Dicyclomine Contraindications and Precautions in Gastrointestinal Disorders

Contraindications and Warnings

• The FDA contraindicates dicyclomine in patients with obstructive disease of the gastrointestinal tract, severe ulcerative colitis, reflux esophagitis, myasthenia gravis, glaucoma, and obstructive uropathy 1, 2, 3
• The British Society of Gastroenterology recommends avoiding tricyclic antidepressants, which share anticholinergic properties with dicyclomine, in patients with constipation-predominant IBS 4, 5

Clinical Guidelines and Recommendations

• The British Society of Gastroenterology guidelines suggest that antispasmodics with anticholinergic action, including dicyclomine, should be used with caution in IBS patients, especially those with constipation-predominant symptoms 4, 5
• The American Gastroenterological Association guidelines note that regular use of dicyclomine in constipation may be limited due to its anticholinergic effects 6

Alternative Therapies

• The British Society of Gastroenterology and the American Gastroenterological Association recommend alternative therapies for constipation-predominant IBS, including linaclotide, lubiprostone, tenapanor, plecanatide, and tegaserod, which have strong evidence for efficacy 1, 2, 3

Patient Selection and Monitoring

• Dicyclomine may be used with caution in patients with diarrhea-predominant IBS or pain-predominant IBS without constipation, but requires careful assessment and monitoring for constipation symptoms 4, 5, 6