From the FDA Drug Label
4 CONTRAINDICATIONS Dicyclomine hydrochloride is contraindicated in infants less than 6 months of age [see Use in Specific Populations (8.4)], nursing mothers [see Use in Specific Populations (8.3)] and in patients with:
• unstable cardiovascular status in acute hemorrhage • myasthenia gravis [see Warnings and Precautions (5.4)] • glaucoma [see Adverse Reactions (6.3) and Drug Interactions (7.1)] • obstructive uropathy [see Warnings and Precautions (5.8)] • obstructive disease of the gastrointestinal tract [see Warnings and Precautions (5.5)] • severe ulcerative colitis [see Warnings and Precautions (5.7)] • reflux esophagitis
Dicyclomine is contraindicated in patients with obstructive disease of the gastrointestinal tract. Post gastric bypass surgery, the gastrointestinal tract is altered, which may lead to obstruction. Therefore, dicyclomine is contraindicated post gastric bypass due to the potential risk of obstructive disease of the gastrointestinal tract 1.
From the Research
Dicyclomine is not contraindicated after gastric bypass surgery, but caution is advised due to potential changes in medication absorption and increased side effects. Patients who have undergone gastric bypass can typically take dicyclomine (brand name Bentyl) when needed for irritable bowel syndrome or intestinal spasms, though the standard dosing of 20-40 mg orally three to four times daily may need adjustment 2. After gastric bypass, medication absorption can be altered due to changes in the gastrointestinal anatomy, potentially affecting how quickly dicyclomine is absorbed or how effectively it works.
Key Considerations
- Patients might experience more pronounced side effects such as dry mouth, blurred vision, or constipation due to the anticholinergic properties of dicyclomine 2.
- It's essential to monitor for these effects and discuss any concerns with a healthcare provider.
- Liquid formulations may be preferred over tablets in the early post-operative period to minimize potential issues with absorption.
- The anticholinergic properties of dicyclomine work by relaxing smooth muscle in the gastrointestinal tract, which remains effective even after bypass surgery, though the changed gut anatomy might influence its overall efficacy.
Clinical Guidance
- Always consult with the bariatric surgeon or gastroenterologist before starting or continuing this medication after surgery to ensure safe and effective use.
- Consider alternative medications or adjustments to the treatment plan if significant side effects or concerns arise.
- Note that while dicyclomine's use in managing irritable bowel syndrome is supported by older studies like the one from 1981 2, more recent guidelines on related topics, such as the management of malignant bowel obstruction 3 or the use of domperidone 4, do not directly address the use of dicyclomine post-gastric bypass, emphasizing the need for individualized clinical judgment.