Dicyclomine Dosing in Pediatrics
Dicyclomine is contraindicated in infants under 6 months of age due to life-threatening risks including respiratory depression and death, and for children over 2 years, the dose is 5-10 mg orally three to four times daily (maximum 40 mg/day), NOT calculated per kilogram. 1
Age-Based Dosing Algorithm
Infants Under 6 Months
- Absolute contraindication - dicyclomine must be avoided entirely in this age group due to documented cases of serious adverse events including respiratory depression and death 1
Infants and Toddlers (6 Months to 2 Years)
- Extreme caution required - use should be limited to specialist supervision only 1
- No standardized per-kilogram dosing exists for this age group 1
- Non-pharmacological interventions should be attempted first for conditions like infantile colic 1
Children Over 2 Years
- Initial dose: 5-10 mg orally, three to four times daily 1
- Maximum daily dose: 40 mg per day 1
- Oral administration is strongly preferred 1
- Dosing is fixed by age, not weight-based 1
Critical Safety Monitoring
When dicyclomine is used in children over 2 years, continuous monitoring is essential:
- Cardiovascular: Monitor for sinus tachycardia and dysrhythmias 1
- Anticholinergic effects: Watch for dry mouth, blurred vision, urinary retention, flushing, and altered mental status 1
- Hemodynamic: Assess for orthostatic hypotension 1
- Vital signs: Continuous monitoring during administration 1
Absolute Contraindications
Dicyclomine must not be used in pediatric patients with:
- Autonomic neuropathy 1
- Intestinal obstruction 1
- Myasthenia gravis 1
- Anticholinergic delirium or intoxication 1
Drug Interaction Precautions
- Avoid concomitant anticholinergic medications due to risk of additive anticholinergic toxicity 1
- Exercise caution with sedatives (benzodiazepines, opioids) as they may enhance sedative effects 1
Common Pitfalls to Avoid
- Do not calculate dicyclomine per kilogram - this is a fixed-dose medication in children, not weight-based 1
- Do not use in infants under 6 months regardless of indication - the risk-benefit ratio is unacceptable 1
- Do not use as first-line for infantile colic - attempt feeding modifications and probiotics first, and consider alternative anticholinergic agents if pharmacotherapy is necessary 1
- Do not administer to patients already exhibiting anticholinergic symptoms as this will worsen their clinical picture 1