Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder characterized by abdominal pain, bloating, and altered bowel habits (constipation, diarrhea, or both) without any identifiable structural or biochemical abnormalities. It affects approximately 10-15% of the global population, with a higher prevalence in women and individuals younger than 50.
There is no cure for IBS, so treatment goals continue to focus on symptom management and improving quality of life. According to the American College of Gastroenterology, dicyclomine is an antispasmodic medication that can help treat abdominal pain and cramping associated with IBS.
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What Is Dicyclomine (Bentyl)?
Dicyclomine, sold under the brand name Bentyl, was approved by the U.S. Food and Drug Administration (FDA) in 1950 for treating functional bowel/irritable bowel syndrome. It is an antispasmodic agent used to treat muscle spasms and pain in the gastrointestinal (GI) tract.
Dicyclomine is available in 10 mg capsules, 20 mg tablets, an oral syrup, and an injectable solution.
How Dicyclomine Works
Dicyclomine is classified as an anticholinergic agent, specifically an antimuscarinic. This means that it blocks the actions of acetylcholine.
Acetylcholine is a neurotransmitter that binds to muscarinic receptors to signal muscles to contract.
Dicyclomine blocks these muscarinic receptors. You can think of it as placing a cover over the lock so that acetylcholine can't attach and send its contraction signal. In doing so, it facilitates muscular relaxation.
Additionally, dicyclomine helps reduce muscle spasms by having direct antispasmodic effects on the smooth muscles in the intestines. It blocks chemicals called bradykinin and histamine, which can cause the intestinal muscles to tighten and spasm.
Dicyclomine is well-absorbed orally, with peak plasma concentrations reached within 60-90 minutes. The injectable form is twice as bioavailable as the oral forms. Patients typically begin to feel relief from symptoms within one hour of taking dicyclomine, and its effects can last for four to six hours.
Dicyclomine is predominantly eliminated from the body through the kidneys. Its half-life is approximately two hours, which means it stays active in your body for a relatively short period after a single dose. Dicyclomine needs to be taken multiple times throughout the day to maintain its effects.
Who Should Take Dicyclomine?
Dicyclomine is suitable for patients seeking relief from chronic abdominal pain, particularly that associated with IBS.
According to a study conducted in 1981, patients with IBS who took 40 mg of dicyclomine four times daily had greater improvements in their symptoms, including abdominal pain, tenderness, and bowel function, than those given a placebo.
Dicyclomine may be suitable for patients seeking relief from chronic abdominal pain associated with IBS, but treatment should be individualized based on patient-specific factors and in consultation with a healthcare provider.
Contraindications
Dicyclomine is contraindicated in individuals with specific medical conditions to prevent adverse effects and ensure patient safety:
- Infants less than six months old
- Breastfeeding individuals
- Glaucoma
- Unstable cardiovascular conditions
- Myasthenia gravis
- Obstructive uropathy (blocked urine flow)
- GI obstruction
- Severe ulcerative colitis
- Reflux esophagitis
Special Populations
Pregnancy: Dicyclomine is a Category B pregnancy drug. This means that animal studies have not shown any risk to the developing fetus, but there is insufficient clinical data in humans. Therefore, dicyclomine should only be used during pregnancy if clearly needed and if the potential benefits outweigh any possible risks.
Older Patients: Dicyclomine is listed in the Beers Criteria as potentially inappropriate for older adults due to increased sensitivity to anticholinergic effects. It should generally be avoided or used cautiously in geriatric patients to minimize the risk of adverse side effects.
Renal and Hepatic Impairment: Dicyclomine should be administered cautiously in patients with known kidney and liver dysfunction.
Dicyclomine Dosage and Administration
The recommended starting dose is 20 mg by mouth four times daily.
After one week of treatment, your doctor may recommend increasing the dose to 40 mg four times daily. Dosage adjustments should be performed by a qualified healthcare provider based on individual patient needs and medical history.
Dicyclomine is also available as an injection administered into the muscle at 10-20 mg four times daily for people who can't take the medication by mouth. The injectable solution should not be used for longer than two days and should never be administered into the vein.
Potential Side Effects of Dicyclomine
Dicyclomine's anticholinergic effects can cause unwanted side effects in more than 5% of people who take it. The most common side effects include:
- Dizziness (40%)
- Dry mouth (33%)
- Blurred vision (27%)
- Nausea (14%)
- Drowsiness (9%)
- Weakness (7%)
- Nervousness (6%)
- Constipation
Tips for Managing Minor Side Effects
- Drinking plenty of water and chewing sugar-free gum can help alleviate dry mouth.
- Gradually moving from sitting or lying positions can reduce dizziness.
- Lubricating eye drops or artificial tears may help with dry eyes and blurred vision.
- Taking dicyclomine with food can lessen feelings of nausea.
- Incorporating more fiber into your diet, staying hydrated, and engaging in regular exercise can help manage constipation.
Consult your healthcare provider for personalized strategies to manage side effects.
