Dicyclomine

INTRODUCTION

Indications

Management of irritable bowel syndrome in patients who do not respond to usual interventions (sedation/change in diet).

Action

May have a direct and local effect on GI smooth muscle, reducing motility and tone. Therapeutic Effects: Decreased GI motility.

Adverse Reactions/Side Effects

CNS: confusion (increased in geriatric patients), drowsiness, light-headedness (IM only). EENT: blurred vision, increased intraocular pressure. CV: palpitations, tachycardia. GI: PARALYTIC ILEUS, constipation, heartburn, decreased salivation, dry mouth, nausea, vomiting. GU: erectile dysfunction, urinary hesitancy, urinary retention. Derm: decreased sweating. Endo: decreased lactation. Local: pain/redness at IM site. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician immediately if these reactions occur.

• Monitor signs of intestinal paralysis (paralytic ileus), including nausea, lack of bowel sounds or movements, abdominal bloating/distention, and vomiting. Report these signs to the physician immediately.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report a rapid heart rate (tachycardia) or signs of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Monitor any changes in irritable bowel symptoms (decreased abdominal pain, decreased diarrhea, improved appetite) to help document whether drug therapy is successful.

• Be alert for decreased sweating and altered/increased body temperature (hyperpyrexia). Notify physician of a prolonged or persistent elevation in body temperature.

• Monitor IM injection site for pain and redness. Report prolonged or excessive injection- site reactions to the physician.

Interventions

• Because of the risk of arrhythmias and impaired thermoregulation, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

Patient/Client-Related Instruction

• Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged drowsiness, light-headedness, confusion, vision problems, problems with urination, sexual dysfunction, or GI problems (nausea, vomiting, constipation, heartburn, dry mouth).

Pharmacokinetics

Absorption: Well absorbed after oral and IM administration.

Distribution: Unknown.

Metabolism and Excretion: 80% eliminated in urine, 10% in feces.

Half-life: 1.8 hr (initial phase), 9–10 hr (terminal phase).

TIME/ACTION PROFILE (antispasmodic effect)