Summary of medicine characteristics - DICYCLOVERINE ORAL SOLUTION
1 NAME OF THE MEDICINAL PRODUCT
1 NAME OF THE MEDICINAL PRODUCTDicycloverine Oral Solution
2 QUALITATIVE AND QUANTITATIVE COMPOSITION
2 QUALITATIVE AND QUANTITATIVE COMPOSITIONDicycloverine Hydrochloride 10mg/5ml
Excipient(s) with known effect
Each 5ml of oral solution contains
Sucrose: 2.33g
Sodium benzoate: 1.25mg
For the full list of excipients, see section 6.1
3 PHARMACEUTICAL FORM
Solution
4 CLINICAL PARTICULARS
4.1 Therapeutic indications
Dicyloverine is a smooth muscle antispasmodic primarily indicated for treatment of functional conditions involving smooth muscle spasm of the gastrointestinal tract. The commonest of these are irritable colon (mucous colitis, spastic colon).
4.2 Posology and method of administration
Posology
Adults
One to two 5ml spoonfuls (10 – 20mg) three times daily before or after meals.
Children (2–12 years):
One 5ml spoonful (10mg) three times daily.
Children (6 months – 2 years)
5 – 10mg three or four times daily, 15 minutes before feeds. Do not exceed a daily dose of 40mg. If it is necessary to dilute Dicyloverine Oral Solution this may be done using Syrup or if diluted immediately prior to use with water.
Method of administration
Oral
4.3 Contraindications
Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
Known idiosyncrasy to dicycloverine hydrochloride. Infants under 6 months of age.
4.4 Special warnings and precautions for use
Products containing dicycloverine hydrochloride should be used with caution in any patient with or suspected of having glaucoma or prostatic hypertrophy. Use with care in patients with hiatus hernia associated with reflux oesophagitis because anticholinergic drugs may aggravate the condition. There are reports of infants, 3 months of age and under, administered dicycloverine hydrochloride syrup who have evidenced respiratory symptoms (breathing difficulty, shortness of breath, breathlessness, respiratory collapse, apnoea) as well as seizures, syncope, asphyxia, pulse rate fluctuations, muscular hypotonia and coma. The above symptoms have occurred within minutes of ingestion and lasted 20–30 minutes. The symptoms were reported in association with dicycloverine hydrochloride oral solution therapy but the cause and effect relationship has neither been disproved or proved. The timing and nature of the reactions suggest that they were a consequence of local irritation and/or aspiration, rather than to a direct pharmacological effect. Although no causal relationship between these effects, observed in infants and dicycloverine administration has been established, dicycloverine hydrochloride is contra-indicated in infants under 6 months of age.
Patients with rare hereditary problems of fructose intolerance, glucose galactose malabsorbtion or sucrase-isomaltase insufficiency should not take this medicine
4.5 Interaction with other medicinal products and other forms of interaction
No interaction studies have been performed.
4.6 Fertility, pregnancy and lactation
Pregnancy
Epidemiological studies in pregnant women with products containing dicycloverine hydrochloride (at doses up to 40mg/day) have not shown that dicycloverine hydrochloride increases the risk of foetal abnormalities if administered during the first trimester of pregnancy. Reproduction studies have been performed in rats and rabbits at doses of up to 100 times the maximum recommended dose (based on 60mg per day for an adult person) and have revealed no evidence of impaired fertility or harm to the foetus due to dicycloverine. Since the risk of teratogenicity cannot be excluded with absolute certainty for any product, the drug should be used during pregnancy only if clearly needed.
Breast-feeding
It is not known whether dicycloverine is secreted in human milk. Because many drugs are secreted in human milk, caution should be exercised when dicycloverine is administered to a nursing mother.
4.7 Effects on ability to drive and use machines
Not relevant.
4.8 Undesirable effects
The following adverse reactions are classified by system organ class and ranked under heading of frequency using the following convention:
Rare (>1/10,000 to <1/1,000)
Not known: frequency cannot be estimated from the available data
| MedDRA system organ class database | Frequency | Adverse reactions |
| Nervous system disorders | Rare | Sedation, headache |
| Not known | Dizziness may occur | |
| Metabolism and nutrition disorders | Rare | Anorexia |
| