GI Antispasmodics – Test Prep and Practice Pearls

Abdominal cramping and intestinal spasms are common complaints in patients with conditions such as irritable bowel syndrome (IBS). Two of the most frequently prescribed medications for these symptoms are dicyclomine and hyoscyamine. These medications work by blocking muscarinic receptors, reducing smooth muscle contractions in the gastrointestinal tract and helping relieve painful spasms.

While these medications can be effective, they are not without risks. Because of their anticholinergic effects, patients may experience dry mouth, constipation, blurred vision, dizziness, and urinary retention. Older adults are particularly susceptible to these adverse effects, making careful patient selection and monitoring especially important. Patients with benign prostatic hyperplasia (BPH), glaucoma, or cognitive impairment may be at higher risk for complications.

In this episode of the Real Life Pharmacology podcast, we’ll review how dicyclomine and hyoscyamine work, discuss their most common clinical uses, compare their adverse effect profiles, and highlight practical education points to help optimize safe and effective use.

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Top 200 Drugs Podcast – Medications 66-70

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Pantoprazole (Protonix) is a PPI that can be used for GERD and peptic ulcer disease. I differentiate why this medication is different from the commonly used omeprazole.

Dicyclomine (Bentyl) is an anticholinergic medication that may be used to help reduce pain and spasms associated with irritable bowel syndrome.

Sumatriptan (Imitrex) is a selective 5HT1 receptor agonist, which potentially helps with vasoconstriction that contributes to migraine symptoms.

Chlorhexidine (Peridex) is an antibiotic oral rinse that can be used for gingivitis.

Metoprolol (Lopressor, Toprol XL) is a beta-blocker that may be used for atrial fibrillation, angina prevention, and hypertension. It is not a first-line medication for hypertension.

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Dicyclomine Pharmacology

Dicyclomine is an anticholinergic agent that is used to help manage GI pain associated with IBS.

Dicyclomine has a very short half-life which means that it can be dosed multiple times per day.

Be careful with patients who have predominant constipation with their IBS as dicyclomine can exacerbate this.

Bentyl is the brand name of dicyclomine. This drug blocks the action of acetylcholine.

I discuss important drug interactions on the podcast, be sure to check out my latest project which is a 200+ page book on managing drug interactions in primary care.

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