Dicyclomine (Colicaid) Dosing for Pediatric Patients
Dicyclomine is contraindicated in infants under 6 months of age and should not be used for infantile colic in this age group due to serious safety concerns, including risk of respiratory depression and other anticholinergic toxicity. 1, 2, 3
Critical Safety Information
Age-Based Contraindications and Restrictions
Infants under 6 months: Dicyclomine is absolutely contraindicated due to reports of serious adverse effects including respiratory symptoms, seizures, syncope, asphyxia, pulse rate fluctuations, and muscular hypotonia. 2, 3, 4
Children 6 months to 2 years: Use should be extremely limited and only under specialist supervision, with no standardized dosing available. 1
Children over 2 years: Initial dose is 5-10 mg three to four times daily, with a maximum daily dose of 40 mg per day. 1
Documented Adverse Effects
When dicyclomine has been studied in infants, serious side effects were reported including:
- Prolonged sleep (4% of cases) 4
- Wide-eyed state (4% of cases) 4
- Drowsiness (13% of cases) 4
- Respiratory depression and other life-threatening anticholinergic effects 2, 3
Evidence Against Use in Infantile Colic
The evidence base does not support dicyclomine for treating infantile colic, and the risk-benefit ratio is unfavorable. 4
A Cochrane systematic review found that while one small study (48 infants) showed increased response rates with dicyclomine versus placebo (RR 2.50,95% CI 1.17 to 5.34), the evidence quality was very low and serious adverse events were documented. 4
The same review concluded that dicyclomine cannot be recommended for infants with colic due to safety concerns outweighing any potential benefits. 4
Recommended Alternatives for Infantile Colic
For infants presenting with colic symptoms, first-line management should focus on parental counseling and reassurance about the benign, self-limiting nature of the condition. 2, 3
Evidence-Based Treatment Options
Breastfed infants: Consider Lactobacillus reuteri (strain DSM 17938) or maternal dietary allergen reduction. 2
Formula-fed infants: Consider switching to a hydrolyzed formula or amino acid formula, which has shown significant short-term improvements in colic symptoms (94% improvement rate in recent cohort study). 2, 5
Simethicone: Not effective - multiple studies show no difference from placebo (RR 0.95% CI 0.73 to 1.23). 2, 6, 3, 4
Monitoring Requirements If Dicyclomine Used in Children >2 Years
If dicyclomine must be used in children over 2 years for appropriate indications (not colic):
- Monitor vital signs closely during administration 1
- Watch for anticholinergic side effects: dry mouth, blurred vision, urinary retention, tachycardia 1
- Assess for signs of toxicity: flushing, altered mental status, urinary retention 1
- Avoid concomitant use with other anticholinergic medications 1
- Use extreme caution in children with autonomic neuropathy, intestinal obstruction, or myasthenia gravis 1
Clinical Pitfalls to Avoid
Never use dicyclomine in infants under 6 months - this is an absolute contraindication with documented serious adverse events. 1, 2, 3
Do not prescribe dicyclomine for infantile colic at any age - safer and more effective alternatives exist, and the evidence does not support its use for this indication. 2, 3, 4
Consider non-pharmacological interventions first including feeding technique modifications and probiotics before any medication. 1, 2