dicyclomine (Rx)

Brand and Other Names:Bentyl
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

capsule

  • 10mg

injectable solution

  • 10mg/mL

syrup

  • 10mg/5mL

tablet

  • 20mg
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Irritable Bowel Syndrome

20 mg PO q6hr; may increase up to 40 mg q6hr; if efficacy not achieved in 2 weeks or adverse effects require dose <80 mg/day, therapy should be discontinued; safety data not available for doses > 80 mg/day for periods > 2 weeks

10-20 mg IM q6hr; not to exceed 80 mg/day IM

Dosing considerations

  • IM use should not be longer than 1-2 days; replace IM with PO as soon as possible
  • Do not use IV

Administration

Take 30-60 minutes before a meal

Dosage Forms & Strengths

capsule

  • 10mg

injectable solution

  • 10mg/mL

syrup

  • 10mg/5mL

tablet

  • 20mg
more...

Irritable Bowel Syndrome (Off-label)

Infants >6 months: 5 mg PO q6-8hr; not to exceed 20 mg/day PO

Children: 10 mg PO q6-8hr; not to exceed 40 mg/day PO

Administration

Take 30-60 minutes before a meal

Irritable bowel syndrome

10-20 mg PO q6hr; may gradually increase PRN; not to exceed 160 mg/day

Dosing considerations

High incidence of anticholinergic effects; avoid except in short-term situations to decrease secretions (Beers Criteria)

Do not use IM in geriatric patients

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Interactions

Interaction Checker

and dicyclomine

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    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Dizziness (40%)

            Xerostomia (33%)

            Blurred vision (27%)

            1-10%

            Somnolence (9%)

            Nervousness (6%)

            Weakness (7%)

            Frequency Not Defined

            Abdominal distension

            Confusional state

            Cycloplegia

            Delirium

            Dermatitis

            Erythema

            Fatigue

            Hallucinations

            Insomnia

            Malaise

            Palpitation

            Rash

            Syncope

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            Warnings

            Contraindications

            Hypersensitivity to dicyclomine or any anticholinergic drugs

            Closed-angle glaucoma

            Myasthenia gravis

            Hemorrhage with cardiovascular instability

            Paralytic ileus

            Breast feeding

            Intestinal atony of elderly/debilitated patients

            Toxic megacolon

            GI obstruction

            Obstructive uropathy

            Severe ulcerative colitis

            Reflux esophagitis

            Infants aged <6 months (reports of seizure, respiratory failure, death)

            Cautions

            Caution in renal/hepatic impairment

            Caution in benign prostatic hyperplasia

            Caution in congestive heart failure

            Caution in tachycardia secondary to cardiac insufficiency or thyrotoxicosis, hypertension, coronary artery disease, chronic obstructive pulmonary disease, hiatal hernia, mitral stenosis, brain damage or spastic paralysis in children, salivary secretion disorder, down syndrome, autonimic neuropathy, hyperthyroidism

            Tachyarrhythmia; assess before administration

            Toxin-mediated diarrhea

            Elderly (Beers Criteria)

            May cause drowsiness; avoid alcohol

            For IM injection only; IV injection may result in thrombosis or thrombophlebitis and injection-site reactions

            Heat prostration can occur (fever and heat stroke due to decreased sweating)

            Psychosis in patients sensitive to anticholinergic drugs reported (eg, elderly, mentally ill individuals); signs and symptoms resolve within 12-24 hr after discontinuation

            Incomplete intestinal obstruction: Diarrhea may be an early symptom, especially in patients with ileostomy or colostomy

            Salmonella dysenteric patients: Due to risk of toxic megacolon

            Use caution in patients with mild-moderate ulcerative colitis

            Effects may be potentiated when used with other sedative drugs or ethanol

            Serious respiratory reactions, CNS symptoms, and deaths reported following administration to infants

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            Pregnancy & Lactation

            Pregnancy category: B

            Lactation: Enters breast milk; contraindicated

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Anticholinergic/antispasmodic; no effect on acid secretion, but direct smooth muscle relaxant effects; blocks the action of ACh at parasympathetic sites in smooth muscle, secretory glands, and CNS

            Absorption

            Bioavailability: PO (67% of IM)

            Onset: 1-2 hr

            Duration: <4 hr

            Peak plasma time: PO (60-90 min)

            Distribution

            Vd: 3.65 L/kg

            Metabolism

            Metabolites: Ranitidine N-oxide, desmethylranitidine, ranitidine

            Elimination

            Half-life: 1.8 hr

            Excretion: Urine (80%); feces (8%)

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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