DICYCLOMINE HYDROCHLORIDE

DICYCLOMINE HYDROCHLORIDE (dye-sye'kloe-meen) Bentyl, Bentylol , Byclomine, Dibent, Dilomine, Formulex , Lomine , Nospaz, Protylol , Spasmoject Classifications: anticholinergic; antispasmodic; Therapeutic: antispasmodic Prototype: Atropine Pregnancy Category: B

Availability

10 mg, 20 mg capsules; 20 mg tablets; 10 mg/5 mL syrup; 10 mg/mL injection

Action

Synthetic tertiary amine with antispasmodic properties. Relieves smooth muscle spasm in GI and biliary tracts, uterus, and ureters by nonspecific direct relaxant action.

Therapeutic Effect

Exerts antispasmotic effect of the GI as well as the urinary tract.

Uses

Adjunctively in treatment of functional bowel disorders/irritable bowel syndrome.

Unlabeled Uses

Acute enterocolitis, peptic ulcer, and infant colic, urinary incontinence.

Contraindications

Hypersensitivity to anticholinergic drugs; obstructive diseases of GU and GI tracts, paralytic ileus, intestinal atony, biliary tract disease; closed-angle glaucoma; unstable cardiovascular status; severe ulcerative colitis, toxic megacolon, esophagitis; myasthenia gravis; peripheral neuropathy; infants <6 mo; pregnancy (category B), lactation.

Cautious Use

Prostatic hypertrophy; autonomic neuropathy; hyperthyroidism; coronary heart disease, CHF, arrhythmias, hypertension; hepatic or renal disease; GERD, hiatal hernia associated with esophageal reflux.

Route & Dosage

Irritable Bowel Disorders Adult: PO 20–40 mg q.i.d. IM 20 mg q.i.d. Child: PO 10 mg t.i.d. or q.i.d. (max: 40 mg/d) Infant (>6 mo): PO 5 mg t.i.d. or q.i.d.

Administration

Oral

• Give 30 min before meals and at bedtime.

Intramuscular

• Give deep IM into a large muscle. Do NOT give IV.
• Store below 30° C (86° F) unless otherwise directed.

Adverse Effects (≥1%)

All: Dose related. Body as a Whole: Allergic reactions; curare-like effect (cyanosis, apnea, respiratory arrest); decreased sweating; suppression of lactation; urticaria. CNS: Lightheadedness, drowsiness, headache, insomnia, brief euphoria, fever, restlessness, irritability, coma, seizures. CV: Fluctuations in heart rate, palpitation, tachycardia. GI: Dry mouth, nausea, constipation, paralytic ileus, vomiting, diminished sense of taste, bloated feeling. Urogenital: Urinary hesitancy, urinary retention, impotence. Special Senses: Blurred vision.

Pharmacokinetics

Absorption: Readily from GI tract. Onset: 1–2 h. Duration: 4 h. Metabolism: In liver. Elimination: 80% in urine, 10% in feces. Half-Life: 9–10 h.

Nursing Implications

Assessment & Drug Effects

• Monitor for adverse effects especially in infants. Treatment of infant colic with dicyclomine includes some risk, especially in infants <2 mo of age. Doubling the usual dose of 5 mg can produce serious toxic effects. Infants <6 wk have developed respiratory symptoms as well as seizures, fluctuations in heart rate, weakness, and coma within minutes after taking syrup formulation. Symptoms generally last 20–30 min and are believed to be due to local irritation.
• Monitor I&O to assess for urinary retention.
• If drug produces drowsiness and light-headedness, supervision of ambulation and other safety precautions are warranted.

Patient & Family Education

• Exercise caution in hot weather. Dicyclomine may increase risk of heatstroke by decreasing sweating, especially in older adults.
• Do not drive or engage in other potentially hazardous activities until reaction to drug is known.
• Report changes in urine volume, voiding pattern.

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Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug