Skip to Content

Dicyclomine

Pronunciation

Pronunciation

(dye SYE kloe meen)

Index Terms

  • Dicyclomine Hydrochloride
  • Dicycloverine Hydrochloride

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Capsule, Oral, as hydrochloride:

Bentyl: 10 mg [contains brilliant blue fcf (fd&c blue #1), fd&c red #40]

Generic: 10 mg

Solution, Intramuscular, as hydrochloride:

Bentyl: 10 mg/mL (2 mL) [pyrogen free]

Generic: 10 mg/mL (2 mL)

Solution, Oral, as hydrochloride:

Generic: 10 mg/5 mL (473 mL)

Tablet, Oral, as hydrochloride:

Bentyl: 20 mg

Generic: 20 mg

Brand Names: U.S.

  • Bentyl

Pharmacologic Category

  • Anticholinergic Agent

Pharmacology

Blocks the action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands and the CNS

Absorption

Oral: Rapid and well absorbed

Distribution

Vd: 3.65 L/kg

Metabolism

Extensive

Excretion

Urine (80%, small amounts as unchanged drug); feces (8%)

Onset of Action

1 to 2 hours

Time to Peak

Oral: 60-90 minutes

Duration of Action

Up to 4 hours

Half-Life Elimination

Initial phase: ~1.8 hours; Terminal phase: Undetermined, but somewhat longer than the initial phase

Use: Labeled Indications

Treatment of functional bowel/irritable bowel syndrome

Contraindications

Obstructive diseases of the GI tract; severe ulcerative colitis; reflux esophagitis; unstable cardiovascular status in acute hemorrhage; obstructive uropathy; glaucoma; myasthenia gravis; breast-feeding; infants <6 months of age

Canadian labeling: Additional contraindications (not in U.S. labeling): Hypersensitivity to dicyclomine or any component of the formulation

Dosing: Adult

Gastrointestinal motility disorders/irritable bowel:

Oral: Initial: 20 mg 4 times daily for 7 days; after 1 week, may increase to 40 mg 4 times daily. If efficacy not achieved in 2 weeks or if adverse effects require a dose <80 mg/day, therapy should be discontinued. Safety data are not available for doses >80 mg daily for a duration that exceeds 2 weeks.

IM (should not be used IV): 10-20 mg 4 times daily for 1-2 days; convert to oral therapy as soon as possible

Dosing: Geriatric

Refer to adult dosing. Use caution; lower dosages may be required.

Dosing: Renal Impairment

No dosage adjustment provided in the manufacturer’s labeling (has not been studied); use with caution.

Dosing: Hepatic Impairment

No dosage adjustment provided in the manufacturer’s labeling (has not been studied); use with caution.

Administration

Injection solution: Do not administer IV; administer as IM injection only.

Storage

Capsule, tablet: Store at room temperature, preferably below 30°C (86°F). Protect tablet from direct sunlight.

Oral solution: Store at 20°C to 25°C (68°F to 77°F); protect from excessive heat.

Solution for injection: Store at room temperature, preferably below 30°C (86°F); protect from freezing.

Drug Interactions

AbobotulinumtoxinA: Anticholinergic Agents may enhance the anticholinergic effect of AbobotulinumtoxinA. Monitor therapy

Acetylcholinesterase Inhibitors: Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors. Acetylcholinesterase Inhibitors may diminish the therapeutic effect of Anticholinergic Agents. Monitor therapy

Aclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination

Analgesics (Opioid): Anticholinergic Agents may enhance the adverse/toxic effect of Analgesics (Opioid). Specifically, the risk for constipation and urinary retention may be increased with this combination. Monitor therapy

Anticholinergic Agents: May enhance the adverse/toxic effect of other Anticholinergic Agents. Monitor therapy

Cannabinoid-Containing Products: Anticholinergic Agents may enhance the tachycardic effect of Cannabinoid-Containing Products. Exceptions: Cannabidiol. Monitor therapy

Chloral Betaine: May enhance the adverse/toxic effect of Anticholinergic Agents. Monitor therapy

Cimetropium: Anticholinergic Agents may enhance the anticholinergic effect of Cimetropium. Avoid combination

Eluxadoline: Anticholinergic Agents may enhance the constipating effect of Eluxadoline. Avoid combination

Gastrointestinal Agents (Prokinetic): Anticholinergic Agents may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic). Monitor therapy

Glucagon: Anticholinergic Agents may enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased. Avoid combination

Glycopyrrolate (Oral Inhalation): Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation). Avoid combination

Ipratropium (Oral Inhalation): May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination

Itopride: Anticholinergic Agents may diminish the therapeutic effect of Itopride. Monitor therapy

Levosulpiride: Anticholinergic Agents may diminish the therapeutic effect of Levosulpiride. Avoid combination

Mianserin: May enhance the anticholinergic effect of Anticholinergic Agents. Monitor therapy

Mirabegron: Anticholinergic Agents may enhance the adverse/toxic effect of Mirabegron. Monitor therapy

Nitroglycerin: Anticholinergic Agents may decrease the absorption of Nitroglycerin. Specifically, anticholinergic agents may decrease the dissolution of sublingual nitroglycerin tablets, possibly impairing or slowing nitroglycerin absorption. Avoid combination

