Dicyclomine (Bentyl) is an anticholinergic drug that is used in patients with irritable bowel syndrome with predominant diarrhea and intestinal spasms.

Dicyclomine Uses:

• Gastrointestinal motility disorders and irritable bowel:
  • It is indicated for the treatment of functional bowel disorders like irritable bowel syndrome.

Other drugs recommended for the treatment of IBS include:

• Lubiprostone (Amitiza) for the treatment of IBS with constipation.
• Linaclotide (Linzess) for the treatment of chronic constipation and IBS with constipation.
• Zelnorm (Tegaserod) - a 5 HT-4 agonist for the treatment of IBS with constipation.

Dicyclomine (Bentyl) Dose in Adults:

Dicyclomine (Bentyl) Dose in the treatment of Gastrointestinal motility disorders and irritable bowel:

• Initial treatment:
  • 20 mg orally four times a day for seven days.
• The dose may be increased to 40 mg four times a day after one week.
• Discontinuation of therapy:
  • If no improvement is noted within 2 weeks or if less than 80 mg per day is used because of intolerable adverse effects, the treatment should be discontinued.
  • The safety of the drug at doses exceeding 80 mg per day for greater than 2 weeks has not been established.
• IM: 10 to 20 mg four times a day for a day or two and then convert to oral treatment as soon as possible.

Dicyclomine (Bentyl) Dose in Childrens:

Dicyclomine (Bentyl) Dose in the treatment of Gastrointestinal motility disorders and irritable bowel syndrome:

• Infants ≥6 months and Children <2 years:
  • 5 to 10 mg orally three or four times a day administered 15 minutes before feeding.
• Children 2 years of age or older.
  • 10 mg orally three or four times a day.
• Adolescents:
  • 10 to 20 mg orally thrice or four times a day.
  • If no improvement is noted within 2 weeks, the treatment should be discontinued.

Pregnancy Risk Category: B

• It has not been shown to have adverse teratogenic effects on fetal outcomes in the first trimester when used at the usual doses.
• Other medications are recommended for treatment of irritable intestinal syndrome during pregnancy.

Use of dicyclomine during breastfeeding

• It is excreted from breastmilk and contraindicated for lactating mothers.
• Lactation may be affected by anticholinergic drugs. It can also cause severe adverse effects in infants and should be avoided by lactating mothers.

Dose in Kidney Disease:

• Use with caution in patients with renal impairment.
• There are no dosage adjustments provided in the manufacturer's labeling as it has not been studied in patients with kidney disease.   

Dose in Liver Disease:

• Use with caution in patients with liver disease.
• There are no dosage adjustments provided in the manufacturer's labeling as it has not been studied in patients with liver disease.   

Common Side Effects of Dicyclomine (Bentyl):

• Central nervous system:
  • Dizziness
• Gastrointestinal:
  • Xerostomia
  • Nausea
• Ophthalmic:
  • Blurred vision

Less Common Side Effects of Dicyclomine (Bentyl):

• Central nervous system:
  • Drowsiness
  • Nervousness
• Neuromuscular & skeletal:
  • Weakness

Contraindications to Dicyclomine (Bentyl):

• Obstructive diseases of gastrointestinal tract
• Grave ulcerative colitis
• Reflux esophagitis
• Patients with acute hemorhage have unstable cardiovascular status
• Obstructive Uropathy
• Glaucoma
• Myasthenia gravis
• Breastfeeding women
• Infants under 6 months old

Canadian labeling: Additional contraindications not in US labeling

• Hypersensitivity to any drug component or drug ingredient

Warnings and precautions

• CNS effects
  • Blurred vision and mental impairment may result from the use of this drug. People who are required to be alert for driving or operating heavy machinery should be aware of the dangers.
• Diarrhea
  • Diarrhea patients who experience diarrhea should stop taking the medication as this could indicate incomplete intestinal obstruction.
• Heat prostration
  • You should use extreme caution when exercising in hot conditions or when the drug is being administered. In hot weather, heat prostration can occur.
• Psychosis and Delirium:
  • Patients who are sensitive to anticholinergic drugs (such as those with preexisting mental illnesses or elderly patients) may experience psychosis and delirium if they take too many anticholinergic medications.
• Cardiovascular disease
  • The drug should not be used by patients with heart disease, hypertension, or coronary artery disease.
  • Before administering the drug, monitor pulse rate and check for tachycardia.
• Hepatic impairment
  • Patients with liver impairment should be cautious.
• Hyperthyroidism
  • Hyperthyroid patients should be cautious when taking the drug.
• Neuropathy
  • Patients suffering from autonomic neuropathy must be cautious when taking the drug.
• Prostatic hyperplasia
  • Patients with suspected or known prostatic hyperplasia must be cautious when taking the drug.
• Renal impairment
  • Patients with impaired renal function should be cautious when taking the drug.
• Salmonella dysentery
  • Anticholinergic drugs should not be used by patients with salmonella dysentery due to the increased risk for toxic intestinal dilation or perforation.
• Ulcerative colitis
  • Patients with severe ulcerative colitis should be avoided. It should be avoided by patients with mild-moderate ulcerative colitis.

Dicyclomine (dicycloverine): Drug Interaction

Note: Drug Interaction Categories:

• Risk Factor C: Monitor When Using Combination
• Risk Factor D: Consider Treatment Modification
• Risk Factor X: Avoid Concomitant Use

Monitoring parameters:

• Monitor Pulse, anticholinergic effects, urinary output, and gastrointestinal symptoms.

How to administer Dicyclomine (Bentyl)?

It is administered only as an intramuscular injection. Avoid intravenous use

Mechanism of action of Dicyclomine (Bentyl):

It prevents acetylcholine from acting at parasympathetic locations found in smooth muscles, secretory and central nervous systems.

The onset of action:

• 1 to 2 hours

Duration:

• Up to 4 hours

Absorption:

• It is rapidly absorbed and well absorbed after oral administration.

Metabolism:

• It undergoes extensive metabolism.

Half-life elimination:

• Initial phase: About 1.8 hours.
• The terminal phase is undetermined but is a little longer than the initial phase

Time to peak:

• 60 to 90 minutes after oral administration

Excretion:

• 80% of the drug is excreted in urine (a small amount is excreted as unchanged drug);
• feces (8%)

International Brand Names of Dicyclomine:

• Bentyl
• Bentylol
• JAMP-Dicyclomine HCl
• Protylol
• RIVA-Dicyclomine
• Babypasmil
• Bentyl
• Blisscolic
• Coligon
• Coochil
• Cyclominol
• Diclomine
• Dicymine
• Merbentyl
• Nomcramp
• Notensyl
• Spasdon Drops
• Spasmorest
• Spatomin
• Swityl
• Trigan
• Wintyl

Dicyclomine Brand Names in Pakistan: