What are the implications of administering Bentyl (dicyclomine) 20mg twice daily to a 43-year-old male patient post colectomy with ileostomy formation?

From the Guidelines

I would not recommend Bentyl (dicyclomine) 20mg BID for this post-colectomy patient with an ileostomy. The patient's recent colectomy and ileostomy formation suggest a need for careful management of intestinal motility and secretion to prevent complications such as ileus, small bowel obstruction, or dehydration. As noted in the study by 1, antimotility agents like loperamide are preferred for reducing intestinal motility and secretion in patients with short bowel syndrome, and they should be guided by objective measurements of effect on stool output. In this case, the use of Bentyl, an anticholinergic antispasmodic medication, could potentially lead to decreased intestinal motility, which may worsen the patient's condition. Instead, alternative approaches such as ensuring proper hydration, evaluating for possible partial obstruction, or considering loperamide for high-output ileostomy should be explored. Key considerations for this patient include:

• Managing stool output and preventing dehydration and electrolyte imbalances
• Avoiding medications that may decrease intestinal motility or worsen ileostomy function
• Evaluating for possible complications such as partial obstruction or small bowel obstruction
• Considering alternative medications such as loperamide for high-output ileostomy
• Ensuring proper hydration and nutrition to support intestinal adaptation and healing.

From the FDA Drug Label

1 INDICATIONS AND USAGE Dicyclomine hydrochloride tablets, USP are indicated for the treatment of patients with functional bowel/irritable bowel syndrome.

The patient is requesting Bentyl 20mg BID after a colectomy and ileostomy formation.

• The indication for dicyclomine (Bentyl) is for functional bowel/irritable bowel syndrome.
• There is no information in the provided drug labels that directly addresses the use of dicyclomine in a patient with a recent colectomy and ileostomy formation.
• Given the lack of direct information, caution should be exercised when considering the use of dicyclomine in this patient population.
• It is essential to consider the potential adverse effects of dicyclomine, particularly those related to its anticholinergic properties, which may be relevant in a post-surgical patient 2.
• However, without direct evidence or guidance from the drug label, it is uncertain whether dicyclomine is appropriate for this patient.
• Therefore, the decision to use dicyclomine in this context should be made with caution and ideally after consulting with a specialist or the patient's surgical team.

From the Research

Patient Request for Bentyl 20mg BID

The patient is requesting Bentyl 20mg BID after undergoing a colectomy and ileostomy formation.

• The patient's request for Bentyl, an anticholinergic medication, may be related to managing symptoms such as abdominal cramps or spasms.
• However, there is limited information available on the use of Bentyl in patients with an ileostomy.

Medication Absorption in Ileostomy Patients

• A study published in the British Journal of Nursing 3 highlights the importance of considering medication absorption in patients with an ileostomy.
• The study notes that patients with an ileostomy may require assessment of their medication regimen to identify potential absorption issues.
• However, there is limited literature available on the specific absorption of Bentyl in patients with an ileostomy.

Post-Operative Complications and Medication Use

• A systematic review published in Alimentary Pharmacology & Therapeutics 4 reports on the outcomes and post-operative complications following colectomy for ulcerative colitis.
• The review notes that early and late complications arise in about one-third of patients undergoing surgery for ulcerative colitis.
• Another study published in The British Journal of Surgery 5 explores the use of non-steroidal anti-inflammatory drugs (NSAIDs) to reduce ileus after colorectal surgery.
• The study finds that NSAIDs do not reduce the time for gastrointestinal recovery after colorectal surgery but are safe and associated with reduced postoperative opioid requirement.

Anticholinergic Medications and Gastroesophageal Reflux

• A pilot study published in The American Journal of Gastroenterology 6 investigates the effects of an oral anticholinergic drug on gastroesophageal reflux in normal, ambulant subjects.
• The study finds that the anticholinergic drug dicyclomine decreases early postprandial upright reflux episodes but increases the percent time pH < 4 during the first two hours supine.
• The effects of anticholinergic medications like Bentyl on gastroesophageal reflux in patients with an ileostomy are not well understood and require further study.