Clinical data | |
---|---|
Trade names | Byclomine, Bentyl, Dibent, others |
AHFS/Drugs.com | Monograph |
MedlinePlus | a684007 |
License data |
|
Pregnancy category |
|
ATC code | |
Legal status | |
Legal status | |
Pharmacokinetic data | |
Protein binding | >99% |
Elimination half-life | 5 h |
Identifiers | |
| |
CAS Number | |
PubChem CID | |
IUPHAR/BPS | |
DrugBank | |
ChemSpider | |
UNII | |
KEGG | |
ChEBI | |
ChEMBL | |
CompTox Dashboard (EPA) | |
ECHA InfoCard | 100.000.919 |
Chemical and physical data | |
Formula | C19H35NO2 |
Molar mass | 309.494 g·mol−1 |
3D model (JSmol) | |
| |
| |
(verify) |
Dicycloverine, also known as dicyclomine, sold under the brand name Bentyl among others, is a medication that is used to treat spasms of the intestines such as those that occur in irritable bowel syndrome. [1] [2] It is taken by mouth or by injection into a muscle. [2] While it has been used in baby colic and enterocolitis, evidence does not support these uses. [2]
Common side effects include dry mouth, blurry vision, weakness, sleepiness, and lightheadedness. [2] Serious side effects may include psychosis and breathing problems in babies. [2] Use in pregnancy appears to be safe while use during breastfeeding is not recommended. [3] How it works is not entirely clear. [2]
Dicycloverine was approved for medical use in the United States in 1950. [2] It is available as a generic medication. [1] In 2021, it was the 148th most commonly prescribed medication in the United States, with more than 3 million prescriptions. [4] [5]
Dicycloverine is used to treat the symptoms of irritable bowel syndrome, specifically hypermotility, in adults. [6] [7] As of 2016, clinical guidelines recommended dicycloverine and other antispasmodics for IBS with diarrhea as a first line treatment. [6]
Dicyclomine can also be helpful for the treatment of Anxiety, but this is an off label use. [8]
This medicine should not be used for people who have an obstructive GI or urinary condition, severe ulcerative colitis, reflux, any unstable cardiac condition, glaucoma, myasthenia gravis, and anyone who is acutely bleeding. [7]
It should not be given to children or infants with colic due to the risks of convulsions, difficult breathing, irritability, and restlessness, [9] and there is little evidence to support the efficacy in such use in any case. [10]
Dicycloverine is known to impair thinking and coordination. [7]
The effect on the baby during pregnancy or breastfeeding is not well understood. [7]
Dicycloverine can cause a range of anticholinergic side effects such as dry mouth, nausea, blurred vision, dizziness, confusion, severe constipation, stomach pain, heart palpitations, difficulty urinating, and seizures. [6]
Dicycloverine is a selective muscarinic acetylcholine 1 receptor antagonist. [11] It blocks the action of acetylcholine on muscarinic receptors on smooth muscles in the gastrointestinal tract, relaxing the smooth muscle. [6]
Dicycloverine was first synthesized chemically in the United States circa 1945 by scientists at William S. Merrell Company. [12]
It was first marketed in 1952 for gastrointestinal disorders, including colic in infants. [9] The INN name "dicycloverine" was recommended in 1959. [13] It was included in the combination drug for morning sickness called Bendectin, along with doxylamine and vitamin B6 which was launched in the US in 1956; dicycloverine was removed from the formulation in 1976 after Merrell determined that it added no value. Bendectin became the subject of many lawsuits due to allegations that it had caused birth defects similar to thalidomide, which Merrell had also marketed in the US and Canada. [14]
In the 1980s, several governments restricted its use in infants due to reports of convulsions, difficult breathing, irritability, and restlessness in infants given the drug. [9]
In 1994, the US Federal Trade Commission ordered Marion Merrell Dow, which had acquired Rugby Darby—the only generic manufacturer of dicycloverine in the US—to promise to grant licenses to its intellectual property on the drug to any company that wanted it, based on antitrust concerns. The US market for the medication at that time was around $8 million; Dow had 60% of it and Rugby had 40%. The next year, Hoechst Marion Roussel, which by that time had acquired the business, granted a license to Endo Pharmaceuticals. By 2000 several other generic competitors had started selling the medication. The case was part of the reshaping of the US pharmaceutical market that occurred in the 1990s, to favor generic entry. [15]
Rarely, there have been reports of dicycloverine abuse. Dicycloverine is an antagonist at σ1 [16] and 5-HT2A [17] receptor sites, though its affinities for these targets are roughly one-fifth to one-tenth as strong as its affinities for CHRM1 [18] and CHRM4 [19] (its clinical targets). It is also a relatively non-polar tertiary amine, able to cross the blood–brain barrier, leading to delirium at high concentrations. [6] [20]
Atropine is a tropane alkaloid and anticholinergic medication used to treat certain types of nerve agent and pesticide poisonings as well as some types of slow heart rate, and to decrease saliva production during surgery. It is typically given intravenously or by injection into a muscle. Eye drops are also available which are used to treat uveitis and early amblyopia. The intravenous solution usually begins working within a minute and lasts half an hour to an hour. Large doses may be required to treat some poisonings.
Benzatropine (INN), known as benztropine in the United States and Japan, is a medication used to treat movement disorders like parkinsonism and dystonia, as well as extrapyramidal side effects of antipsychotics, including akathisia. It is not useful for tardive dyskinesia. It is taken by mouth or by injection into a vein or muscle. Benefits are seen within two hours and last for up to ten hours.
