeutic effects of Levosulpiride.
Oxatomide
Anticholinergic Agents may have an enhanced anticholinergic effect.
Potassium Chloride
Potassium Chloride may have an ulcerogenic effect that can be exacerbated by anticholinergic agents.Treatment: Patients taking drugs that have significant anticholinergic effects should not consume any oral dose form of potassium chloride.
Potassium Citrate
Potassium Citrate may be more ulcerogenic if it is given to anticholinergic agents.
Revefenacin
Revefenacin may be enhanced by anticholinergic agents.
Tiotropium
Anticholinergic agents may increase the anticholinergic effects of Tiotropium.
Umeclidinium
Anticholinergic Agents may have an enhanced anticholinergic effect.
Monitoring parameters:
Monitor Pulse, anticholinergic effects, urinary output, and gastrointestinal symptoms.
How should I take dicyclomine?
Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.
Dicyclomine oral is taken by mouth.
Measure liquid medicine with the supplied syringe or a dose-measuring device (not a kitchen spoon).
Dicyclomine injection is given in a muscle if you are unable to take the medicine by mouth.
Call your doctor if your symptoms do not improve after 2 weeks.
Store at room temperature away from moisture and heat.
Mechanism of action of Dicyclomine :
It prevents acetylcholine from acting at parasympathetic locations found in smooth muscles, secretory and central nervous systems.
The onset of action:
1 to 2 hours
Duration:
Up to 4 hours
Absorption:
It is rapidly absorbed and well absorbed after oral administration.
Metabolism:
It undergoes extensive metabolism.
Half-life elimination:
Initial phase: About 1.8 hours.
The terminal phase is undetermined but is a little longer than the initial phase
Time to peak:
60 to 90 minutes after oral administration
Excretion:
80% of the drug is excreted in urine (a small amount is excreted as unchanged drug);
feces (8%)
What happens if I miss a dose?
Skip the missed dose and use your next dose at the regular time. Do not use two doses at one time.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
Overdose can cause nausea, vomiting, dilated pupils, weakness or loss of movement in any part of your body, trouble swallowing, fainting, or seizure (convulsions).
International Brand Names of Dicyclomine:
Bentyl
Bentylol
JAMP-Dicyclomine HCl
Protylol
RIVA-Dicyclomine
Babypasmil
Bentyl
Blisscolic
Coligon
Coochil
Cyclominol
Diclomine
Dicymine
Merbentyl
Nomcramp
Notensyl
Spasdon Drops
Spasmorest
Spatomin
Swityl
Trigan
Wintyl
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