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Nutritional and Dietary Supplementation during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Used primarily for the treatment of spastic or irritable colon, dicyclomine was at one time used in combination with doxylamine and pyridoxine in the popular antiemetic preparation, Bendectin®. No increase in the frequency of congenital anomalies was found in the offspring of about 100 women who used this agent in early pregnancy (Aselton et al., 1985). The frequency of malformations was not increased in the offspring of animals given dicyclomine in doses several times that of the human dose during embryogenesis (Gibson et al., 1968).
Rational Medical Therapy of Functional GI Disorders
Published in Kevin W. Olden, Handbook of Functional Gastrointestinal Disorders, 2020
Richard M. Sperling, Kenneth R. McQuaid
A number of controlled trials have suggested benefit for some subsets of patients or specific symptoms. Dicyclomine 40 mg q.i.d. was superior to placebo in a 2-week trial in improving patients’ overall sense of well-being and abdominal pain (157). However, anticholinergic side effects occurred in 69%, necessitating a dose reduction or withdrawal of medication in over half of these patients. Given the high incidence of side effects, the ability of the investigators to remain blinded is suspect. In a smaller dose of 20 mg t.i.d., dicyclomine had no effect on abdominal pain, distension, or altered bowel movements (158). A 6-week double-blind crossover study of prifinium demonstrated a significant improvement over placebo in global symptoms (159). However, this study has been criticized for its inadequate assessment of treatment response, as well as poor study design (25). Two Italian studies looking at cimetroprium, a “gut-selective” antimuscarinic agent, deserve comment. In the first study, of 48 patients treated for 6 months, significant improvement compared with placebo was noted in the intensity and frequency of abdominal pain and in overall level of symptoms (160). In a second placebo-controlled trial, of 70 patients treated for 12 weeks, significant improvement in the frequency and severity of abdominal pain as well as in the overall assessment of treatment was noted in the cimetroprium group (161). In the two studies, 48% and 17% of patients, respectively, experienced anticholinergic side effects, although none required a dose reduction or study withdrawal.
Gastrointestinal disorders
Published in Anne Lee, Sally Inch, David Finnigan, Therapeutics in Pregnancy and Lactation, 2019
Treatment aims to relieve the major symptoms. Avoidance of ‘trigger’ foods and simple dietary change may help. Bulking agents, with an adequate fluid intake, relieve constipation and are better tolerated than bran. Anticholinergic agents (dicyclomine and hyoscine) and smooth muscle relaxants (mebeverine and alverine) are not recommended in pregnancy because there is inadequate safety data.7,20 Peppermint is widely used in confectionery and peppermint oil is probably safe, though pharmacological safety data is lacking.
Fabry disease – a multisystemic disease with gastrointestinal manifestations
Published in Gut Microbes, 2022
Some major GI symptoms in patients with FD can be treated with various concomitant drugs that are symptomatically effective. Patients with acute diarrhea can be treated with classical anti-diarrhea medication such as loperamid. By contrast, patients suffering from gastroparesis can benefit from treatments with pro-motility agents, such as metoclopramide, which increase the contractile force and accelerate intraluminal transit.68 Patients suffering from upper GI symptoms may benefit from proton pump inhibitors (e.g. omeprazole) or ondansetron if nausea is present.34 Medication against bloating and flatulence may include the administration of simethicone, which eliminates and prevents foam formation.69,70 Furthermore, linaclotide, which is an oligo-peptide agonist of guanylate cyclase 2C is used to treat IBS with constipation and chronic constipation with unknown cause.71,72 The antispasmodic dicyclomine, which blocks the action of acetylcholine on cholinergic receptors in smooth muscles in the GI tract, is used to treat spasms of the intestine in IBS,73 and might also be of relevance, although it should be used with caution, especially in patients with any unstable cardiac condition.
Investigation of anti-Parkinson activity of dicyclomine
Published in International Journal of Neuroscience, 2022
Maham Sanawar, Uzma Saleem, Fareeha Anwar, Samra Nazir, Muhammad Furqan Akhtar, Bashir Ahmad, Tariq Ismail
Intra-peritoneal injection of haloperidol (HAL) and paraquat (PQT) resulted in large production of reactive oxygen species (ROS) which cause oxidative stress, degradation of dopaminergic neurons, neuroinflammation and finally motor impairment and neuronal injury [11,12]. Neuropathological findings of PD include accumulation of neocortical Lewy bodies, plagues or tangles, degeneration of neurons particularly TH-IR (tyrosine hydroxylase-immunoreactive) neuron [13]. M1 muscarinic receptors (M1R) are mostly present in cerebral cortex, hippocampus, amygdala and striatum. They play a key role in the control of motor and cognitive functions. In PD, there is an imbalance concentration of dopamine and acetylcholine due to degeneration of dopaminergic neurons [14]. In order to maintain the balance between two neurotransmitters, muscarinic receptor antagonists having high affinity for M1Rs can be used clinically for the treatment [15,16]. Dicyclomine is a selective M1 muscarinic antagonist [17]. mAChR antagonists increased dopamine concentration [18]. Due to the increased prevalence of PD, it is worthwhile to investigate the potential of dicyclomine which may provide us the rationale approach for the treatment.
Current and emerging pharmacological approaches for treating diarrhea-predominant irritable bowel syndrome
Published in Expert Opinion on Pharmacotherapy, 2020
Akhil Munjal, Bhavtosh Dedania, Brooks D. Cash
Conventional drug therapies for IBS mostly target symptoms of altered stool form (constipation/diarrhea) and bloating and have minimal effects on abdominal pain, which is a major component of IBS symptomatology and significantly affects quality of life. Anti-spasmodics like hyoscyamine, dicyclomine, and peppermint oil have long been used for treating IBS, with the most robust literature supporting peppermint oil. However, side effects from these remedies can limit their utility. Peppermint oil can be associated with bothersome heartburn or dyspepsia. Dicyclomine and hyoscyamine can cause anticholinergic symptoms such as fatigue, dizziness, dry eyes and dry mouth. A small 2-week double-blind study evaluated dicyclomine 40 mg 4 times daily on an ambulatory population and found it to be superior to placebo in controlling overall patient symptoms of pain, abdominal tenderness, and improved bowel habits, albeit with a high incidence of adverse effects [62].