Hyoscyamine is a naturally occurring tropane alkaloid and plant toxin. It is a secondary metabolite found in certain plants of the family Solanaceae, including henbane, mandrake, angel's trumpets, jimsonweed, the sorcerers' tree, and Atropa belladonna. It is the levorotary isomer of atropine and thus sometimes known as levo-atropine.
Loperamide, sold under the brand name Imodium, among others, is a medication of the opioid receptor agonist class used to decrease the frequency of diarrhea. It is often used for this purpose in irritable bowel syndrome, inflammatory bowel disease, short bowel syndrome Crohn's disease and ulcerative colitis. It is not recommended for those with blood in the stool, mucus in the stool, or fevers. The medication is taken by mouth.
Metoclopramide is a medication used for stomach and esophageal problems. It is commonly used to treat and prevent nausea and vomiting, to help with emptying of the stomach in people with delayed stomach emptying, and to help with gastroesophageal reflux disease. It is also used to treat migraine headaches.
Pravastatin, sold under the brand name Pravachol among others, is a statin medication, used for preventing cardiovascular disease in those at high risk and treating abnormal lipids. It is suggested to be used together with diet changes, exercise, and weight loss. It is taken by mouth.
Chlorphenamine (CP, CPM), also known as chlorpheniramine, is an antihistamine used to treat the symptoms of allergic conditions such as allergic rhinitis (hay fever). It is taken orally (by mouth). The medication takes effect within two hours and lasts for about 4–6 hours. It is a first-generation antihistamine and works by blocking the histamine H1 receptor.
Ipratropium bromide, sold under the trade name Atrovent among others, is a type of anticholinergic medication which is applied by different routes: inhaler, nebulizer, or nasal spray, for different reasons.
Cyclobenzaprine, sold under several brand names including, historically, Flexeril, is a muscle relaxer used for muscle spasms from musculoskeletal conditions of sudden onset. It is not useful in cerebral palsy. It is taken by mouth.
Ondansetron, sold under the brand name Zofran among others, is a medication used to prevent nausea and vomiting caused by cancer chemotherapy, radiation therapy, migraines or surgery. It is also effective for treating gastroenteritis. It can be given orally, intramuscularly, or intravenously.
Doxylamine is an antihistamine medication used to treat insomnia and allergies, and—in combination with pyridoxine (vitamin B6)—to treat morning sickness in pregnant women. It is available over-the-counter and is typically sold under such brand names as Equate or Unisom, among others; and it is used in nighttime cold medicines (e.g., NyQuil) and pain medications containing acetaminophen and/or codeine to help with sleep. The medication is delivered chemically by the salt doxylamine succinate and is taken by mouth. Doxylamine and other first-generation antihistamines are the most widely used sleep medications in the world. Typical side effects of doxylamine (at recommended doses) include dizziness, drowsiness, grogginess, and dry mouth, among others.
Tolterodine, sold under the brand name Detrol among others, is a medication used to treat frequent urination, urinary incontinence, or urinary urgency. Effects are seen within an hour. It is taken by mouth.
Tizanidine, sold under the brand name Zanaflex among others, is an alpha-2 (α2) adrenergic receptor agonist, similar to clonidine, that is used to treat muscle spasticity due to spinal cord injury, multiple sclerosis, and spastic cerebral palsy. Effectiveness appears similar to baclofen or diazepam. It is taken by mouth.
Olmesartan, sold under the brand name Benicar among others, is a medication used to treat high blood pressure (hypertension). It is taken orally. Versions are available as the combination olmesartan/hydrochlorothiazide and olmesartan/amlodipine. It is available as a prodrug, olmesartan medoxomil.
Biperiden, sold under the brand name Akineton among others, is a medication used to treat Parkinson disease, certain drug-induced movement disorders and Tourette Syndrome. It is not recommended for tardive dyskinesias. It is taken by mouth, injection into a vein, or muscle.
Pyridoxine/doxylamine, sold under the brand name Diclectin among others, is a combination of pyridoxine hydrochloride (vitamin B6) and doxylamine succinate. It is generally used for nausea and vomiting of pregnancy (morning sickness); even though its efficacy has not been proven and subsequent research has led to the removal of recommendations in medical journals.
Lofepramine, sold under the brand names Gamanil, Lomont, and Tymelyt among others, is a tricyclic antidepressant (TCA) which is used to treat depression. The TCAs are so named as they share the common property of having three rings in their chemical structure. Like most TCAs lofepramine is believed to work in relieving depression by increasing concentrations of the neurotransmitters norepinephrine and serotonin in the synapse, by inhibiting their reuptake. It is usually considered a third-generation TCA, as unlike the first- and second-generation TCAs it is relatively safe in overdose and has milder and less frequent side effects.
Solifenacin, sold as the brand name Vesicare among others, is a medicine used to treat overactive bladder and neurogenic detrusor overactivity (NDO). It may help with incontinence, urinary frequency, and urinary urgency.
Guaifenesin/phenylephrine is a combination of the drugs guaifenesin and phenylephrine and is a preparation against the symptoms of cold, flu and allergy. Guaifenesine is an expectorant, phenylephrine is a decongestant. The drug is sold under the brand name Entex and as generic brands. Entex La is 400 mg guaifenesin and 30 mg phenylephrine hydrochloride. Entex Pse is 600 mg guaifenesin and 120 mg phenylephrine hydrochloride. Both are extended release products, meaning that the non-active ingredients are chosen to dissolve slowly to provide a prolonged therapeutic effect.
Meclizine, sold under the brand name Bonine, among others, is an antihistamine used to treat motion sickness and dizziness (vertigo). It is taken by mouth. Effects generally begin in an hour and last for up to a day.