OnabotulinumtoxinA: Anticholinergic Agents may enhance the anticholinergic effect of OnabotulinumtoxinA. Monitor therapy

Oxatomide: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination

Potassium Chloride: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride. Avoid combination

Pramlintide: May enhance the anticholinergic effect of Anticholinergic Agents. These effects are specific to the GI tract. Consider therapy modification

Ramosetron: Anticholinergic Agents may enhance the constipating effect of Ramosetron. Monitor therapy

RimabotulinumtoxinB: Anticholinergic Agents may enhance the anticholinergic effect of RimabotulinumtoxinB. Monitor therapy

Secretin: Anticholinergic Agents may diminish the therapeutic effect of Secretin. Management: Avoid using drugs with substantial anticholinergic effects in patients receiving secretin whenever possible. If such agents must be used in combination, monitor closely for a diminished response to secretin. Consider therapy modification

Thiazide and Thiazide-Like Diuretics: Anticholinergic Agents may increase the serum concentration of Thiazide and Thiazide-Like Diuretics. Monitor therapy

Tiotropium: Anticholinergic Agents may enhance the anticholinergic effect of Tiotropium. Avoid combination

Topiramate: Anticholinergic Agents may enhance the adverse/toxic effect of Topiramate. Monitor therapy

Umeclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination

Adverse Reactions

>10%:

Central nervous system: Dizziness (40%)

Gastrointestinal: Xerostomia (33%), nausea (14%)

Ophthalmic: Blurred vision (27%)

1% to 10%:

Central nervous system: Drowsiness (9%), nervousness (6%)

Neuromuscular & skeletal: Weakness (7%)

Postmarketing and/or case reports (Limited to important or life-threatening): Abdominal distention, abdominal pain, anaphylactic shock, angioedema, confusion, constipation, cycloplegia, decreased lactation, delirium, dermatitis (allergic), dyspepsia, dyspnea, erythema, facial edema, fatigue, hallucination, headache, hypersensitivity, insomnia, malaise, mydriasis, nasal congestion, palpitations, skin rash, syncope, tachyarrhythmia, vomiting

Warnings/Precautions

Concerns related to adverse effects:

• CNS effects: May cause drowsiness and/or blurred vision, which may impair physical or mental abilities; patients must be cautioned about performing tasks which require mental alertness (eg, operating machinery or driving).

• Diarrhea: May be a sign of incomplete intestinal obstruction, treatment should be discontinued if this occurs.

• Heat prostration: May occur in the presence of increased environmental temperature; use caution in hot weather and/or exercise.

• Psychosis/delirium: Has been reported in patients with an extreme sensitivity to anticholinergic effects or at excessive dosages, such as the elderly or patients with mental illness.

Disease-related concerns:

• Cardiovascular disease: Use with caution in patients with coronary artery disease, tachyarrhythmias, heart failure, or hypertension; evaluate tachycardia prior to administration.

• Hepatic impairment: Use with caution in patients with hepatic impairment.

• Hyperthyroidism: Use with caution in patients with hyperthyroidism.

• Neuropathy: Use with caution in patients with autonomic neuropathy.

• Prostatic hyperplasia: Use with caution in patients with prostatic hyperplasia (known or suspected).

• Renal impairment: Use with caution in patients with renal impairment.

• Salmonella dysentery: Do not use anticholinergic agents in patients with salmonella dysentery; toxic dilatation of intestine and intestinal perforation may occur.

• Ulcerative colitis: Use with caution in patients with mild-moderate ulcerative colitis. Use is contraindicated in patients with severe ulcerative colitis.

Concurrent drug therapy issues:

• Sedatives: Effects may be potentiated when used with other sedative drugs or ethanol.

Special populations:

• Pediatric: Serious respiratory reactions, central nervous symptoms, and deaths have been reported following administration to infants; use in infants <6 months of age is contraindicated).

Other warnings/precautions:

• Appropriate administration: Injectable formulation is for IM administration only; inadvertent IV administration may cause thrombosis/thrombophlebitis and injection site reactions (eg, pain, edema, skin color change, reflex sympathetic dystrophy).

Monitoring Parameters

Pulse, anticholinergic effect, urinary output, GI symptoms

Pregnancy Risk Factor

B

Pregnancy Considerations

Adverse events have not been observed in animal reproduction studies. In epidemiologic studies, birth defects were not observed in pregnant women taking doses up to 40 mg daily throughout the first trimester; information has not been located when used in pregnant women at recommended doses (80-160 mg daily). Use for the treatment of irritable bowel syndrome (IBS) is not recommended during pregnancy (Mahadevan, 2006).

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience fatigue, blurred vision, nausea, anxiety, loss of strength and energy, dry mouth, or dry skin. Have patient report immediately to prescriber severe dizziness, passing out, confusion, change in speech, difficulty swallowing, difficulty speaking, change in balance, vision changes, urinary retention, severe diarrhea, severe constipation, bradycardia, tachycardia, abnormal heartbeat, hallucinations, memory impairment, or mood changes (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.

Hide