Dicyclomine + Ethylmorphine

Usage

Dicyclomine + Ethylmorphine is a combination drug primarily used to relieve abdominal pain associated with muscle spasms in the gastrointestinal tract. It is sometimes prescribed for conditions like irritable bowel syndrome (IBS).

• Pharmacological Classification: This combination includes two drug classes:

  • Dicyclomine: Anticholinergic, Antispasmodic
  • Ethylmorphine: Opioid Analgesic, Antitussive

• Mechanism of Action:

  • Dicyclomine relaxes the smooth muscles of the gastrointestinal tract by blocking the action of acetylcholine, a neurotransmitter that stimulates muscle contraction. This reduces spasms and associated pain, bloating, and discomfort.
  • Ethylmorphine acts on opioid receptors in the central nervous system, reducing the perception of pain. It also has antitussive (cough suppressant) properties.

Alternate Names

There is no officially recognized International Nonproprietary Name (INN) for this combination. Regional variations may exist.

• Brand Names:
  • Spasmo Acidion
  • Spasmindon

How It Works

• Pharmacodynamics: Dicyclomine exerts its antispasmodic effect by competitively inhibiting the action of acetylcholine at muscarinic receptors, particularly in the smooth muscles of the GI tract. Ethylmorphine binds to opioid receptors in the CNS, mainly mu receptors, mimicking the effects of endogenous opioids to decrease pain perception.

• Pharmacokinetics:

  • Dicyclomine: Administered orally or intramuscularly. It is well-absorbed orally, with peak plasma concentrations reached in 1-2 hours. Metabolized primarily in the liver.
  • Ethylmorphine: Administered orally. Absorbed from the GI tract. Metabolized in the liver, partly converted to morphine. Excreted primarily by the kidneys.

• Mode of Action/Receptor Binding:

  • Dicyclomine: Competitive antagonist at muscarinic receptors.
  • Ethylmorphine: Agonist at mu opioid receptors.

• Elimination Pathways:

  • Dicyclomine: Primarily hepatic metabolism followed by renal excretion.
  • Ethylmorphine: Hepatic metabolism (including conversion to morphine) and renal excretion.

Dosage

Standard Dosage

Adults:

Oral: Dicyclomine typically starts at 20 mg four times a day, which may be increased to 40 mg four times a day if needed. Ethylmorphine dosages are less standardized in this combination and should be individualized by the physician. IM: Dicyclomine can be given as 10-20 mg IM four times daily for 1-2 days when oral administration is not feasible. This route is typically used short-term.

Children:

The combination is generally not recommended for children. Dicyclomine alone is not recommended in children under 6 months, and ethylmorphine carries respiratory risks in children, especially those with underlying respiratory issues.

Special Cases:

• Elderly Patients: Dosage reduction may be necessary due to increased sensitivity to side effects.
• Patients with Renal Impairment: Caution is advised; dose adjustment may be needed.
• Patients with Hepatic Dysfunction: Dose adjustment may be necessary.
• Patients with Comorbid Conditions: Use with caution in patients with glaucoma, myasthenia gravis, urinary retention, bowel obstruction, or respiratory problems.

Clinical Use Cases

The combination is typically not used in hospital settings like intubation, surgical procedures, mechanical ventilation, or ICU. In emergency situations, other medications are preferred.

Dosage Adjustments

Adjustments are made based on individual patient response, tolerance, and the presence of renal or hepatic impairment.

Side Effects

Common Side Effects:

• Dry mouth
• Blurred vision
• Dizziness
• Drowsiness
• Constipation
• Nausea
• Vomiting
• Weakness
• Nervousness
• Sweating
• Shortness of breath

Rare but Serious Side Effects:

• Confusion
• Hallucinations
• Difficulty urinating
• Irregular heartbeat
• Allergic reactions (rash, itching, swelling)
• Respiratory depression (with ethylmorphine)

Long-Term Effects:

• Potential for dependence with chronic ethylmorphine use.
• Anticholinergic effects can worsen with prolonged dicyclomine use.

Adverse Drug Reactions (ADR):

Any severe or unusual reaction should be reported and the medication stopped.

