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Bentyl (Dicyclomine Hydrochloride)

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Bentyl (Dicyclomine Hydrochloride) HIGHLIGHTS OF PRESCRIBING INFORMATION • Peripheral and central nervous system: heat prostration can occur with These highlights do not include all the information needed to use drug use (fever and heat stroke due to decreased sweating); drug should BENTYL safely and effectively. See full prescribing information for be discontinued and supportive measures instituted (5.3) BENTYL. • Psychosis in patients sensitive to anticholinergic drugs: signs and symptoms resolve within 12 to 24 hours after discontinuation of BENTYL (dicyclomine hydrochloride) capsules, for oral use BENTYL (5.3) BENTYL (dicyclomine hydrochloride) tablets, for oral use • Myasthenia Gravis: overdose may lead to muscular weakness and BENTYL (dicyclomine hydrochloride) oral syrup paralysis. BENTYL should be given to patients with myasthenia gravis BENTYL (dicyclomine hydrochloride) injection, for intramuscular use only to reduce adverse muscarinic effects of an anticholinesterase (5.4) Initial U.S. Approval: 1950 • Incomplete intestinal obstruction: diarrhea may be an early symptom especially in patients with ileostomy or colostomy. Treatment with ----------------------------INDICATIONS AND USAGE--------------------------- BENTYL would be inappropriate and possibly fatal (5.5) BENTYL is an antispasmodic and anticholinergic (antimuscarinic) agent • Salmonella dysenteric patients: due to risk of toxic megacolon (5.6) indicated for the treatment of functional bowel/irritable bowel syndrome (1) • Ulcerative colitis: BENTYL should be used with caution in these ----------------------DOSAGE AND ADMINISTRATION----------------------- patients; large doses may suppress intestinal motility or aggravate the Dosage for BENTYL must be adjusted to individual patient needs (2). serious complications of toxic megacolon (5.7) If a dose is missed, patients should continue the normal dosing schedule (2). • Prostatic hypertrophy: BENTYL should be used with caution in these Oral in adults (2.1): patients; may lead to urinary retention (5.8) • Starting dose: 20 mg four times a day. After a week treatment with the • Hepatic and renal disease: should be used with caution (5.9) starting dose, the dose may be escalated to 40 mg four times a day, unless • Geriatric: use with caution in elderly who may be more susceptible to side effects limit dosage escalation BENTYL’s adverse events (5.10) • Discontinue BENTYL if efficacy not achieved or side effects require ------------------------------ADVERSE REACTIONS------------------------------- doses less than 80 mg per day after two weeks of treatment The most serious adverse reactions include cardiovascular and central nervous Intramuscular in adults (2.2): system symptoms. The most common adverse reactions (> 5% of patients) are • Intramuscular administration recommended no longer than 1 or 2 days dizziness, dry mouth, vision blurred, nausea, somnolence, asthenia and when patients cannot take oral administration nervousness (6) • Recommended dose: 10 mg to 20 mg four times a day To report SUSPECTED ADVERSE REACTIONS, contact AXCAN ---------------------DOSAGE FORMS AND STRENGTHS---------------------- Pharma US, Inc. at 1-800-472-2634 or FDA at 1-800-FDA-1088 or • BENTYL capsules 10 mg (3) • BENTYL syrup 10 mg/5 mL (3) www.fda.gov/medwatch. • BENTYL tablets 20 mg (3) • BENTYL injection 20 mg/2 mL (10 mg/mL) (3) ------------------------------DRUG INTERACTIONS------------------------------­ • Antiglaucoma agents: anticholinergics antagonize antiglaucoma agents ------------------------------- CONTRAINDICATIONS----------------------------- and may increase intraoccular pressure (7) • Infants less than 6 months of age (4) • Glaucoma (4) • Anticholinergic agents: may affect the gastrointestinal absorption of • Nursing mothers (4) • Obstructive uropathy (4) various drugs; may also increase certain actions or side effects of other • Unstable cardiovascular status in • Obstructive disease of the anticholinergic drugs (7) acute hemorrhage (4) gastrointestinal tract (4) • Antacids: interfere with the absorption of anticholinergic agents (7) • Myasthenia gravis (4) • Severe ulcerative colitis (4) -----------------------USE IN SPECIFIC POPULATIONS-----------------------­ • Reflux esophagitis (4) • Pregnancy: use only if clearly needed (8.1) -----------------------WARNINGS AND PRECAUTIONS-----------------------­ • Pediatric Use: Safety and effectiveness not established (8.4) • For Intramuscular injection only; should not be administered by any • Hepatic and renal impairment: caution must be taken with patients with other route. Intravenous injection may result in thrombosis or significantly impaired hepatic and renal function (8.6) thrombophlebitis and injection site reactions (5.1) • Cardiovascular conditions: worsening of conditions (5.2) See 17 for PATIENT COUNSELING INFORMATION. Revised: 07/2011 _______________________________________________________________________________________________________________________________________ FULL PRESCRIBING INFORMATION: CONTENTS* 7.5 Effect on Absorption of Other Drugs 1 INDICATIONS AND USAGE 7.6 Effect on Gastric Acid Secretion 2 DOSAGE AND ADMINISTRATION 8 USE IN SPECIFIC POPULATIONS 2.1 Oral Dosage and Administration in Adults 8.1 Pregnancy 2.2 Intramuscular Dosage and Administration in Adults 8.3 Nursing Mothers 2.3 Preparation for Intramuscular Administration 8.4 Pediatric Use 3 DOSAGE FORMS AND STRENGTHS 8.5 Geriatric Use 4 CONTRAINDICATIONS 8.6 Renal Impairment 5 WARNINGS AND PRECAUTIONS 8.7 Hepatic Impairment 5.1 Inadvertent Intravenous Administration 10 OVERDOSAGE 5.2 Cardiovascular Conditions 11 DESCRIPTION 5.3 Peripheral and Central Nervous System 12 CLINICAL PHARMACOLOGY 5.4 Myasthenia Gravis 12.1 Mechanism of Action 5.5 Intestinal Obstruction 12.2 Pharmacodynamics 5.6 Toxic Dilatation of Intestinemegacolon 12.3 Pharmacokinetics 5.7 Ulcerative Colitis 13 NONCLINICAL TOXICOLOGY 5.8 Prostatic Hypertrophy 13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility 5.9 Hepatic and Renal Disease 14 CLINICAL STUDIES 5.10 Geriatric Population 16 HOW SUPPLIED/STORAGE AND HANDLING 6 ADVERSE REACTIONS 17 PATIENT COUNSELING INFORMATION 6.1 Clinical Trials Experience 17.1 Inadvertent Intravenous Administration 6.2 Postmarketing Experience 17.2 Use in Infants 6.3 Adverse Reactions Reported with Similar Drugs with 17.3 Use in Nursing Mothers Anticholinergic/Antispasmodic Action 17.4 Peripheral and Central Nervous System 7 DRUG INTERACTIONS 7.1 Antiglaucoma Agents 7.2 Other Drugs with Anticholinergic Activity *Sections or subsections omitted from the full prescribing information 7.3 Other Gastrointestinal Motility Drugs are not listed 7.4 Effect of Antacids Reference ID: 2981284 FULL PRESCRIBING INFORMATION 5.2 Cardiovascular Conditions Dicyclomine hydrochloride needs to be used with caution in conditions characterized by tachyarrhythmia such as thyrotoxicosis, 1 INDICATIONS AND USAGE ® congestive heart failure and in cardiac surgery, where they may BENTYL (dicyclomine hydrochloride ) is indicated for the further accelerate the heart rate. Investigate any tachycardia before treatment of patients with functional bowel/irritable bowel syndrome. administration of dicyclomine hydrochloride. Care is required in patients with coronary heart disease, as ischemia and infarction may 2 DOSAGE AND ADMINISTRATION be worsened, and in patients with hypertension [see Adverse Dosage must be adjusted to individual patient needs. Reactions (6.3)]. 2.1 Oral Dosage and Administration in Adults The recommended initial dose is 20 mg four times a day. 5.3 Peripheral and Central Nervous System The peripheral effects of dicyclomine hydrochloride are a After one week treatment with the initial dose, the dose may be consequence of their inhibitory effect on muscarinic receptors of the increased to 40 mg four times a day unless side effects limit dosage autonomic nervous system. They include dryness of the mouth with escalation. difficulty in swallowing and talking, thirst, reduced bronchial If efficacy is not achieved within 2 weeks or side effects require secretions, dilatation of the pupils (mydriasis) with loss of doses below 80 mg per day, the drug should be discontinued. accommodation (cycloplegia) and photophobia, flushing and dryness Documented safety data are not available for doses above 80 mg of the skin, transient bradycardia followed by tachycardia, with daily for periods longer than 2 weeks. palpitations and arrhythmias, and difficulty in micturition, as well as 2.2 Intramuscular Dosage and Administration in Adults reduction in the tone and motility of the gastrointestinal tract leading BENTYL Intramuscular Injection must be administered via to constipation [see Adverse Reactions (6)]. intramuscular route only. Do not administer by any other route. In the presence of high environmental temperature heat The recommended intramuscular dose is 10mg to 20 mg four prostration can occur with drug use (fever and heat stroke due to times a day [see Clinical Pharmacology (12)]. decreased sweating). It should also be used cautiously in patients The intramuscular injection is to be used only for 1 or 2 days when with fever. If symptoms occur, the drug should be discontinued and the patient cannot take oral medication. supportive measures instituted. Because of the inhibitory effect on Intramuscular injection is about twice as bioavailable as oral muscarinic receptors within the autonomic nervous system, caution dosage forms. should be taken in patients with autonomic neuropathy. 2.3 Preparation for Intramuscular Administration Central nervous
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