CYCLOPAM

Indications

• Irritable bowel syndrome
• Functional gastrointestinal disorders
• Spasm of the gastrointestinal tract

Dosage

Children: Refer to the BNF for Children for appropriate pediatric dosing guidelines.

Adults: Typically, dicyclomine is administered in doses of 20-40 mg orally, taken 4 times daily, or 10-20 mg by intramuscular injection. Dicyclomine should not be given intravenously.

Mechanism of action

Dicyclomine exerts its effects through direct antimuscarinic activity at M1, M2, and M3 receptors, along with non-competitive antagonism of bradykinin and histamine. This results in a relaxation of smooth muscle, particularly in the ileum, leading to decreased contractions and alleviation of spasms. Its major action is a non-specific direct relaxant effect on smooth muscle rather than a competitive antagonism of acetylcholine.

Pharmacodynamics

Dicyclomine is classified as an anticholinergic drug, which is effective in relaxing smooth muscle in the intestines. Its onset of action provides symptomatic relief in conditions characterized by gastrointestinal spasm and discomfort. The drug is typically dosed multiple times throughout the day, reflecting its moderate duration of action.

Pharmacokinetics

Dicyclomine is absorbed after oral administration, with peak plasma concentrations usually occurring within 1 to 2 hours. It undergoes hepatic metabolism, and its metabolites are excreted primarily in the urine. The half-life of dicyclomine varies but is generally around 1-2 hours, which supports the need for multiple daily dosing.

Contra-indications

• Glaucoma
• Myasthenia gravis
• Severe ulcerative colitis
• Obstructive uropathy
• Severe hepatic impairment

Adverse effects

• Dry mouth
• Dizziness
• Drowsiness
• Nausea
• Constipation
• Blurred vision
• Tachycardia

Interactions

• Other anticholinergic drugs may increase the risk of side effects
• CNS depressants may enhance drowsiness
• Antacids may affect absorption

Precautions

• Use with caution in patients with urinary retention
• May exacerbate existing gastrointestinal obstruction
• Caution in elderly patients due to increased sensitivity to anticholinergics
• Monitor for signs of overdose, especially in children

Pregnancy

Dicyclomine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Consult healthcare professionals for guidance.

Breast-feeding

Dicyclomine may pass into breast milk. Caution is advised when administered to nursing women.

Storage

Store at room temperature, away from moisture and heat. Keep out of reach of children.

Formulations

• Oral tablet (20 mg, 40 mg)
• Injectable solution (10 mg/2 mL, 20 mg/2 mL)

Indications

• Relief of gas-related symptoms such as bloating
• Flatulence
• Discomfort from excess gas in the gastrointestinal tract

Dosage

Children: Refer to the BNF for Children for specific dosing information.

Adults: Refer to the BNF for specific dosing information.

Mechanism of action

Simethicone acts as an antifoaming agent by reducing the surface tension of gas bubbles in the stomach and intestines. This action allows smaller gas bubbles to combine into larger bubbles that can be expelled more easily, thus alleviating discomfort caused by gas buildup.

Pharmacodynamics

Simethicone does not get absorbed into the bloodstream; it works locally within the gastrointestinal tract. The reduction of surface tension helps to alleviate the symptoms of gas-related discomfort by promoting the passage of gas through the digestive system.

Pharmacokinetics

Simethicone is not absorbed from the gastrointestinal tract and is excreted unchanged in the feces. Its onset of action is typically rapid, with effects usually being felt within minutes after administration. The duration of action can vary depending on the dose and the individual patient's gastrointestinal motility.

Adverse effects

• Nausea
• Vomiting
• Diarrhea
• Constipation
• Abdominal discomfort

Precautions

• Use caution in patients with a known hypersensitivity to simethicone or any component of the formulation.
• Consult a healthcare professional if symptoms persist after use.

Pregnancy

Simethicone is generally considered safe to use during pregnancy as it is not absorbed systemically.

Breast-feeding

Simethicone is not absorbed into the bloodstream and is considered safe for use during breastfeeding.

Storage

Store at room temperature, away from moisture and heat. Keep out of reach of children.

Formulations

• Chewable tablets
• Softgels
• Liquid suspension

Mechanism of action

Dicyclomine achieves its action partially through direct antimuscarinic activity of the M1, M3, and M2 receptors; and partially through antagonism of bradykinin and histamine. Dicyclomine non-competitively inhibits the action of bradykinin and histamine, resulting in direct action on the smooth muscle, and decreased strength of contractions seen in spasms of the ileum. ...MAJOR ACTION APPEARS TO BE NONSPECIFIC DIRECT RELAXANT ACTION ON SMOOTH MUSLCE RATHER THAN COMPETITIVE ANTAGONISM OF ACH.

Pharmacodynamics

Dicyclomine is an anticholinergic drug used to relax the smooth muscles of the intestines. It's duration of action is not especially long as it is usually taken 4 times daily with individual doses of 20-40mg orally or 10-20mg by intramuscular injection. Dicyclomine should not be administered intravenously.