Rare but serious side effects of dicyclomine can occur. These symptoms are more likely to occur in older adults or patients taking medications that can interact with dicyclomine. Symptoms that warrant immediate medical attention include:
- Shortness of breath
- Arrhythmias (irregular heartbeat)
- Heart palpitations
- Confusion
- Hallucinations
- Trouble swallowing or talking
- Heat stroke
- Anticholinergic toxicity
Anticholinergic toxicity occurs when there is excessive inhibition of acetylcholine in the nervous system. The following mnemonic is helpful for remembering the classic signs and symptoms it typically presents with:
- Red as a beet (flushed skin)
- Dry as a bone (dry mouth and eyes)
- Blind as a bat (dilated pupils, blurred vision)
- Mad as a hatter (confusion, delirium)
- Hot as a hare (fever)
- Full as a flask (urinary retention)
Interactions With Other Medications
Some medications should not be taken with dicyclomine because they can reduce its effectiveness or increase the risk of adverse effects. Important interactions include:
- Glaucoma Medications: Anticholinergics antagonize the effects of antiglaucoma drugs and can increase intraocular pressure.
- Antacids: Antacids reduce stomach acid to manage heartburn and indigestion. They can interfere with the absorption of dicyclomine, making it less effective.
- Other Anticholinergics: Other anticholinergic agents amplify dicyclomine's effects, increasing the risk of serious side effects. Examples of anticholinergic medications include oxybutynin, scopolamine, tricyclic antidepressants, and diphenhydramine. Examples of anticholinergic herbs include Atropa belladonna (belladonna), Datura stramonium (jimsonweed), and Hyoscyamus niger (black henbane).
This is not a complete list of potential interactions. To prevent unwanted drug interactions, always inform your healthcare provider of all medications, supplements, and herbs you are taking before starting dicyclomine.
Not only can alcohol exacerbate IBS symptoms, but it also impairs cognitive function and can intensify some of dicyclomine's side effects, like drowsiness and dizziness. It's recommended to avoid drinking alcohol while taking dicyclomine.
Alternatives to Dicyclomine (Bentyl)
If dicyclomine is not suitable due to intolerable side effects, continued or worsening symptoms, or contraindications, discuss with your healthcare provider the best management strategies for your IBS.
Alternative treatment options may include:
- Other Medications: The FDA has approved alosetron, eluxadoline, rifaximin, lubiprostone, and linaclotide for treating IBS.
- Diet: FODMAPs, which stands for "Fermentable Oligo-, Di-, Mono-saccharides And Polyols," are a group of specific types of carbohydrates that can be difficult for some people to digest. Research suggests that following a low-FODMAP diet can reduce IBS symptoms.
- Peppermint Oil: The American College of Gastroenterology recommends giving enteric-coated peppermint oil to patients with IBS based on high-quality evidence suggesting this intervention can significantly improve pain scores.
- Stress Reduction: Stress is a common IBS trigger because it can disrupt GI function, leading to increased pain sensitivity and altered bowel function. Cognitive behavioral therapy, mindfulness, and hypnotherapy are examples of evidence-based psychotherapies that can help provide patients with tools to cope with excessive stress to manage and prevent their IBS symptoms.
- Regular Exercise: Exercise supports GI and mental health. Research indicates that patients with IBS who increase their physical activity experience improved GI and psychological symptoms associated with IBS.
These alternatives offer various approaches to managing IBS and can be tailored to individual patient needs. Always consult your healthcare provider to determine the most appropriate treatment options for your condition.
Frequently Asked Questions (FAQs) About Dicyclomine (Bentyl)
1. Is Dicyclomine Safe During Pregnancy?
The safety of dicyclomine during pregnancy has not been fully established. Pregnant individuals should consult their healthcare provider to weigh the benefits and risks before using this medication.
2. How Quickly Does Dicyclomine Work?
Dicyclomine typically begins to relieve symptoms within one hour after ingestion. Its peak effect is usually seen within 2 hours, providing timely relief from GI spasms and discomfort.
3. Can I Take Dicyclomine Long-Term?
Intramuscular dicyclomine should not be used for longer than two days.
Oral dicyclomine may be appropriate for managing IBS long-term; however, safety data are not available for doses above 80 mg daily for longer than two weeks. Prolonged use can increase the risk of side effects, especially in elderly patients. Patients taking dicyclomine long-term should follow up with their healthcare provider regularly to monitor the drug's effectiveness and safety.
4. Does Dicyclomine Affect Mental Health?
Dicyclomine can affect the central nervous system, potentially affecting mood and cognitive function. These side effects are more likely to occur in patients older than 65 or those with preexisting mental health conditions. If you experience changes in mood or cognitive function while taking dicyclomine, consult your healthcare provider promptly.
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Key Takeaways
- Dicyclomine (Bentyl) is an FDA-approved medication for treating IBS.
- Its antispasmodic properties effectively reduce abdominal pain and cramping, enhancing the quality of life for many patients.
- However, like all medications, it carries potential side effects and interactions that necessitate careful consideration and consultation with healthcare providers.
- If you are struggling with IBS or related GI issues, consult your healthcare provider to determine if dicyclomine is the right treatment option for you.
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