Drug Interactions between Bentyl and tirzepatide

Tirzepatide may affect the absorption of other medications that you take by mouth. In some cases, this may affect how well and/or how fast those medications work, or it may make no difference. Talk to a healthcare provider if you have any questions or concerns, and contact your doctor if your symptoms worsen or your condition changes. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Ask your doctor before using dicyclomine together with ethanol (alcohol). Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while you are taking dicyclomine. You should be warned not to exceed recommended dosages and to avoid activities requiring mental alertness. If your doctor prescribes these medications together, you may need a dose adjustment to safely take this combination. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Agents with anticholinergic activity can exacerbate many of the manifestations of autonomic neuropathy, including tachycardia, anhidrosis, bladder atony, obstipation, dry mouth and eyes, cycloplegia and blurring of vision, and sexual impotence in males. Therapy with antimuscarinic agents and higher dosages of antispasmodic agents (e.g., dicyclomine or oxybutynin) should be administered cautiously in patients with autonomic neuropathy.

Therapy with dicyclomine is contraindicated in patients with unstable cardiovascular status in acute hemorrhage.

Anticholinergics are contraindicated in patients with obstructive diseases such as achalasia, esophageal stricture or stenosis, pyloroduodenal stenosis, stenosing peptic ulcer, pyloric obstruction, and paralytic ileus. Anticholinergics may further suppress intestinal motility with resultant precipitation or aggravation of toxic megacolon.

Therapy with dicyclomine is contraindicated in patients with reflux esophagitis.

Anticholinergics are contraindicated in patients with obstructive diseases such as achalasia, esophageal stricture or stenosis, pyloroduodenal stenosis, stenosing peptic ulcer, pyloric obstruction, and paralytic ileus. Anticholinergics may further suppress intestinal motility with resultant precipitation or aggravation of toxic megacolon.

Anticholinergic agents are contraindicated in patients with primary glaucoma, a tendency toward glaucoma (narrow anterior chamber angle), or adhesions (synechiae) between the iris and lens, as well as for the elderly and others in whom undiagnosed glaucoma or excessive pressure in the eye may be present. Because anticholinergics cause mydriasis, they may exacerbate these conditions.

The use of drugs with antiperistaltic activity (primarily antidiarrheal and antimuscarinic agents, but also antispasmodic agents such as dicyclomine or oxybutynin at high dosages) is contraindicated in patients with diarrhea due to pseudomembranous enterocolitis or enterotoxin-producing bacteria. These drugs may prolong and/or worsen diarrhea associated with organisms that invade the intestinal mucosa, such as toxigenic E. coli, Salmonella and Shigella, and pseudomembranous colitis due to broad-spectrum antibiotics. Other symptoms and complications such as fever, shedding of organisms and extraintestinal illness may also be increased or prolonged. In general, because antiperistaltic agents decrease gastrointestinal motility, they may delay the excretion of infective gastroenteric organisms or toxins and should be used cautiously in patients with any infectious diarrhea, particularly if accompanied by high fever or pus or blood in the stool. Some cough and cold and other combination products may occasionally include antimuscarinic agents for their drying effects and may, therefore, require careful selection when necessary.

Tirzepatide is contraindicated in patients with a personal or family history of medullary thyroid carcinoma (MTC) and in patients with multiple endocrine neoplasia syndrome type 2. Patients with elevated serum calcitonin or thyroid nodules noted on physical examination or neck imaging should be further evaluated. Patients should be counseled regarding the potential risk for MTC with the use of tirzepatide and should be informed of symptoms of thyroid tumors.

Because antimuscarinic agents have anticholinergic effects, they are contraindicated in patients with myasthenia gravis. Their use may be appropriate to reduce adverse muscarinic effects caused by an anticholinesterase agent.

Anticholinergic agents and agents with secondary anticholinergic activity may aggravate tardive dyskinesia or induce previously suppressed symptoms. Therapy with these agents should be avoided, if possible, or administered cautiously in patients with preexisting tardive dyskinesia, particularly in the elderly. If tardive dyskinesia symptoms develop or worsen during treatment with an anticholinergic agent, prompt withdrawal of therapy will provide better chances of improving the condition.

Tirzepatide is contraindicated in patients with a personal or family history of medullary thyroid carcinoma (MTC) and in patients with multiple endocrine neoplasia syndrome type 2. Patients with elevated serum calcitonin or thyroid nodules noted on physical examination or neck imaging should be further evaluated. Patients should be counseled regarding the potential risk for MTC with the use of tirzepatide and should be informed of symptoms of thyroid tumors.

Therapy with dicyclomine is contraindicated in patients with severe ulcerative colitis. Antimuscarinic agents, such as dicyclomine may suppress intestinal motility and produce paralytic ileus with resultant precipitation of toxic megacolon. Antimuscarinic agents should be administered cautiously to patients with ulcerative colitis.

In general, the use of anticholinergic agents is contraindicated in patients with urinary retention and bladder neck obstruction caused by prostatic hypertrophy. Dysuria may occur and may require catheterization. Also, anticholinergic drugs may aggravate partial obstructive uropathy. Caution is advised even when using agents with mild to moderate anticholinergic activity, particularly in elderly patients.

Antimuscarinic agents block vagal inhibition of the SA nodal pacemaker. These agents should be administered cautiously in patients with tachycardia, congestive heart failure, or coronary artery disease. Premature ventricular depolarization or ventricular tachycardia or fibrillation associated with antimuscarinic drugs is rare.

