Dicyclomine (Bentyl) Contraindications and Precautions
- breast-feeding
- closed-angle glaucoma
- esophagitis
- GI obstruction
- infants
- intravenous administration
- myasthenia gravis
- neonates
- ulcerative colitis
- urinary tract obstruction
- anticholinergic medications
- cardiac arrhythmias
- children
- contact lenses
- coronary artery disease
- driving or operating machinery
- elderly
- gastroesophageal reflux disease (GERD)
- heart failure
- hemorrhagic shock
- hiatal hernia
- hypertension
- hyperthyroidism
- ileus
- peripheral neuropathy
- pregnancy
- prostatic hypertrophy
- toxic megacolon
Dicyclomine (Bentyl) Contraindications and Precautions
Dicyclomine injection is for intramuscular administration only; do not give via intravenous administration.
The anticholinergic effects of dicyclomine may be significant and are additive with other anticholinergic medications.
Dicyclomine should not be used in severe ulcerative colitis, reflux esophagitis or if there is GI obstruction, Dicyclomine exerts its effects on the smooth muscle of the GI tract and may exacerbate ulcerative colitis, toxic megacolon, and intestinal atony. Large doses of dicyclomine can suppress intestinal motility to such an extent that a paralytic ileus is produced. Dicyclomine should be used with caution in these conditions. Dicyclomine is contraindicated by the manufacturer in patients with reflux esophagitis and should be used with caution in patients gastroesophageal reflux disease (GERD) or hiatal hernia. Antimuscarinics decrease gastric motility and relax the lower esophageal sphincter. These effects promote gastric retention and aggravate reflux in these patients.
Dicyclomine should not be used in patients with closed-angle glaucoma because of the risk of drug-induced cycloplegia and mydriasis that would increase intraocular pressure.
Although dicyclomine produces less cardiovascular effects than atropine, dicyclomine should nevertheless be used with caution in patients with coronary artery disease, cardiac arrhythmias, or congestive heart failure because the drug can aggravate these conditions. Antimuscarinics should also be used with caution in patients with hypertension since they have some actions on the heart that can exacerbate this condition. Dicyclomine is contraindicated in patients with unstable hemorrhage (hemorrhagic shock).
The manufacturer warns that dicyclomine should be used with caution in patients with hepatic disease or renal disease. The exact elimination pathways for dicyclomine are not known. Approximately 80% of an oral dose of dicyclomine is excreted in the urine and about 9% in the feces.
Dicyclomine should not be used in patients with myasthenia gravis or urinary tract obstruction. It should be used with caution in hyperthyroidism, benign prostatic hypertrophy (BPH), or peripheral neuropathy because dicyclomine can aggravate these conditions.
Dicyclomine should be used with caution in hot or humid environments because it can cause heat prostration (fever and heat stroke) due to drug-induced inhibition of the sweating mechanism, although the effects of dicyclomine on the sweat gland are less than those of atropine.
Patients should be warned that use of dicyclomine can produce drowsiness or blurred vision, so they should avoid driving or operating machinery while taking this medication.
The anticholinergic effects of dicyclomine may make the eyes dry. This can cause an increased lens awareness, or blurred vision for wearers of contact lenses. The use of lubricating drops may be necessary, or in severe cases discontinued use of contact lenses while taking dicyclomine.
Dicyclomine should be used with caution in the elderly; lower doses may be needed. Older patients are more susceptible to anticholinergic effects. There is also the possibility of precipitating undiagnosed glaucoma in the elderly. It is generally recommended that dicyclomine (especially long-term use) be avoided in elderly patients due to the high potential for anticholinergic effects.
Dicyclomine is contraindicated in neonates and infants younger than 6 months of age. Serious respiratory symptoms, seizures, syncope, pulse-rate fluctuations, muscular hypotonia, or coma have followed administration of dicyclomine syrup to infants. Respiratory symptoms include dyspnea, breathlessness, shortness of breath, respiratory collapse, apnea, and asphyxia. The safe use of dicyclomine in children has not been established by the manufacturer; caution should be exercised when administering dicyclomine to children.
Dicyclomine is classified by the FDA as a pregnancy risk category B drug. Dicyclomine has been used historically as part of a 3 drug regimen (dicyclomine; doxylamine; pyridoxine) to treat nausea and vomiting during pregnancy. This drug combination (Bendectin®, Debendox®) has been withdrawn from the market because of litigation based on reports of congenital limb defects. An analysis of these cases has reported a relative risk of 1.1 for limb deficiency in children of pregnant mothers exposed to the drug combination; the authors conclude that the drug combination is not associated with increased risk of congenital limb defects.
Dicyclomine is excreted into human milk. Dicyclomine is contraindicated during breast-feeding. The use of dicyclomine in breast-feeding mothers is not recommended, due to potential serious adverse events that may occur from infant ingestion of the drug. Respiratory distress has been reported in infants aged < 6 months who ingested dicyclomine directly (not via breast milk). In addition, anticholinergics such as dicyclomine may inhibit lactation.
[ Last revised: 7/21/2004 9:09:00 AM ]
References
. Fick DM, Cooper JW, Wade WE, et al. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med 2003;163:2716 - 24.
. Mazzotta P, Magee LA. A risk-benefit assessment of pharmacological and nonpharmacological treatments for nausea and vomiting of pregnancy. Drugs 2000;59:781 - 800.
. McCredie J, Kricker A, Elliott J, et al. The innocent bystander. Doxylamine/dicyclomine/pyridoxine and congenital limb defects. Med J Aust 1984;140:525 - 7.
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