dicyclomine
dicyclomine
[di-si´klo-mēn]dicyclomine (dicycloverine (UK))
Pharmacologic class: Anticholinergic
Therapeutic class: Antispasmodic
Pregnancy risk category B
Action
Thought to exert direct effect on GI smooth muscle by inhibiting acetylcholine at receptor sites, thereby reducing GI tract motility and tone
Availability
Capsules: 10 mg
Solution for injection: 10 mg/ml
Syrup: 10 mg/5 ml
Tablets: 20 mg
Indications and dosages
➣ Irritable bowel syndrome in patients unresponsive to usual interventions
Adults: 20 mg P.O. or I.M. q.i.d.; may increase up to 160 mg/day
Contraindications
• Hypersensitivity to drug
• GI or genitourinary tract obstruction
• Severe ulcerative colitis
• Reflux esophagitis
• Unstable cardiovascular status
• Glaucoma
• Myasthenia gravis
• Breastfeeding
• Infants younger than 6 months
Precautions
Use cautiously in:
• hepatic or renal impairment, autonomic neuropathy, cardiovascular disease, prostatic hypertrophy
• elderly patients
• pregnant patients (safety not established).
Administration
• Give 30 to 60 minutes before meals; give bedtime dose at least 2 hours after evening meal.
See Don't administer by I.V. route.
• Don't give by I.M. route for more than 2 days.
Adverse reactions
CNS: confusion, drowsiness, light-headedness (with I.M. use), psychosis
CV: palpitations, tachycardia
EENT: blurred vision, increased intraocular pressure
GI: nausea, vomiting, constipation, heartburn, decreased salivation, dry mouth, paralytic ileus
GU: urinary hesitancy or retention, erectile dysfunction, decreased lactation
Skin: decreased sweating, rash, itching, urticaria
Other: pain and redness at I.M. site, allergic reactions including anaphylaxis
Interactions
Drug-drug. Adsorbent antidiarrheals, antacids: decreased dicyclomine absorption
Cyclopropane anesthetics: increased risk of cardiovascular adverse reactions
Oral drugs: altered absorption of these drugs
Potassium (oral): increased GI mucosal lesions
Other anticholinergics (including antihistamines, disopyramide, quinidine): additive anticholinergic effects
Drug-diagnostic tests. Gastric acid secretion test: antagonism of pentagastrin and histamine (testing agents)
Patient monitoring
See Stay alert for anaphylaxis.
• Monitor vital signs and fluid intake and output. Ask patient about palpitations.
See Assess for light-headedness, confusion, and rash after I.M. injection.
• Evaluate patient's vision, particularly for blurring and other signs and symptoms of increasing intraocular pressure.
• Assess bowel pattern, particularly for signs and symptoms of paralytic ileus.
Patient teaching
• Instruct patient to take drug 30 to 60 minutes before meals and to take bedtime dose at least 2 hours after evening meal.
• Advise patient not to take antacids or adsorbent antidiarrheals within 2 hours of dicyclomine.
See Urge patient to promptly report rash, abdominal pain, decreased urinary output, or absence of bowel movements.
• Caution patient to avoid driving or other hazardous activities until he knows how drug affects concentration, vision, and alertness.
See Instruct patient to avoid exposure to high temperatures and to immediately notify prescriber if fever and decreased sweating occur in high environmental temperature.
• Advise patient to minimize GI upset by eating small, frequent servings of healthy food and drinking plenty of fluids.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.