What is the recommended dose of dicyclomine (anticholinergic medication)?

Recommended Dosage of Dicyclomine

The recommended adult dosage of dicyclomine is 20 mg four times daily (80 mg/day), which can be increased to a maximum of 40 mg four times daily (160 mg/day) if needed. 1

Adult Dosing

Initial Dosage

• Start with 20 mg orally four times daily 1, 2
• Take with meals to reduce gastrointestinal side effects 2

Maintenance/Maximum Dosage

• Can be titrated up to 40 mg four times daily (160 mg/day) based on clinical response 1, 2
• Dosage adjustments should be made after evaluating response over 2 weeks 2

Special Populations

Elderly Patients

• Start at the lower end of the dosing range (20 mg four times daily) 1
• Dose selection should be cautious due to:
  • Greater frequency of decreased hepatic function 1
  • Greater frequency of decreased renal function 1
  • Higher likelihood of concomitant disease or other drug therapy 1

Renal Impairment

• Use with caution as dicyclomine is substantially excreted by the kidneys 1
• Monitor renal function in these patients 1
• Risk of toxic reactions may be greater in patients with impaired renal function 1

Hepatic Impairment

• Administer with caution in patients with hepatic impairment 1
• Specific dose adjustments are not well established 1

Important Contraindications

• Contraindicated in infants less than 6 months of age 1
• Contraindicated in women who are breastfeeding 1
• Use with caution in patients taking other anticholinergic medications 3

Clinical Pearls

• Dicyclomine's effects may vary depending on body position (upright vs. supine) and fed/fasting state 4
• When used for irritable bowel syndrome, clinical improvement is typically observed within 2 weeks 2
• Monitor for anticholinergic side effects such as dry mouth, blurred vision, urinary retention, and constipation 2
• Potential drug interaction with hydrochlorothiazide may lead to contraction alkalosis 3
• For treatment of irritable bowel syndrome, the 40 mg four times daily dose has been shown to be superior to placebo in clinical trials 2

Administration Considerations

• Can be taken with food to minimize gastrointestinal side effects 2
• Maintain consistent timing of doses throughout the day for optimal therapeutic effect 2
• Avoid abrupt discontinuation; consider gradual tapering if stopping treatment after long-term use 1