Tirzepatide has been associated with gastrointestinal adverse reactions (including nausea, vomiting, diarrhea); such events may lead to dehydration, which could cause acute kidney injury if severe. There have been postmarketing reports of acute kidney injury and worsening of chronic renal failure (which may sometimes require hemodialysis) in patients treated with glucagon-like peptide-1 (GLP-1) receptor agonists; some of these events were reported in patients without known underlying renal disease, and most of the reported cases occurred in patients who experienced nausea, vomiting, diarrhea, or dehydration. Renal function should be monitored when starting or escalating doses of tirzepatide in patients with renal dysfunction reporting severe gastrointestinal adverse reactions. No dose adjustment is recommended for patients with renal dysfunction.

Tirzepatide has not been studied in patients with nonproliferative diabetic retinopathy requiring acute therapy, proliferative diabetic retinopathy, or diabetic macular edema; caution is recommended in these patients. Rapid improvement in glucose control has been associated with a temporary worsening of diabetic retinopathy. Patients with history of diabetic retinopathy should be monitored for progression of diabetic retinopathy.

Tirzepatide has been associated with gastrointestinal adverse reactions (including nausea, vomiting, diarrhea); such events may lead to dehydration, which could cause acute kidney injury if severe. There have been postmarketing reports of acute kidney injury and worsening of chronic renal failure (which may sometimes require hemodialysis) in patients treated with glucagon-like peptide-1 (GLP-1) receptor agonists; some of these events were reported in patients without known underlying renal disease, and most of the reported cases occurred in patients who experienced nausea, vomiting, diarrhea, or dehydration. Renal function should be monitored when starting or escalating doses of tirzepatide in patients with renal dysfunction reporting severe gastrointestinal adverse reactions. No dose adjustment is recommended for patients with renal dysfunction.

Antimuscarinic agents decrease gastric motility and relax the lower esophageal sphincter which promotes gastric retention and can aggravate reflux. These drugs should be administered cautiously in patients with gastroesophageal reflux or hiatal hernia associated with reflux esophagitis.

Use of tirzepatide has been associated with gastrointestinal adverse reactions (sometimes severe). Because tirzepatide has not been studied in patients with severe gastrointestinal disease (including severe gastroparesis), it is not recommended in these patients.

Caution is recommended when using dicyclomine in patients with hyperthyroidism.

Antimuscarinic agents block vagal inhibition of the SA nodal pacemaker. These agents should be administered cautiously in patients with tachycardia, congestive heart failure, or coronary artery disease. Premature ventricular depolarization or ventricular tachycardia or fibrillation associated with antimuscarinic drugs is rare.

Effects of hepatic impairment on pharmacokinetics, safety and efficacy of dicyclomine have not been studied. Dicyclomine should be administered with caution in patients with hepatic impairment.

Acute pancreatitis (including fatal and nonfatal hemorrhagic or necrotizing pancreatitis) has been observed in patients treated with glucagon-like peptide-1 (GLP-1) receptor agonists; acute pancreatitis has been reported in patients treated with tirzepatide in clinical trials. Tirzepatide has not been studied in patients with history of pancreatitis; it is unknown if such patients are at higher risk of developing pancreatitis on tirzepatide. After initiation of tirzepatide, patients should be observed carefully for signs/symptoms of pancreatitis (including persistent severe abdominal pain [sometimes radiating to the back], with or without vomiting); if pancreatitis is suspected, tirzepatide should be discontinued and appropriate management should be started.

Toxic psychosis manifested as confusion, disorientation, agitation, excitation, memory impairment, delusions and hallucinations may develop at toxic and therapeutic dosages of antimuscarinic agents. Therapy with these agents should be administered cautiously in patients with mental disorders receiving antimuscarinic agents for control of drug-induced extrapyramidal effects, especially at the beginning of therapy or during dosage adjustment. Psychiatric deterioration and psychotic flare-ups have also been reported following withdrawal of therapy. Symptoms include delusions, hallucinations, aggression or violent behavior, and suicidal tendencies. In high dosages, antimuscarinic agents may sometimes produce euphorigenic effects. For this reason, it can be a drug of abuse.

Effects of renal impairment on pharmacokinetics, safety and efficacy of dicyclomine have not been studied. Dicyclomine is substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Dicyclomine should be administered with caution in patients with renal impairment.

Tirzepatide has been associated with gastrointestinal adverse reactions (including nausea, vomiting, diarrhea); such events may lead to dehydration, which could cause acute kidney injury if severe. There have been postmarketing reports of acute kidney injury and worsening of chronic renal failure (which may sometimes require hemodialysis) in patients treated with glucagon-like peptide-1 (GLP-1) receptor agonists; some of these events were reported in patients without known underlying renal disease, and most of the reported cases occurred in patients who experienced nausea, vomiting, diarrhea, or dehydration. Renal function should be monitored when starting or escalating doses of tirzepatide in patients with renal dysfunction reporting severe gastrointestinal adverse reactions. No dose adjustment is recommended for patients with renal dysfunction.

Tirzepatide has been associated with gastrointestinal adverse reactions (including nausea, vomiting, diarrhea); such events may lead to dehydration, which could cause acute kidney injury if severe. There have been postmarketing reports of acute kidney injury and worsening of chronic renal failure (which may sometimes require hemodialysis) in patients treated with glucagon-like peptide-1 (GLP-1) receptor agonists; some of these events were reported in patients without known underlying renal disease, and most of the reported cases occurred in patients who experienced nausea, vomiting, diarrhea, or dehydration. Renal function should be monitored when starting or escalating doses of tirzepatide in patients with renal dysfunction reporting severe gastrointestinal adverse reactions. No dose adjustment is recommended for patients with renal dysfunction.

Atropine-like agents may increase the risk of hyperthermia in patients with fever by producing anhidrosis. Therapy with atropine-like agents should be administered cautiously in febrile patients.

Cardiovascular effects of anticholinergics may exacerbate hypertension. Therapy with anticholinergic agents should be administered cautiously in patients with hypertension.