Contraindications

• Glaucoma
• Myasthenia gravis
• Urinary retention
• Obstructive gastrointestinal disorders
• Severe ulcerative colitis
• Infants under 6 months
• Hypersensitivity to either drug

Drug Interactions

• Other anticholinergics: Additive effects.
• CNS depressants (alcohol, benzodiazepines, opioids): Increased sedation and respiratory depression.
• MAO inhibitors: Increased risk of anticholinergic side effects.
• CYP3A4 inhibitors/inducers: May affect metabolism of dicyclomine.
• CYP2D6 inhibitors/inducers: May affect metabolism of ethylmorphine.

Pregnancy and Breastfeeding

• Pregnancy: Dicyclomine is Pregnancy Category B. Use with caution and only if clearly needed. Ethylmorphine should generally be avoided in pregnancy due to the risk of neonatal withdrawal syndrome.

• Breastfeeding: Dicyclomine may be excreted in breast milk. Ethylmorphine is contraindicated during breastfeeding.

Drug Profile Summary

• Mechanism of Action: Dicyclomine: Anticholinergic, blocks acetylcholine at muscarinic receptors. Ethylmorphine: Opioid analgesic, agonist at mu opioid receptors.

• Side Effects: Dry mouth, blurred vision, dizziness, drowsiness, constipation, nausea, vomiting, urinary retention, confusion.

• Contraindications: Glaucoma, urinary retention, GI obstruction, myasthenia gravis, infants under 6 months.

• Drug Interactions: Other anticholinergics, CNS depressants, MAO inhibitors.

• Pregnancy & Breastfeeding: Dicyclomine: use with caution if benefits outweigh risks. Ethylmorphine: contraindicated.

• Dosage: Adults: Dicyclomine 20-40 mg orally four times/day or 10-20 mg IM four times/day (short term). Ethylmorphine dose varies based on indication and formulation.

• Monitoring Parameters: Vital signs, respiratory function, mental status, GI symptoms.

Popular Combinations

This particular combination is not a widely recognized or “popular” combination. Other combinations may be more commonly employed for managing abdominal pain and related symptoms.

Precautions

• Monitor for anticholinergic and opioid-related side effects.
• Use with caution in elderly patients and those with renal or hepatic impairment.
• Avoid alcohol.
• Caution when driving or operating machinery.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Dicyclomine + Ethylmorphine?

A: The dosage for this combination is not standardized. Dicyclomine typically starts at 20 mg four times a day, potentially increased to 40 mg four times daily. Ethylmorphine dosing should be individualized by the physician based on the patient’s specific needs and the condition being treated.

Q2: What are the primary uses of this combination?

A: It is primarily indicated for abdominal pain associated with gastrointestinal spasms.

Q3: Can this combination be used in children?

A: It is generally not recommended for pediatric use.

Q4: What are the main side effects to watch for?

A: Common side effects include dry mouth, blurred vision, dizziness, drowsiness, constipation, and nausea. Serious side effects include confusion, hallucinations, urinary retention, and respiratory depression (primarily with ethylmorphine).

Q5: Are there any contraindications to its use?

A: Yes, contraindications include glaucoma, myasthenia gravis, urinary retention, bowel obstruction, and hypersensitivity to either drug.

Q6: How does dicyclomine work in this combination?

A: Dicyclomine acts as an antispasmodic, relaxing the smooth muscles in the GI tract.

Q7: How does ethylmorphine work in this combination?

A: Ethylmorphine is an opioid analgesic that acts on the central nervous system to reduce pain perception.

Q8: What are the key drug interactions?

A: Significant interactions can occur with other anticholinergics, CNS depressants (alcohol, benzodiazepines, opioids), and MAO inhibitors.

Q9: Can pregnant or breastfeeding women take this medication?

A: Dicyclomine use during pregnancy should be carefully evaluated by a physician. Ethylmorphine should generally be avoided during pregnancy and is contraindicated while breastfeeding.

Q10: Is this a common drug combination?

A: No, this is not a standard or frequently prescribed combination.