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Pronunciation
(dye SYE kloe meen)
Generic Available (U.S.)
Yes: Excludes syrup
Index Terms
Brand Names: U.S.
Brand Names: Canada
Pharmacologic Category
Pharmacologic Category Synonyms
Use: Labeled Indications
Treatment of functional bowel/irritable bowel syndrome
Use: Unlabeled
Urinary incontinence
Pregnancy Risk Factor
B
Pregnancy Considerations
Teratogenic effects have not been observed in animal studies.
Lactation
Enters breast milk/contraindicated
Contraindications
Hypersensitivity to dicyclomine or any component of the formulation; obstructive diseases of the GI tract; severe ulcerative colitis; reflux esophagitis; unstable cardiovascular status in acute hemorrhage; obstructive uropathy; narrow-angle glaucoma; myasthenia gravis; breast-feeding; should not be used in infants <6 months of age
Warnings/Precautions
Concerns related to adverse effects:
• CNS effects: May cause drowsiness and/or blurred vision, which may impair physical or mental abilities; patients must be cautioned about performing tasks which require mental alertness (eg, operating machinery or driving).
• Diarrhea: May be a sign of incomplete intestinal obstruction, treatment should be discontinued if this occurs.
• Heat prostration: May occur in the presence of increased environmental temperature; use caution in hot weather and/or exercise.
• Psychosis: Has been reported in patients with an extreme sensitivity to anticholinergic effects or at excessive dosages.
Disease-related concerns:
• Cardiovascular disease: Use with caution in patients with coronary artery disease, tachyarrhythmias, heart failure, or hypertension; evaluate tachycardia prior to administration.
• Hepatic impairment: Use with caution in patients with hepatic impairment.
• Hiatal hernia: Use with caution in patients with hiatal hernia.
• Hyperthyroidism: Use with caution in patients with hyperthyroidism.
• Neuropathy: Use with caution in patients with autonomic neuropathy.
• Prostatic hyperplasia: Use with caution in patients with prostatic hyperplasia (known or suspected).
• Renal impairment: Use with caution in patients with renal impairment.
• Ulcerative colitis: Use with caution in patients with mild-moderate ulcerative colitis.
Special populations:
• Elderly: Avoid long term use in this age group due to potent anticholinergic effects and uncertain effectiveness (Beers Criteria).
• Pediatrics: Safety and efficacy have not been established in children. Serious respiratory reactions, central nervous symptoms, and deaths have been reported following administration to infants; use in infants <6 months of age is contraindicated).
Other warnings/precautions:
• Appropriate administration: Injectable formulation is for I.M. administration only; inadvertent I.V. administration may cause thrombosis/thrombophlebitis and injection site reactions (eg, pain, edema, skin color change, reflex sympathetic dystrophy).
Adverse Reactions
Adverse reactions are included here that have been reported for pharmacologically similar drugs with anticholinergic/antispasmodic action.
Cardiovascular: Palpitation, syncope, tachycardia
Central nervous system: Dizziness (29%), lightheadedness (11%), drowsiness (9%), tingling, headache, nervousness (6%), numbness, mental confusion and/or excitement, dyskinesia, lethargy, speech disturbance, insomnia
Dermatologic: Rash, urticaria, itching, and other dermal manifestations
Endocrine & metabolic: Suppression of lactation
Gastrointestinal: Xerostomia (33%), nausea (14%), vomiting, constipation, bloated feeling, abdominal pain, taste loss, anorexia
Genitourinary: Urinary hesitancy, urinary retention, impotence
Local: Irritation (injection), focal coagulation necrosis (injection)
Neuromuscular & skeletal: Weakness (7%)
Ocular: Blurred vision (27%), diplopia, mydriasis, cycloplegia, increased ocular tension
Respiratory: Dyspnea, apnea, asphyxia, nasal stuffiness or congestion, sneezing, throat congestion
Miscellaneous: Anaphylaxis, diaphoresis decreased, severe allergic reaction
Metabolism/Transport Effects
None known.
