dicyclomine

General

Pronunciation
dye-SYE-kloe-meen [Pronunciation]

Trade Name(s)

• Bentyl

• Bentylol [Canada]

• Formulex [Canada]

• Protylol [Canada]

Indications

Management of irritable bowel syndrome in patients who do not respond to usual interventions (sedation/change in diet).

Action

May have a direct and local effect on GI smooth muscle, reducing motility and tone.

Therapeutic Effect(s):
Decreased GI motility.

Pharmacokinetics

Absorption: Well absorbed after oral and IM administration.

Distribution: Unknown.

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

Half-life: 1.8 hr (initial phase), 9–10 hr (terminal phase).

TIME/ACTION PROFILE (antispasmodic effect)

Contraindication/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;

• Pedi: Infants <6 mo;

• Lactation: Lactation.

• High environmental temperatures (risk of heat prostration);

• Hepatic/renal impairment;

• Autonomic neuropathy;

• Cardiovascular disease;

• Prostatic hyperplasia;

• Geri: Appears on Beers list. Geriatric patients have ↑ sensitivity to anticholinergics;

• OB: Safety not established.

Adverse Reactions/Side Effects

CNS: confusion, drowsiness, light-headedness (IM only).

EENT: blurred vision, ↑ intraocular pressure.

CV: palpitations, tachycardia.

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

GU: erectile dysfunction, urinary hesitancy, urinary retention.

Derm: ↓ sweating.

Endo: ↓ lactation.

Local: pain/redness at IM site.

Misc: ALLERGIC REACTIONS INCLUDING ANAPHYLAXIS .

*CAPITALS indicates life-threatening.
*italic indicates most frequent.

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 q 4–6 hr, adjusted as tolerated..

Availability

• Tablets: 10 mg[canada], 20 mg

• Capsules: 10 mg

• Syrup: 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.

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

• Severe anticholinergic symptoms may be reversed with physostigmine or neostigmine.

Potential Nursing Diagnoses

• Acute pain (Indications)

• Diarrhea (Indications)

Implementation

• PO: Administer dicyclomine 30 min–1 hr before meals.

• 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. Missed doses should be taken 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.

• 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.

Evaluation/Desired Outcomes

A decrease in the symptoms of irritable bowel syndrome.