- Irritable Bowel Syndrome (IBS) Slideshow Pictures
- Digestive Disease Myths
- Irritable Bowel Syndrome (IBS) Quiz
- Dicyclomine vs. Librax: What's the difference?
- What is Dicyclomine? What is Librax?
- What are the side effects of dicyclomine and Librax?
- What is the dosage of dicyclomine vs. Librax?
- What drugs interact with dicyclomine and Librax?
- Are dicyclomine and Librax safe to use while pregnant or breastfeeding?
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.
What are the side effects of dicyclomine and Librax?
Common side effects include:
- dry mouth (xerostomia),
- blurred vision,
- increased heart rate,
- heart palpitations,
- difficulty urinating, and
Other important side effects include:
- changes in taste perception,
- difficulty swallowing,
- headache, nervousness,
- difficulty falling asleep,
- bloating, and
- difficulty breathing.
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?
- 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.
- 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?
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:
- antiarrhythmic agents of Class I (for example, quinidine),
- antipsychotic agents (for example, phenothiazines),
- 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.
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?
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.
Chlordiazepoxide hydrochloride/clidinium bromide is not recommended for use in pregnant women because it increases the risk of congenital malformations during the first trimester.
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Bentyl (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 the management of acute gastroenteritis (stomach flu).
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Related Disease Conditions
FODMAPs (Low FODMAP Diet for IBS)
FODMAPs are foods that contain sugar alcohols and short chain carbohydrates. The gut can't digest them very well. There are "low" FODMAP foods and "high" FODMAP foods. Foods high in FODMAPs lay in the gut and ferment, which causes symptoms of: Excessive gas Bloating Abdominal pain Diarrhea Some people with digestive diseases and disorders, for example, IBS, microscopic colitis, IBD (Crohn's disease and ulcerative colitis), and other functional bowel disorders often are placed on a low FODMAP diet to decrease the amount of high FODMAPs foods in the diet, which create uncomfortable symptoms.
IBS vs. IBD: Differences and Similarities
IBS (irritable bowel syndrome) and IBD (inflammatory bowel disease) are both problems with the digestive tract (gastrointestinal or GI tract), but they are not the same disease. IBS is a functional disorder (a problem with the way the GI tract functions), and IBD is a disease that causes chronic prolonged inflammation of the GI tract, that can lead to ulcers and other problems that may require surgery. The most common forms of IBD are Crohn's disease and ulcerative colitis, or UC. Researchers do not know the exact cause of either disease, but they believe that IBS may be caused and triggered by a variety of factors (foods, stress, and the nervous system of the GI tract), while IBD may be genetic or due a problem with the immune system.Common symptoms of both diseases are an urgent need to have a bowel movement, diarrhea, nausea, vomiting, and abdominal pain and cramping. There are differences between the signs and symptoms of irritable bowel syndrome and inflammatory bowel disease, for example, symptoms unique to IBD are: Fever Joint pain or soreness Skin changes Rectal bleeding Anemia Eye redness or pain Unintentional weight loss Feeling tired Symptoms unique to irritable bowel syndrome include: Sexual problems Fibromyalgia Abdominal bloating Whitish mucous in the stool Changes in bowel movements and in the way stools look An urgent need to urinate Urinating frequently Treatment for IBS is with diet recommendations from a doctor or nutritionist, medication, and lifestyle changes like stress management and avoiding foods that trigger the condition. Treatments for IBD depend upon the type of disease, its symptoms, and health of the patient. Surgery may be necessary for some individuals.REFERENCES: Brown, AC, et al. "Existing Dietary Guidelines for Crohn's Disease and Ulcerative Colitis." Medscape. Lehrer, J. "Irritable Bowel Syndrome." Medscape. Updated: Apr 04, 2017. Rowe, W. "Inflammatory Bowel Disease." Medscape. Updated: Jun 17, 2016. Romanowski, A, MS, RD. "Matching the Right Diet to the Right Patient." Medscape. Jan 27, 2017.
Irritable Bowel Syndrome (IBS)
Irritable bowel syndrome (IBS) is a GI (gastrointestinal) disorder with signs and symptoms that include abdominal pain, bloating, increased gas (flatulence), abdominal cramping, diarrhea, constipation, and food intolerance.Two new tests are now available that may help diagnose irritable bowel syndrome with diarrhea and constipation (IBS-M) irritable bowel syndrome with diarrhea (IBS-D), and irritable bowel syndrome with constipation (IBS-C). Treatment for IBS includes diet changes, medications, and other lifestyle changes to manage symptoms.
Irritable Bowel Syndrome in Children (IBS)
Irritable bowel syndrome (IBS) in children is a functional gastrointestinal disorder with signs and symptoms of: Abdominal pain Bloating Diarrhea Constipation The cause of IBS is unknown, however, certain foods, stress, anxiety, and depression may contribute to the symptoms of IBS. There is no cure for IBS in children; however, medications, dietary changes, and stress management may relieve symptoms.
IBS Triggers (Prevention)
Irritable bowel syndrome (IBS) is a functional disease that can affect the quality of those who suffer from this condition. People with IBS can make lifestyle changes that may modify or control the number and severity of episodes. Certain foods, medications, and hormone levels may trigger IBS episodes, for example fatty foods, dairy products, eating foods in large quantities, foods that contain high levels of sorbitol, foods that produce intestinal gas (broccoli, onions, cabbage, and beans), chocolate, caffeine, physiological stress, some antibiotics, some antidepressants, medicine with sorbitol, and menstrual pain. Exercise, diet, and other lifestyle changes can decrease IBS flares, and prevent the number and severity of IBS episodes of diarrhea and constipation.
IBS-D (Irritable Bowel Syndrome with Diarrhea)
IBS-D or irritable bowel syndrome with diarrhea refers to IBS with diarrhea. Symptoms of IBS-D include intestinal gas (flatulence), loose stools, frequent stools, abdominal pain, diarrhea, and nausea. New non-FDA approved IBS tests may help diagnose IBS and IBS-D. Treatment of IBS-D is geared to toward managing symptoms with diet, medication, and lifestyle changes.
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Dicyclomine drug interactions section courtesy of the U.S. Food and Drug Administration