Dicyclomine HCl

 Action Relieves smooth muscle spasm of GI tract through anticholinergic effects and direct action on GI smooth muscle.

 Indications Treatment of functional bowel/irritable bowel syndrome (irritable colon, spastic colon, mucous colitis). Unlabeled use(s): Intestinal colic in children > 6 mo.

 Contraindications Narrow angle glaucoma; adhesions between iris and lens; obstructive uropathy; obstructive disease of GI tract; paralytic ileus; intestinal atony of elderly or debilitated patient; severe ulcerative colitis; toxic megacolon complicating ulcerative colitis; hepatic or renal disease; tachycardia; myocardial ischemia; unstable cardiovascular status in acute hemorrhage; myasthenia gravis; infants < 6 mo.

 Route/Dosage

ADULTS: Initial dose: PO 80 mg/day in 4 equally divided doses. Increase to 160 mg/day in 4 equally divided doses. IM 80 mg/day in 4 divided doses.

 Interactions

Amantadine, tricyclic antidepressants: May cause increased anticholinergic side effects. Atenolol, digoxin: May increase pharmacologic effects of these drugs. Phenothiazines: May reduce antipsychotic effectiveness.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Palpitations; tachycardia. CNS: Headache; flushing; nervousness; drowsiness; weakness; dizziness; confusion; insomnia; fever (especially in children); mental confusion or excitement (especially in elderly, even with small doses); CNS stimulation (restlessness, tremor); lightheadedness. DERM: Severe allergic reactions including anaphylaxis, urticaria and dermal manifestations; local irritation following injection. EENT: Blurred vision; mydriasis; photophobia; cycloplegia; increased IOP; dilated pupils; nasal congestion. GI: Dry mouth; altered taste perception; nausea; vomiting; dysphagia; heartburn; constipation; bloated feeling; paralytic ileus. GU: Urinary hesitancy and retention; impotence. OTHER: Suppression of lactation; decreased sweating.

 Precautions

Pregnancy: Category B. Lactation: Excreted in breast milk. Children: Safety and efficacy have not been established. Contraindicated in infants < 6 mo. In infants, serious respiratory symptoms, seizures, syncope, pulse rate fluctuation, muscular hypotonia, coma and death have been reported. Elderly or debilitated patients: Elderly patients may react with excitement, agitation, drowsiness, and other untoward manifestations to even small doses. Special risk patients: Use with caution in patients with autonomic neuropathy, hyperthyroidism, hypertension, coronary heart disease, CHF, hiatal hernia, prostatic hypertrophy. Anticholinergic psychosis: Reported in sensitive individuals and may include confusion, disorientation, short-term memory loss, hallucinations, dysarthria, ataxia, coma, euphoria, decreased anxiety, fatigue, insomnia, agitation and mannerisms, and inappropriate affect. Diarrhea: May be symptom of incomplete intestinal obstruction, especially in patients with ileostomy or colostomy. Treatment of diarrhea with drug is inappropriate and possibly harmful. Gastric ulcer: May delay gastric emptying rate and complicate therapy. Heat prostration: Can occur in presence of high environmental temperature.

 Administration/Storage

• For parenteral administration, give only intramuscularly. Drug is not for IV use.
• Administer drug 30 min before meals.
• Store in tightly closed container at room temperature and protect from light. Injection fluid should be clear.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Assess baseline vital signs.
• Monitor I&O.
• Ask patient if difficulty in voiding is a problem.
• Assess hydration status (eg, skin turgor, mucous membranes, stool consistency, frequency) and bowel sounds.
• Monitor patient for changes in vital signs and sensorium (eg, fever, tachycardia, confusion, anxiety).

 Patient/Family Education

• Instruct patient not to take any otc medications without consulting physician.
• Advise contact lens wearers to use lubricating solutions.
• Warn patients to avoid direct sunlight and any heat extremes (eg, exercise in hot weather, saunas, prolonged activity in hot weather).
• Instruct patient to take sips of water frequently, suck on ice chips or sugarless hard candy or chew sugarless gum if dry mouth occurs.
• Alert patients to pay special attention to fever, decreased ability to sweat and changes in bowel or bladder habits.
• Advise elderly patients to report eye pain to physician or ophthalmologist and to undergo testing for glaucoma.
• Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.
• Tell patient to report any difficulty in swallowing to physician.