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# Dicyclomine (Bentyl)
## Overview
Dicyclomine is an antispasmodic and anticholinergic agent. It acts via direct effect on smooth muscle and blockade of acetylcholine at muscarinic receptor sites. Note: The input "Dj citral" is identified as a misspelling of Dicyclomine.
## Primary Indications
Functional bowel/irritable bowel syndrome (IBS).
## Adult Dosing
* **Initial:** 20 mg orally four times daily.
* **Maintenance:** May increase to 40 mg four times daily after one week if tolerated.
* **Maximum:** 160 mg per day.
## Pediatric Dosing
Use is not recommended in infants < 6 months due to reported fatalities associated with anticholinergic toxicity. Clinical efficacy and safety in children have not been established; dosing is off-label and varies by local institutional protocol.
## Dose Adjustments
* **Renal/Hepatic Impairment:** No specific guidelines; use with caution.
* **Geriatric:** Avoid if possible (Beers Criteria). If necessary, start at the lowest effective dose due to increased risk of cognitive impairment, delirium, and urinary retention.
## Contraindications
* Infants < 6 months.
* Unstable cardiovascular status in acute hemorrhage.
* Myasthenia gravis.
* Obstructive diseases of the GI tract (e.g., pyloroduodenal stenosis, paralytic ileus).
* Severe ulcerative colitis or toxic megacolon.
* Glaucoma.
* Reflux esophagitis.
## Adverse Effects
* **Common:** Dry mouth, dizziness, blurred vision, nausea, lightheadedness, somnolence, weakness, nervousness.
* **Serious:** Anticholinergic toxicity (tachycardia, confusion, urinary retention, hyperthermia), anaphylaxis, respiratory distress.
## Key Drug Interactions
* **Anticholinergics:** Additive toxicity (e.g., atropine, TCAs, antihistamines).
* **Digoxin:** Dicyclomine may increase serum digoxin levels by decreasing GI motility.
* **Antacids:** May decrease absorption of dicyclomine; separate doses.
## Monitoring
* Monitor for signs of anticholinergic toxicity (especially in the elderly).
* Monitor bowel sounds and stool frequency for signs of paralytic ileus or obstruction.
* Maintain awareness of visual changes or urinary symptoms.
## Clinical Pearls
* Dicyclomine's anticholinergic effects place elderly patients at high risk for falls and cognitive decline.
* Patients should be advised to avoid driving or operating machinery until the extent of drowsiness/blurred vision is known.
* Administer 30 minutes before meals.
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**Disclaimer:** This information is for educational purposes and does not substitute for professional medical judgment. Always verify current prescribing information, institutional protocols, and patient-specific factors before administration.
