Dicyclomine Hydrochloride

Pronunciation

Pronunciation: die-SIGH-kloe-meen HIGH-droe-KLOR-ide
Class: Antispasmodic

Trade Names

Bentyl
- Capsules 10 mg
- Tablets 20 mg
- Syrup 10 mg/5 mL
- Injection 10 mg/mL

Dibent
- Injection 10 mg/mL

Dicyclomine hydrochloride
- Injection 10 mg/mL

Bentylol (Canada)
Riva-Dicyclomine (Canada)

Pharmacology

Relieves smooth muscle spasm of GI tract through anticholinergic effects and direct action on GI smooth muscle.

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Pharmacokinetics

Absorption

Rapidly absorbed. T max is 60 to 90 min (oral).

Distribution

Vd approximately 3.65 L/kg.

Elimination

79.5% excreted in the urine and 8.4% in feces. Half-life is approximately 1.8 h.

Indications and Usage

Treatment of functional bowel/irritable bowel syndrome (eg, irritable colon, spastic colon, mucous colitis).

Unlabeled Uses

Intestinal colic in children older than 6 mo.

Contraindications

Narrow angle glaucoma; adhesions between iris and lens; obstructive uropathy; obstructive disease of GI tract; paralytic ileus; intestinal atony of elderly or debilitated patient; severe ulcerative colitis; toxic megacolon complicating ulcerative colitis; hepatic or renal disease; tachycardia; myocardial ischemia; unstable cardiovascular status in acute hemorrhage; myasthenia gravis; infants younger than 6 mo.

Dosage and Administration

Adults

PO 80 mg/day in 4 equally divided doses. Increase to 160 mg/day in 4 equally divided doses. Administer 30 min before meals.

IM 80 mg/day in 4 divided doses. Administer 30 min before meals.

Storage/Stability

Store in tightly closed container at room temperature and protect from light. Injection fluid should be clear.

Drug Interactions

Amantadine, tricyclic antidepressants

May cause increased anticholinergic adverse reactions.

Atenolol, digoxin

May increase pharmacologic effects of these drugs.

Phenothiazines

May reduce antipsychotic effectiveness.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Palpitations, tachycardia.

CNS

CNS stimulation (restlessness, tremor), confusion, dizziness, drowsiness, fever (especially in children), flushing, headache, insomnia, light-headedness, mental confusion or excitement (especially in elderly, even with small doses), nervousness, weakness.

Dermatologic

Local irritation following injection; severe allergic reactions including anaphylaxis, dermal manifestations, and urticaria.

EENT

Blurred vision, cycloplegia, dilated pupils, increased IOP, mydriasis, nasal congestion, photophobia.

GI

Altered taste perception, bloated feeling, constipation, dry mouth, dysphagia, heartburn, nausea, paralytic ileus, vomiting.

Genitourinary

Impotence, urinary hesitancy and retention.

Miscellaneous

Decreased sweating, suppression of lactation.

Precautions

Pregnancy

Category B .

Lactation

Excreted in breast milk.

Children

Safety and efficacy have not been established. Contraindicated in infants younger than 6 mo. In infants, serious respiratory symptoms, seizures, syncope, pulse rate fluctuation, muscular hypotonia, coma, and death have been reported.

Elderly

Elderly patients may react with excitement, agitation, drowsiness, and other untoward manifestations to even small doses.

Special Risk Patients

Use with caution in patients with autonomic neuropathy, hyperthyroidism, hypertension, coronary heart disease, CHF, hiatal hernia, prostatic hypertrophy.

Anticholinergic psychosis

Reported in sensitive individuals and may include confusion, disorientation, short-term memory loss, hallucinations, dysarthria, ataxia, coma, euphoria, decreased anxiety, fatigue, insomnia, agitation and mannerisms, and inappropriate affect.

Diarrhea

Diarrhea may be symptom of incomplete intestinal obstruction, especially in patients with ileostomy or colostomy. Treatment of diarrhea with drug is inappropriate and possibly harmful.

Gastric ulcer

May delay gastric emptying rate and complicate therapy.

Heat prostration

Can occur in presence of high environmental temperature.

Overdosage

Symptoms

Circulatory failure, vomiting, abdominal distention, muscle weakness, anxiety, stupor, blurred vision, photophobia, dilated pupils, urinary retention.

Patient Information

  • Advise contact lens wearers to use lubricating solutions.
  • Warn patients to avoid direct sunlight and any heat extremes (eg, exercise in hot weather, saunas, prolonged activity in hot weather).
  • Instruct patient to take sips of water frequently, suck on ice chips or sugarless hard candy, or chew sugarless gum if dry mouth occurs.
  • Alert patients to pay special attention to fever, decreased ability to sweat and changes in bowel or bladder habits.
  • Advise elderly patients to report eye pain to health care provider or ophthalmologist and to undergo testing for glaucoma.
  • Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.
  • Tell patient to report any difficulty in swallowing to health care provider.

Copyright © 2009 Wolters Kluwer Health.

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