dicyclomine

Absorption: Well absorbed after oral and IM administration.

Distribution: Unknown.

Metabolism/Excretion: 80% eliminated in urine, 10% in feces.

Half-Life: 9–10 hr.

Time/Action Profile ⬆ ⬇

(antispasmodic effect)

ROUTE	ONSET	PEAK	DURATION
PO, IM	unknown	unknown	unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Obstruction of the GI or GU tract;
Reflux esophagitis;
Severe ulcerative colitis (↑ risk of paralytic ileus);
Unstable cardiovascular status;
Glaucoma;
Myasthenia gravis;
Lactation: Lactation;
Pedi: Infants 6 mo.

Use Cautiously in:

High environmental temperatures (risk of heat prostration);
Renal impairment;
Hepatic impairment;
Autonomic neuropathy;
Cardiovascular disease;
Prostatic hyperplasia;
OB: Safety not established in pregnancy;
Geri: Appears on Beers list. risk of adverse reactions in older adults due to anticholinergic effects. Avoid use in older adults.

Adv. Reactions/Side Effects ⬆ ⬇

CV: palpitations, tachycardia

Derm: ↓sweating

EENT: blurred vision, ↑intraocular pressure

Endo: ↓lactation

GI: constipation, heartburn, ↓salivation, dry mouth, nausea, PARALYTIC ILEUS, vomiting

GU: erectile dysfunction, urinary hesitancy, urinary retention

Local: pain/redness at IM site

Neuro: confusion, delirium, drowsiness, light-headedness (IM only), psychosis

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS)

Interactions ⬆ ⬇

Drug-drug:

Additive anticholinergic effects with other anticholinergics, including antihistamines, quinidine, and disopyramide.
May alter the absorption of other orally administered drugs by slowing motility of the GI tract.
Antacids or adsorbent antidiarrheals↓ the absorption of anticholinergics.
May ↑ GI mucosal lesions in patients taking oral potassium chloride tablets.

Route/Dosage ⬆ ⬇

PO (Adults ): 10–20 mg 3–4 times daily (up to 160 mg/day).
PO (Children ≥2 yr): 10 mg 3–4 times daily, adjusted as tolerated.
PO (Children 6 mo–2 yr): 5–10 mg 3–4 times daily, adjusted as tolerated.
IM (Adults ): 20 mg every 4–6 hr, adjusted as tolerated.

Availability ⬆ ⬇

(Generic available)

Tablets: 10 mg; 20 mg
Capsules: 10 mg
Oral solution cherry flavor: 10 mg/5 mL
Solution for injection: 10 mg/mL

Assessment ⬆ ⬇

Assess for symptoms of irritable bowel syndrome (abdominal cramping, alternating constipation and diarrhea, mucus in stools) before and periodically during therapy.
Assess patient routinely for abdominal distention and auscultate for bowel sounds. If constipation becomes a problem, increasing fluids and adding bulk to the diet may help alleviate the constipating effects of the drug.
Monitor intake and output ratios; may cause urinary retention.
Monitor for peripheral and central nervous system side effects (dry mouth with difficulty in swallowing and talking, thirst, reduced bronchial secretions, mydriasis with loss of accommodation (cycloplegia) and photophobia, flushing and dry skin, transient bradycardia followed by tachycardia, with palpitations and arrhythmias, and difficulty in micturition, reduction in the tone and motility of the GI tract leading to constipation). Symptoms are caused by inhibitory effect on muscarinic receptors within the autonomic nervous system. Effects are dose-related and usually reversible when therapy is discontinued.

Lab Test Considerations:

Antagonizes effects of pentagastrin and histamine during the gastric acid secretion test. Avoid administration for 24 hr preceding the test.

Toxicity and Overdose:

Severe anticholinergic symptoms may be reversed with neostigmine.

Implementation ⬆ ⬇

PO: Administer dicyclomine without regard to food.
IM: Monitor patient after administration; may cause light-headedness and irritation at injection site. Do not administer IV; may cause thrombosis and thrombophlebitis.

Patient/Family Teaching ⬆ ⬇

Instruct patient to take dicyclomine exactly as directed and not to take more than the prescribed amount. Take missed doses as soon as remembered if not just before next dose.
Medication may cause drowsiness and blurred vision. Caution patient to avoid driving or other activities requiring alertness until response to the medication is known.
Advise patient to stay in temperature-controlled rooms. Fever and extremes of heat may cause confusional state, disorientation, amnesia, hallucinations, dysarthria, ataxia, coma, euphoria, fatigue, insomnia, agitation and mannerisms, inappropriate affect, psychosis and delirium. Usually resolves 12–24 hr after discontinuation of dicyclomine.
Inform patient that frequent oral rinses, sugarless gum or candy, and good oral hygiene may help relieve dry mouth. Consult health care professional regarding use of saliva substitute if dry mouth persists for more than 2 wk.
Advise patient receiving dicyclomine to make position changes slowly to minimize the effects of drug-induced orthostatic hypotension.
Caution patient to avoid extremes of temperature. This medication decreases the ability to sweat and may increase the risk of heat stroke.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other Rx, OTC, or herbal products.
Advise patient to notify health care professional immediately if eye pain or increased sensitivity to light occurs. Emphasize the importance of routine eye exams throughout therapy.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected and to avoid breastfeeding.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