From the Guidelines
Dicyclomine should be held in patients experiencing severe anticholinergic side effects, having contraindications to anticholinergic medications, or developing symptoms of bowel obstruction. This recommendation is based on the potential for dicyclomine to cause severe anticholinergic side effects, such as dry mouth, blurred vision, urinary retention, confusion, tachycardia, and constipation, as noted in the study by 1. The study by 1 suggests that antispasmodics, including dicyclomine, can provide relief from irritable bowel syndrome (IBS) symptoms, but it also highlights the importance of considering the potential risks and side effects associated with these medications. Additionally, the study by 1 mentions that anticholinergic effects can lead to cognitive decline, particularly in the elderly population, which further supports the need for caution when using dicyclomine. It is essential to carefully evaluate the benefits and risks of dicyclomine in individual patients, especially those with pre-existing conditions that may be exacerbated by anticholinergic effects, as discussed in the study by 1. Some key points to consider when deciding to hold dicyclomine include:
- Severe anticholinergic side effects
- Contraindications to anticholinergic medications, such as myasthenia gravis, narrow-angle glaucoma, gastrointestinal obstruction, severe ulcerative colitis, reflux esophagitis, and unstable cardiovascular status
- Symptoms of bowel obstruction, including abdominal distention, severe constipation, or absence of bowel sounds
- Potential for cognitive decline, particularly in elderly patients
- Need for careful evaluation of benefits and risks in individual patients.
From the FDA Drug Label
To report SUSPECTED ADVERSE REACTIONS, contact West-Ward Pharmaceuticals Corp. at 1-800-962-8364 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.com The pattern of adverse effects seen with dicyclomine is mostly related to its pharmacological actions at muscarinic receptors [see Clinical Pharmacology (12)] . The most serious adverse reactions reported with dicyclomine hydrochloride include cardiovascular and central nervous system symptoms [see Warnings and Precautions ( 5.2,5.3)].
Dicyclomine should be held due to the following serious adverse reactions:
- Cardiovascular symptoms: palpitations, tachyarrhythmias, hypertension
- Central nervous system symptoms: dizziness, headache, somnolence, syncope, delirium, seizures
- Other serious reactions: anaphylactic shock, respiratory collapse, apnea, asphyxia, coma, and death 2 It is also recommended to hold dicyclomine in certain populations, such as:
- Infants less than 6 months of age due to the risk of serious respiratory symptoms and other adverse reactions 2
- Nursing mothers because dicyclomine is excreted in human milk and may cause serious adverse reactions in breast-fed infants 2
- Patients with renal impairment due to the increased risk of toxic reactions 2
- Patients with hepatic impairment due to the lack of studies on the effects of hepatic impairment on the pharmacokinetics, safety, and efficacy of dicyclomine 2