From the FDA Drug Label
Dicyclomine hydrochloride solution is for intramuscular administration only. Do not administer by any other route. Inadvertent intravenous administration may result in thrombosis, thrombophlebitis, and injection site reactions such as pain, edema, skin color change, and reflex sympathetic dystrophy syndrome [see ADVERSE REACTIONS ( 6.2)] . Cases of thrombosis, thrombophlebitis and injection site reactions such as local pain, edema, skin color change and even reflex sympathetic dystrophy syndrome have been reported following Inadvertent IV injection of dicyclomine hydrochloride.
Bentyl IV mistake can result in serious adverse reactions, including:
- Thrombosis
- Thrombophlebitis
- Injection site reactions, such as:
From the Research
If you've mistakenly administered Bentyl (dicyclomine) intravenously instead of through the intended route, you should immediately stop the infusion and monitor the patient closely for adverse effects, considering the use of oral rivastigmine as an alternative treatment for anticholinergic delirium, as suggested by a recent case report 2. Bentyl is not approved for IV use and should typically be given orally or intramuscularly. Common symptoms of incorrect administration may include tachycardia, hypotension, confusion, agitation, dry mouth, blurred vision, urinary retention, and constipation. Contact the physician immediately to report the error, document the incident according to your facility's protocols, and prepare to provide supportive care as needed. The patient may require cardiac monitoring, IV fluids, and possibly anticholinergic antidotes like physostigmine in severe cases, although the availability of physostigmine may be limited due to national drug shortages in the United States 3. This medication error is concerning because Bentyl is an anticholinergic agent that blocks acetylcholine receptors, and when given intravenously, it can cause rapid and potentially dangerous systemic anticholinergic effects that would normally be moderated by slower absorption through other routes. Some studies have shown that physostigmine is relatively safe and effective in reversing anticholinergic toxidrome 3, 4, 5, 6, but the most recent and highest quality study suggests considering oral rivastigmine as an alternative treatment 2. Key considerations in managing this error include:
- Immediate cessation of the infusion
- Close monitoring for adverse effects
- Supportive care as needed
- Consideration of alternative anticholinergic antidotes like oral rivastigmine
- Documentation and reporting of the incident according to facility protocols.