Dicyclomine Dosing for Children
Dicyclomine is not recommended for use in infants under 6 months of age due to potentially fatal adverse reactions. For older children, dosing should be carefully considered based on age and weight.
Safety Concerns and Contraindications
- Dicyclomine is contraindicated in infants under 6 months of age due to reports of serious adverse events including fatalities 1
- High blood levels of dicyclomine have been detected in infant deaths, with concentrations nearly 10 times the reported adult therapeutic levels 1
Recommended Dosing by Age Group
Children 6 months to 2 years:
- No standardized dosing is available in current pediatric emergency guidelines 2
- Use should be extremely limited and only under specialist supervision
Children over 2 years:
- Initial dose: 5-10 mg three to four times daily
- Maximum daily dose: 40 mg per day
- Dosing should be adjusted based on clinical response and side effect profile
Administration Considerations
- Oral administration is preferred for children
- Monitor closely for anticholinergic side effects including:
- Dry mouth
- Blurred vision
- Urinary retention
- Constipation
- Tachycardia 2
Clinical Evidence
- In studies of infantile colic, dicyclomine eliminated symptoms in 63% of infants compared to 25% with placebo 3
- However, the risk-benefit ratio does not support routine use in infants due to safety concerns 1
Alternative Treatments
- For infantile colic, consider non-pharmacological interventions first:
- Changes in feeding techniques
- Probiotics
- Parental support and education
Monitoring
- Monitor vital signs during administration
- Watch for signs of anticholinergic toxicity:
- Fever
- Flushing
- Altered mental status
- Urinary retention 2
Important Precautions
- Avoid concomitant use with other anticholinergic medications
- Use with extreme caution in children with history of:
- Autonomic neuropathy
- Intestinal obstruction
- Severe ulcerative colitis
- Myasthenia gravis 2
Remember that the use of dicyclomine in pediatric patients should be limited to situations where the benefit clearly outweighs the risk, particularly given the availability of safer alternatives for most conditions.