What is the recommended dosage and treatment duration for dicyclomine in treating smooth muscle spasms?

From the Guidelines

The recommended dosage of dicyclomine for treating smooth muscle spasms in adults is typically 20 mg taken orally four times daily, which can be increased to 40 mg four times daily if needed and tolerated. This recommendation is based on the most recent and highest quality study available, which suggests that antispasmodics, including dicyclomine, can be effective in reducing abdominal pain associated with irritable bowel syndrome (IBS) 1.

Key Considerations

• Treatment usually begins with a lower dose that is gradually increased to minimize side effects.
• The duration of therapy depends on the underlying condition but is generally continued as long as symptoms persist, with periodic reassessment to determine ongoing need.
• For acute conditions, treatment may last 1-2 weeks, while chronic conditions might require longer therapy.
• Dicyclomine works by blocking acetylcholine receptors in smooth muscle, reducing spasms particularly in the gastrointestinal tract.
• Patients should take the medication before meals and at bedtime for optimal effect.

Important Safety Information

• Common side effects include dry mouth, blurred vision, and constipation.
• Dicyclomine should be used cautiously in elderly patients and is contraindicated in certain conditions including glaucoma, myasthenia gravis, and intestinal obstruction.
• If symptoms don't improve after two weeks of treatment, patients should consult their healthcare provider for reevaluation, as suggested by guidelines on the management of IBS 1.

Evidence Summary

The use of antispasmodics like dicyclomine in IBS is supported by a Cochrane Review that included 22 RCTs evaluating 2983 patients with IBS, showing a significantly greater proportion of patients taking antispasmodics who had adequate global relief of IBS symptoms compared to placebo 1. While the overall certainty in evidence is low due to the serious risk of bias and publication bias, the available data suggest that dicyclomine can be an effective treatment option for smooth muscle spasms.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Dicyclomine Dosage and Treatment Duration

• The recommended dosage of dicyclomine for treating smooth muscle spasms is 40 mg, taken 4 times daily 2.
• The treatment duration for dicyclomine in treating smooth muscle spasms can vary, but one study found that a 2-week treatment period was effective in improving symptoms of irritable bowel syndrome (IBS) 2.
• Another study found that dicyclomine produced significant improvement in symptoms of the uninhibited bladder after 8 weeks of therapy, with an average increase in bladder capacity of 137 ml (91%) 3.

Efficacy and Safety of Dicyclomine

• Dicyclomine has been found to be effective in treating chronic abdominal pain in patients with IBS, with improvements in abdominal pain, tenderness, and bowel habits 2.
• However, the efficacy and safety of dicyclomine can vary depending on the individual patient and the specific condition being treated, and each agent should be considered on an individual basis rather than being prescribed based on information across the broad class of agents 4.
• Antispasmodic agents, including dicyclomine, may be effective in selected patients with inflammatory bowel disease (IBD), especially those who are in remission and have mild/moderate chronic pain 5.