Drug Interactions
AbobotulinumtoxinA: Anticholinergic Agents may enhance the anticholinergic effect of AbobotulinumtoxinA. Risk C: Monitor therapy
Acetylcholinesterase Inhibitors (Central): Anticholinergics may diminish the therapeutic effect of Acetylcholinesterase Inhibitors (Central). Acetylcholinesterase Inhibitors (Central) may diminish the therapeutic effect of Anticholinergics. If the anticholinergic action is a side effect of the agent, the result may be beneficial. Risk C: Monitor therapy
Anticholinergics: May enhance the adverse/toxic effect of other Anticholinergics. Exceptions: Levocabastine (Nasal); Paliperidone. Risk C: Monitor therapy
Cannabinoids: Anticholinergic Agents may enhance the tachycardic effect of Cannabinoids. Risk C: Monitor therapy
OnabotulinumtoxinA: Anticholinergic Agents may enhance the anticholinergic effect of OnabotulinumtoxinA. Risk C: Monitor therapy
Potassium Chloride: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Chloride. Risk D: Consider therapy modification
Pramlintide: May enhance the anticholinergic effect of Anticholinergics. These effects are specific to the GI tract. Risk D: Consider therapy modification
RimabotulinumtoxinB: Anticholinergic Agents may enhance the anticholinergic effect of RimabotulinumtoxinB. Risk C: Monitor therapy
Secretin: Anticholinergic Agents may diminish the therapeutic effect of Secretin. Risk D: Consider therapy modification
Ethanol/Nutrition/Herb Interactions
Ethanol: Avoid ethanol (may increase CNS depression).
Storage
Protect from light.
Mechanism of Action
Blocks the action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands and the CNS
Pharmacodynamics/Kinetics
Onset of action: 1-2 hours
Duration: ≤4 hours
Absorption: Oral: Well absorbed
Metabolism: Extensive
Half-life elimination: Initial: 1.8 hours; Terminal: 9-10 hours
Excretion: Urine (small amounts as unchanged drug)
Dosage
Adults:
Oral: Initiate with 80 mg/day in 4 equally divided doses, then increase up to 160 mg/day. Duration: Safety data not available for duration >2 weeks.
I.M. (should not be used I.V.): 80 mg/day in 4 divided doses (20 mg/dose)
Administration: Oral
Administer 30-60 minutes before a meal.
Administration: I.M.
Administer solution for injection as I.M. injection only.
Administration: I.V.
Do not administer I.V.
Monitoring Parameters
Pulse, anticholinergic effect, urinary output, GI symptoms
Patient Education
Take before meals. Avoid alcohol. This drug may impair mental alertness or cause constipation. Report excessive and persistent anticholinergic effects (blurred vision, headache, flushing, tachycardia, nervousness, dizziness, insomnia, mental confusion or excitement, dry mouth, altered taste perception, dysphagia, palpitations, bradycardia, urinary hesitancy or retention, impotence, decreased sweating); change in color of urine or stools; or irritation or redness at injection site.
Geriatric Considerations
Long-term use of antispasmodics should be avoided in the elderly. The potential for a toxic reaction is greater than the potential benefit. In addition, the anticholinergic effects of dicyclomine are not well tolerated in the elderly.
This medication is considered to be potentially inappropriate in this patient population (Beers Criteria: Quality of evidence - moderate; Strength of recommendation - strong).
Dental Health: Effects on Dental Treatment
Key adverse event(s) related to dental treatment: Xerostomia and changes in salivation (normal salivary flow resumes upon discontinuation)
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Mental Health: Effects on Mental Status
May cause nervousness, excitement, insomnia, confusion, drowsiness, dyskinesia
Mental Health: Effects on Psychiatric Treatment
Concurrent use with psychotropics may produce additive sedation and dry mouth
Nursing: Physical Assessment/Monitoring
Monitor for anticholinergic response.
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Capsule, oral, as hydrochloride: 10 mg
Bentyl®: 10 mg
Injection, solution, as hydrochloride: 10 mg/mL (2 mL)
Bentyl®: 10 mg/mL (2 mL)
Syrup, oral, as hydrochloride:
Bentyl®: 10 mg/5 mL (480 mL) [contains propylene glycol]
Tablet, oral, as hydrochloride: 20 mg
Bentyl®: 20 mg
Pricing: U.S. (www.drugstore.com)
Capsules (Bentyl)
10 mg (30): $23.75
Capsules (Dicyclomine HCl)
10 mg (30): $13.99
Syrup (Bentyl)
10 mg/5 mL (240): $35.99
Tablets (Bentyl)
20 mg (30): $29.99
Tablets (Dicyclomine HCl)
20 mg (30): $11.99
References
"American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults," J Am Geriatr Soc, 2012 [epub ahead of print].
International Brand Names
Lexi-Comp.com
Last full review/revision April 2012
Content last modified April 2012
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