From the Guidelines
Dicyclomine is contraindicated in several conditions where its anticholinergic effects could cause harm, including glaucoma, obstructive uropathy, gastrointestinal obstructions, severe ulcerative colitis, myasthenia gravis, and unstable cardiovascular status. The use of dicyclomine in these conditions can exacerbate existing symptoms or lead to severe adverse events. For instance, in patients with glaucoma, especially narrow-angle glaucoma, dicyclomine can increase intraocular pressure, potentially worsening the condition 1. Similarly, patients with obstructive uropathy, such as prostatic hypertrophy, should avoid dicyclomine as it can worsen urinary retention.
Some of the key contraindications for dicyclomine include:
- Glaucoma, especially narrow-angle glaucoma
- Obstructive uropathy, including prostatic hypertrophy
- Gastrointestinal obstructions, such as pyloric or duodenal obstruction, paralytic ileus, intestinal atony, and toxic megacolon
- Severe ulcerative colitis
- Myasthenia gravis
- Unstable cardiovascular status
- Known hypersensitivity to dicyclomine or its components
- Infants under 6 months due to reported serious adverse events, including respiratory depression and death
It is essential to exercise caution when prescribing dicyclomine, particularly in elderly patients, who are more sensitive to anticholinergic effects like confusion, agitation, and hallucinations 1. Additionally, dicyclomine should be used cautiously in hot environments as it reduces sweating, potentially leading to heat stroke. While the study by 1 focuses on the use of antispasmodics, including dicyclomine, in patients with irritable bowel syndrome, it highlights the importance of considering the potential risks and benefits of dicyclomine in various patient populations.
From the FDA Drug Label
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
The contraindications for Dicyclomine are:
- Infants less than 6 months of age
- Nursing mothers
- Unstable cardiovascular status in acute hemorrhage
- Myasthenia gravis
- Glaucoma
- Obstructive uropathy
- Obstructive disease of the gastrointestinal tract
- Severe ulcerative colitis
- Reflux esophagitis 2
From the Research
Dicyclomine Contraindications
- There are no direct contraindications mentioned in the provided studies for Dicyclomine.
- However, some studies suggest that Dicyclomine may have adverse effects in certain situations:
- A study published in 1999 3 found that oral dicyclomine increased the percent time pH < 4 during the first two hours supine, which could be a concern for patients with gastroesophageal reflux disease.
- Another study published in 1994 4 compared the results of a specific hypoallergenic diet with those of pharmacological treatment with dicyclomine hydrochloride in infants with severe colics, and found that pharmacological treatment provided an improvement in 53.3% of cases, while dietary modifications provided an improvement in 95.4% of cases.
- It is also worth noting that Dicyclomine may cause adverse effects such as constipation, diarrhea, and abdominal pain, as mentioned in a study published in 1999 5.
- Additionally, a study published in 1975 6 compared the efficacy and side effects of two dicyclomine formulations, but did not mention any contraindications.
- It is important to note that the provided studies do not directly address the contraindications of Dicyclomine, and therefore, it is recommended to consult other reliable sources for a comprehensive list of contraindications.