Contraindications to Bentyl (Dicyclomine)
Bentyl (dicyclomine) is contraindicated in infants less than 6 months of age, nursing mothers, and patients with unstable cardiovascular status in acute hemorrhage, myasthenia gravis, glaucoma, obstructive uropathy, obstructive gastrointestinal disease, severe ulcerative colitis, and reflux esophagitis. 1
Absolute Contraindications
- Infants under 6 months of age: Dicyclomine is absolutely contraindicated in this population due to risk of serious adverse effects
- Nursing mothers: Contraindicated due to potential transfer through breast milk
- Myasthenia gravis: Can worsen muscle weakness due to curare-like neuromuscular blockade
- Glaucoma: Anticholinergic effects can increase intraocular pressure
- Obstructive uropathy: Can worsen urinary retention
- Gastrointestinal obstruction: Can worsen or mask symptoms of obstruction
- Severe ulcerative colitis: May precipitate toxic megacolon
- Reflux esophagitis: Can worsen symptoms
Relative Contraindications/Use with Caution
- Cardiovascular disease: Ischemia and infarction may be worsened
- Hypertension: May exacerbate elevated blood pressure
- Autonomic neuropathy: Due to inhibitory effects on muscarinic receptors
- Prostatic hypertrophy: May lead to urinary retention
- Hepatic and renal impairment: Altered metabolism and clearance
- Elderly patients: Increased susceptibility to adverse effects
- Fever or high environmental temperature: Risk of heat prostration due to decreased sweating
- Salmonella dysentery: Risk of toxic dilatation of intestine and intestinal perforation
Potential Drug Interactions
- Monoamine oxidase inhibitors: Potential for dangerous interactions
- Hydrochlorothiazide: Case reports of contraction alkalosis 2
- Corticosteroids: May reduce absorption of corticosteroids 3
- Other anticholinergic medications: Additive anticholinergic effects
Side Effects to Monitor
- Central nervous system effects: Confusion, disorientation, amnesia, hallucinations, dysarthria
- Anticholinergic effects: Dry mouth, blurred vision, urinary retention, constipation
- Cardiovascular effects: Tachycardia, palpitations, arrhythmias
- Other concerns: Drowsiness, dizziness, impaired mental alertness
Special Populations
- Pregnancy: Use only if benefits outweigh risks
- Mental illness: Higher risk of psychosis and delirium
- Patients who need to operate machinery or drive: Impaired mental alertness is a concern
The anticholinergic properties of dicyclomine can cause significant adverse effects in susceptible individuals. When prescribing this medication, careful assessment of the patient's medical history is essential to avoid potentially serious complications, particularly in elderly patients who may be more sensitive to anticholinergic side effects.