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# Dicyclomine (Bentyl) ## Overview Dicyclomine is a synthetic antispasmodic and anticholinergic agent that acts directly on smooth muscle to relieve spasms in the gastrointestinal tract. It possesses both anticholinergic effects and a direct effect on smooth muscle relaxation. ## Primary Indications - Treatment of functional bowel/irritable bowel syndrome (IBS). ## Adult Dosing - **Oral:** 20 mg up to 4 times daily. - **Maximum:** 80 mg/day. If efficacy is not achieved after 2 weeks, discontinue use. - **Intramuscular (IM):** 20 mg every 4 to 6 hours. (Not for IV use). ## Pediatric Dosing - **Safety and efficacy in pediatric patients have not been established.** - The drug is contraindicated in infants younger than 6 months due to reported instances of serious respiratory distress, seizures, and death. Use in older children should be avoided unless clearly indicated, following local institutional guidelines. ## Dose Adjustments - **Renal Impairment:** No formal dosage adjustment guidelines; use with caution. - **Hepatic Impairment:** Use with caution; monitor for increased anticholinergic toxicity. - **Geriatric:** Start at the lowest possible dose (10 mg) due to increased risk of anticholinergic side effects (confusion, delirium, urinary retention). ## Contraindications - Infants < 6 months. - Patients with unstable cardiovascular status in acute hemorrhage. - Myasthenia gravis. - Obstructive disease of the GI tract (e.g., paralytic ileus, pyloroduodenal stenosis). - Severe ulcerative colitis or toxic megacolon. - Obstructive uropathy (e.g., bladder neck obstruction). - Glaucoma. ## Adverse Effects - **Common:** Xerostomia (dry mouth), dizziness, blurred vision, nausea, nervousness, asthenia. - **Serious:** Tachycardia, urinary retention, confusion, hallucinations (particularly in the elderly), and heatstroke (due to suppressed sweating). ## Key Drug Interactions - **Anticholinergic agents:** Additive effects (e.g., tricyclic antidepressants, antihistamines, antipsychotics). - **Digoxin:** Dicyclomine may increase oral bioavailability of digoxin tablets by slowing GI motility. - **Potassium chloride:** Increased risk of gastrointestinal mucosal lesions/ulceration when taken with anticholinergics. ## Monitoring - Monitor for signs of anticholinergic toxicity, particularly in elderly patients (confusion, urinary retention, tachycardia). - Monitor efficacy for IBS symptoms; discontinue if no improvement after 2 weeks. ## Clinical Pearls - **Dosage Form:** Dicyclomine should never be administered intravenously (IV). - **Environment:** Advise patients to avoid physical exertion in hot environments, as dicyclomine inhibits sweating and may lead to heatstroke. - **CNS effects:** Dicyclomine may impair mental alertness; caution patients against driving or operating machinery until the effects are known. *** **Disclaimer:** This information is for educational purposes only. Drug information is subject to change. Always verify current prescribing information, institutional protocols, and patient-specific factors via professional clinical databases (e.g., Lexicomp, UpToDate) or the official manufacturer’s product insert before prescribing or administering medication.