Worst Pills, Best Pills

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Drug Profile

Do NOT stop taking this or any drug without the advice of your physician. Some drugs can cause severe adverse effects when they are stopped suddenly.

Do Not Use [what does this mean?]
Generic drug name: atropine (a TROE peen)
Brand name(s):
GENERIC: not available FAMILY: Anticholinergics
Find the drug label by searching at DailyMed.

Do Not Use [what does this mean?]
Generic drug name: atropine, hyoscyamine, scopolamine, and phenobarbital (a TROE peen, hye oh SYE a meen, scoe POL a meen and fee noe BAR bi tal)
Brand name(s): DONNATAL
GENERIC: not available FAMILY: Anticholinergics
Find the drug label by searching at DailyMed.

Do Not Use [what does this mean?]
Generic drug name: dicyclomine (dye SYE kloe meen)
Brand name(s): BENTYL
GENERIC: not available FAMILY: Anticholinergics
Find the drug label by searching at DailyMed.

Do Not Use [what does this mean?]
Generic drug name: hyoscyamine (hye oh SYE a meen)
Brand name(s): LEVBID, LEVSIN
GENERIC: not available FAMILY: Anticholinergics
Find the drug label by searching at DailyMed.

Alternative Treatment [top]

See Diarrhea. For spastic colon, see psyllium and methycellulose.

Safety Warnings For This Drug [top]

Product Warnings

Ask a doctor or pharmacist before use if you are taking antibiotics.

When using this product, tiredness, drowsiness or dizziness may occur. Be careful driving or operating machinery.

Stop using and ask a doctor if symptoms get worse, diarrhea lasts more than two days or you get abdominal swelling or bulging. These may be signs of a serious condition.

If pregnant or breast-feeding, ask a health care professional before use.

Older adults are especially sensitive to the harmful anticholinergic effects of this drug. Drugs in this family should not be used unless absolutely necessary.

Mental Effects: confusion, delirium, short-term memory problems, disorientation and impaired attention.

Physical Effects: dry mouth, constipation, difficulty urinating (especially for a man with an enlarged prostate), blurred vision, decreased sweating with increased body temperature, sexual dysfunction and worsening of glaucoma.

If you are currently taking zolpidem and develop complex sleep behaviors, discontinue the drug immediately and seek medical help.

Otherwise, if you have been taking zolpidem for awhile, do not stop taking this drug suddenly because it may cause drug-induced dependence. Instead, work with your doctor to create a schedule to stop it gradually to avoid withdrawal reactions (including stomach cramps, vomiting, nervousness and panic attacks).

Facts About This Drug [top]

Atropine, hyoscyamine, dicyclomine, and scopolamine are antispasmodic drugs that are used to relieve abdominal discomfort from cramping (spasms) and to control diarrhea. The use of these drugs as treatment for peptic ulcer disease has been replaced by more effective agents.[1] All four have such severe adverse effects that older adults should not use them. Even if you are taking only the usual adult dose, you may suffer from excitement, restlessness, drowsiness or confusion.[2]

In 2007, a...

Atropine, hyoscyamine, dicyclomine, and scopolamine are antispasmodic drugs that are used to relieve abdominal discomfort from cramping (spasms) and to control diarrhea. The use of these drugs as treatment for peptic ulcer disease has been replaced by more effective agents.[1] All four have such severe adverse effects that older adults should not use them. Even if you are taking only the usual adult dose, you may suffer from excitement, restlessness, drowsiness or confusion.[2]

In 2007, a geriatric use subsection was added to the product package insert of dicyclomine. Clinical studies on dicyclomine did not include a sufficient number of patients aged 65 and older to determine if they respond differently from younger subjects.

These drugs should never replace rehydration, which is the primary treatment for diarrhea. If you occasionally have short-term diarrhea, it is best to treat it without drugs using oral rehydration solution (see Diarrhea). If nondrug treatments do not control your diarrhea, see your doctor. The Centers for Disease Control and Prevention has concluded: “Little evidence exists to support the use of nonspecific drug therapy [for acute diarrhea] in children, and much information exists to the contrary.”[3]

The effective adult dose of dicyclomine is 160 milligrams per day, but older adults have unacceptably high rates of adverse reactions at this dose. However, there are no safety data from clinical trials longer than two weeks with doses over 80 milligrams.[4]

In January 2013, the drug product label for dicyclomine was updated to report cases of psychosis and delirium linked to the use of dicyclomine. The reports were noted in patients sensitive to this class of drugs (anticholinergic), such as the elderly and patients with mental illness. The update stated that the symptoms of psychosis and delirium resolved within 12 to 24 hours after stopping dicyclomine.[5]

 The FDA has concluded that DONNATAL lacks evidence of effectiveness.

DONNATAL is a particularly unacceptable drug, as it combines three antispasmodic drugs with a barbiturate, phenobarbital, a drug the World Health Organization has said older adults should not take.[6] The only reason to take phenobarbital is for epilepsy, and in France this is the only use endorsed by the government.[7] You can easily become addicted to phenobarbital. If you stop taking it suddenly, you may suffer withdrawal symptoms such as anxiety, restlessness, muscle twitching, trembling hands, weakness, dizziness, vision problems, nausea, vomiting, trouble sleeping, faintness and lightheadedness. Later, you may suffer more serious symptoms such as seizures and hallucinations. These may last for more than two weeks after you stop taking phenobarbital. The FDA has not classified DONNATAL as “effective” for any indication;[8] such drugs are supposed to be removed from the market, but the FDA has failed to do so. It is an irrational mixture of drugs that is dangerous for older adults to use.[9]

In 2015, a study published in JAMA Internal Medicine showed that strong anticholinergic drugs, including atropine, hyoscyamine and dicyclomine, were associated with an increased risk for dementia in older adults. The study also showed that higher doses and longer use of these drugs are associated with higher risk for dementia.

Refer to the August issue of Worst Pills, Best Pills News for examples of strong anticholinergic drugs.[10]

last reviewed April 30, 2021