Can dicyclomine cause respiratory problems, particularly in patients with chronic obstructive pulmonary disease (COPD) or asthma?

From the Guidelines

Dicyclomine can potentially cause respiratory problems in patients with chronic obstructive pulmonary disease (COPD) or asthma and should be used with caution in these populations. Dicyclomine, an anticholinergic medication commonly prescribed for irritable bowel syndrome, works by blocking acetylcholine receptors, which can lead to decreased secretions and relaxation of smooth muscle in the gastrointestinal tract. However, this anticholinergic effect isn't limited to the digestive system and can impact the respiratory system as well. In patients with COPD or asthma, dicyclomine may cause thickening of bronchial secretions and potentially worsen bronchospasm, making breathing more difficult. The typical dose of dicyclomine is 10-20 mg taken orally three to four times daily, but patients with respiratory conditions should start at the lower end of the dosing range and be monitored closely for any signs of respiratory distress such as increased wheezing, shortness of breath, or chest tightness. If these symptoms occur, the medication should be discontinued and medical attention sought immediately. Alternative treatments for gastrointestinal symptoms that have less impact on the respiratory system might be preferable for patients with significant respiratory disease. Some key points to consider when managing patients with COPD and heart failure, as outlined in the ESC guidelines 1, include the importance of evaluating natriuretic peptide levels and accurately quantifying the relative contribution of cardiac and ventilatory components to the patient's disability. Additionally, agents with documented effects on morbidity and mortality, such as ACEIs, β-blockers, and ARBs, are recommended in patients with co-existing pulmonary disease. However, it's essential to note that the provided evidence does not directly address the use of dicyclomine in patients with COPD or asthma, and the recommendations are based on the potential anticholinergic effects of the medication. Therefore, it is crucial to prioritize the patient's respiratory health and consider alternative treatments when necessary.

From the Research

Dicyclomine and Respiratory Problems

• Dicyclomine is an anticholinergic medication, but the provided studies do not directly address its effects on breathing problems, particularly in patients with chronic obstructive pulmonary disease (COPD) or asthma 2, 3, 4, 5, 6.
• However, anticholinergic agents are known to have important uses as bronchodilators for the treatment of obstructive airway diseases, including COPD and asthma 2, 3, 4.
• The studies discuss the use of anticholinergic bronchodilators such as ipratropium bromide, oxitropium bromide, and tiotropium bromide, which are safe and well-tolerated by patients with COPD and asthma 2, 3, 4.
• There is no direct evidence in the provided studies to suggest that dicyclomine causes breathing problems in patients with COPD or asthma.
• It is essential to note that the studies focus on the use of anticholinergic agents as bronchodilators, and their safety and efficacy in patients with COPD and asthma, rather than the potential respiratory side effects of dicyclomine 2, 3, 4, 5, 6.

Anticholinergic Agents and COPD

• Anticholinergic agents are considered the bronchodilators of choice in the management of COPD, as they work by blocking muscarinic receptors in airway smooth muscle 4.
• Tiotropium bromide, an anticholinergic agent, has been shown to have a duration of action of >24 hours and is well-tolerated, with significant advantages over ipratropium bromide in the control of COPD 4.
• The use of anticholinergic agents in COPD is supported by studies that demonstrate their safety and efficacy in improving lung function and reducing symptoms 2, 3, 4.

Other Medications and COPD

• Recent studies have investigated the use of other medications, such as opioids, for the management of chronic breathlessness in COPD, but have found that they are not effective and may be harmful 5.
• Other medications, such as doxofylline and procaterol, have been evaluated as potential adjunctive therapies for COPD, with doxofylline showing improvement in pulmonary function but also associated with neurological adverse events 6.