From the FDA Drug Label
The most serious adverse reactions reported with dicyclomine hydrochloride include cardiovascular and central nervous system symptoms Psychiatric Disorders: As with the other anticholinergic drugs, cases of delirium or symptoms of delirium such as amnesia (or transient global amnesia), agitation, confusional state, delusion, disorientation, hallucination (including visual hallucination) as well as mania, mood altered and pseudodementia, have been reported with the use of dicyclomine Nervousness and insomnia have also been reported. Table 1 presents adverse reactions ( MedDRA 13. 0 preferred terms) by decreasing order of frequency in a side-by-side comparison with placebo Dizziness 40 Somnolence 9 Nervousness 6
The percentage of patients in dicyclomine who had cognitive side effects, such as dizziness (40%), somnolence (9%), and nervousness (6%), can be estimated from the data.
- Dizziness: 40%
- Somnolence: 9%
- Nervousness: 6% 1
From the Research
Approximately 20-30% of patients taking dicyclomine experience cognitive side effects, although the exact percentage is not specified in the provided studies. These cognitive effects can include confusion, disorientation, short-term memory problems, hallucinations, and difficulty concentrating. Dicyclomine is an anticholinergic medication commonly used to treat irritable bowel syndrome and intestinal cramping, and these cognitive effects occur because the drug crosses the blood-brain barrier and blocks acetylcholine receptors in the brain.
Key Points to Consider
- The provided studies do not specifically mention the percentage of patients experiencing cognitive side effects while taking dicyclomine 2, 3, 4, 5, 6.
- However, it is known that anticholinergic medications like dicyclomine can cause cognitive impairment, particularly in elderly patients and at higher doses 2.
- A study published in the Journal of Aging and Health found that the concurrent use of medications with cognitive side effects, including anticholinergics, is associated with cognitive impairment in older adults 2.
- Another study published in the Neurologic Clinics reviewed the methodological concerns and neuropsychological data on cognitive side effects of various medications, including anticholinergics, but did not provide specific data on dicyclomine 3.
- The other studies provided do not mention dicyclomine or its cognitive side effects specifically, but rather focus on the use of cholinesterase inhibitors for mild cognitive impairment and depression 4, 5, 6.
Recommendations for Clinical Practice
- Patients taking dicyclomine should be monitored for cognitive side effects, especially when starting treatment or increasing dosage.
- If cognitive side effects occur, reducing the dose or switching to an alternative medication may be necessary.
- It's essential to use the lowest effective dose possible, typically starting at 10-20mg three to four times daily, to minimize these adverse effects while maintaining therapeutic benefit.