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Pronunciation:

(dye SYE kloe meen)

U.S. Brand Names:

Bentyl®

Synonyms:

Dicyclomine Hydrochloride; Dicycloverine Hydrochloride

Generic Available:

Yes: Excludes syrup

Canadian Brand Names:

Bentylol®; Formulex®; Lomine

Use:

Treatment of functional disturbances of GI motility such as irritable bowel syndrome

Use - Unlabeled/Investigational:

Urinary incontinence

Pregnancy Risk Factor:

Lactation:

Enters breast milk/contraindicated

Contraindications:

Hypersensitivity to any anticholinergic drug; narrow-angle glaucoma; myasthenia gravis; should not be used in infants <6 months of age

Warnings/Precautions:

Use with caution in patients with hepatic or renal disease, ulcerative colitis, hyperthyroidism, cardiovascular disease, hypertension, tachycardia, GI obstruction, obstruction of the urinary tract. The elderly are at increased risk for anticholinergic effects, confusion and hallucinations.

Adverse Reactions:

Adverse reactions are included here that have been reported for pharmacologically similar drugs with anticholinergic/antispasmodic action

Cardiovascular: Syncope, tachycardia, palpitation

Central nervous system: Dizziness, lightheadedness, tingling, headache, drowsiness, nervousness, numbness, mental confusion and/or excitement, dyskinesia, lethargy, speech disturbance, insomnia

Dermatologic: Rash, urticaria, itching, and other dermal manifestations; severe allergic reaction or drug idiosyncrasies including anaphylaxis

Endocrine & metabolic: Suppression of lactation

Gastrointestinal: Xerostomia, nausea, vomiting, constipation, bloated feeling, abdominal pain, taste loss, anorexia

Genitourinary: Urinary hesitancy, urinary retention, impotence

Neuromuscular & skeletal: Weakness

Ocular: Blurred vision, diplopia, mydriasis, cycloplegia, increased ocular tension

Respiratory: Dyspnea, apnea, asphyxia, nasal stuffiness or congestion, sneezing, throat congestion

Miscellaneous: Decreased diaphoresis

Overdosage/Toxicology:

Symptoms of overdose include CNS stimulation followed by depression, confusion, delusions, nonreactive pupils, tachycardia, and hypertension. Unilateral numbness, cold fingertips, abdominal and flank pain have also been described as symptoms of toxicity.

Drug Interactions:

Decreased effect: Phenothiazines, anti-Parkinson's drugs, haloperidol, sustained release dosage forms; decreased effect with antacids

Increased toxicity: Anticholinergics, amantadine, narcotic analgesics, type I antiarrhythmics, antihistamines, phenothiazines, TCAs

Ethanol/Nutrition/Herb Interactions:

Ethanol: Avoid ethanol (may increase CNS depression).

Stability:

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:

Oral:

Infants >6 months: 5 mg/dose 3-4 times/day

Children: 10 mg/dose 3-4 times/day

Adults: Begin with 80 mg/day in 4 equally divided doses, then increase up to 160 mg/day

I.M. (should not be used I.V.): Adults: 80 mg/day in 4 divided doses (20 mg/dose)

Administration:

I.M.: Do not administer I.V.; administer as I.M. injection only.

Monitoring Parameters:

Pulse, anticholinergic effect, urinary output, GI symptoms

Patient Education:

Inform prescriber of all prescriptions, OTC medications, or herbal products you are taking, and any allergies you have. Do not take any new medication during therapy unless approved by prescriber (especially antihistamines, sleeping aids, or antidepressants). Take as directed before meals; do not increase dose and do not discontinue without consulting prescriber. Avoid alcohol. Void before taking medication. This drug may impair mental alertness (use caution when driving or engaging in tasks that require alertness until response to drug is known); or constipation (increased exercise, fluids, fruit, or fiber may help). 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. Breast-feeding precaution: Do not breast-feed.

Nursing Implications:

Raise bed rails, institute safety measures

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

Dosage Forms:

Capsule, as hydrochloride: 10 mg

Injection, solution, as hydrochloride: 10 mg/mL (2 mL)

Syrup, as hydrochloride: 10 mg/5 mL (480 mL)

Tablet, as hydrochloride: 20 mg

International Brand Names:

Bentylol® (CA); Formulex® (CA); Lomine (CA)

References

Beers MH, Ouslander JG, Rollingher I, et al, "Explicit Criteria for Determining Inappropriate Medication Use in Nursing Home Residents,"Arch Intern Med, 1991, 151(9):1825-32.

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