Dicyclomine vs. Librax: What’s the difference?
- Dicyclomine and Librax (chlordiazepoxide hydrochloride and clidinium bromide) are used to treat irritable bowel syndrome (IBS).
- Librax is also used to treat peptic ulcer disease. It also may be useful in management of acute gastroenteritis (stomach flu).
- Dicyclomine and Librax belong to different drug classes. Dicyclomine is an anticholinergic and Librax is a combination of an anti-anxiety medication and an antispasmodic.
- A brand name for dicyclomine is Bentyl.
- Side effects of dicyclomine and Librax that are similar include dry mouth, confusion, constipation, difficulty urinating, drowsiness, dizziness, nausea, and rash.
- Side effects of dicyclomine that are different from Librax include blurred vision, agitation, increased heart rate, heart palpitations, seizures, changes in taste, difficulty swallowing, headache, nervousness, weakness, impotence, flushing, delirium, difficulty falling asleep (insomnia), vomiting, skin redness, fainting, bloating, and difficulty breathing.
- Side effects of Librax that are different from dicyclomine include liver abnormalities and reduced mental alertness.
What is Dicyclomine? What is Librax?
Dicyclomine is used to treat irritable bowel syndrome (IBS). Dicyclomine is in a class of drugs called anticholinergics. Anticholinergic drugs block the effects of acetylcholine, the chemical transmitter that nerves release in order to cause muscles to contract. They prevent contraction of muscles by blocking the acetylcholine receptors on the muscle cells. Anticholinergic drugs also have a direct relaxing effect on muscle. Dicyclomine is used to reduce contraction of the muscles in the intestines.
Librax (chlordiazepoxide hydrochloride and clidinium bromide) is a combination of an anti-anxiety medication and an antispasmodic used to treat peptic ulcer disease and IBS (irritable bowel syndrome). It also may be useful in management of acute gastroenteritis (stomach flu). Librax also blocks the acid secretion of the gastrointestinal tract and inhibits the action of nerves that are very active in certain diseases.
QUESTION
What is irritable bowel syndrome or IBS?
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What are the side effects of dicyclomine and Librax?
Dicyclomine
Common side effects include:
- dry mouth (xerostomia),
- blurred vision,
- confusion,
- agitation,
- increased heart rate,
- heart palpitations,
- constipation,
- difficulty urinating, and
- seizures.
Other important side effects include:
- changes in taste perception,
- difficulty swallowing,
- headache, nervousness,
- drowsiness,
- weakness,
- dizziness,
- impotence,
- flushing,
- delirium,
- difficulty falling asleep,
- nausea,
- vomiting,
- rash,
- erythema,
- fainting,
- bloating, and
- difficulty breathing.
Librax
Adverse reactions may include drowsiness, dizziness, and confusion. Nausea, constipation, and dry mouth may occur.
Urinary hesitancy or retention are seen, particularly in the elderly.
Skin eruptions and liver abnormalities are less common.
Avoid driving or operating machinery while taking chlordiazepoxide hydrochloride/clidinium bromide because it reduces mental alertness.
What is the dosage of dicyclomine vs. Librax?
Dicyclomine
- The recommended starting oral dose of dicyclomine is 20 mg given 4 times daily. The dose can be increased to 40 mg 4 times daily.
- The recommended intramuscular injection is 10 to 20 mg 4 times daily.
- The intramuscular injection is only used for 1 to 2 days if a patient cannot take capsules or tablets.
Librax
- Chlordiazepoxide hydrochloride/clidinium bromide may be taken with or without food.
- Take 1 to two capsules every 6 to 8 hours before meals and at bedtime.
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What drugs interact with dicyclomine and Librax?
Dicyclomine
Antiglaucoma Agents
Anticholinergics antagonize the effects of antiglaucoma agents and may increase intraoccular pressure. Anticholinergic drugs in the presence of increased intraocular pressure may be hazardous when taken concurrently with agents such as corticosteroids. Use of Bentyl in patients with glaucoma is not recommended.
Other Drugs with Anticholinergic Activity
The following agents may increase certain actions or side effects of anticholinergic drugs including Bentyl:
- amantadine,
- antiarrhythmic agents of Class I (for example, quinidine),
- antihistamines,
- antipsychotic agents (for example, phenothiazines),
- benzodiazepines,
- MAO inhibitors,
- narcotic analgesics (for example, meperidine),
- nitrates and nitrites,
- sympathomimetic agents,
- tricyclic antidepressants, and
- other drugs having anticholinergic activity.
Other Gastrointestinal Motility Drugs
Interaction with other gastrointestinal motility drugs may antagonize the effects of drugs that alter gastrointestinal motility, such as metoclopramide.
Effect of Antacids
Because antacids may interfere with the absorption of anticholinergic agents including Bentyl, simultaneous use of these drugs should be avoided.
Effect on Absorption of Other Drugs
Anticholinergic agents may affect gastrointestinal absorption of various drugs by affecting on gastrointestinal motility, such as slowly dissolving dosage forms of digoxin; increased serum digoxin concentration may result.
Effect on Gastric Acid Secretion
The inhibiting effects of anticholinergic drugs on gastric hydrochloric acid secretion are antagonized by agents used to treat achlorhydria and those used to test gastric secretion.
Librax
Chlordiazepoxide hydrochloride/clidinium bromide should not be used in people with glaucoma or urinary retention (difficulty urinating) due to benign prostatic hypertrophy (BPH) because clidinium blocks the action of choline, increasing intraocular pressure and causing difficulty urinating. Chlordiazepoxide has sedative effects and should not be combined with alcohol or other central nervous system depressants.
Are dicyclomine and Librax safe to use while pregnant or breastfeeding?
Dicyclomine
There are no adequate studies of the effect of dicyclomine in pregnant women at recommended doses (80-160 mg/day). Observation of women who received dicyclomine (up to 40 mg/day) containing products during the first trimester of pregnancy did not reveal any increased risk of harm to the fetus.
Dicyclomine is excreted into breast milk. Since there have been reports of apnea (cessation of breathing) when dicyclomine has been given to children, it should not be used by nursing mothers.
Librax
Chlordiazepoxide hydrochloride/clidinium bromide is not recommended for use in pregnant women because it increases the risk of congenital malformations during the first trimester.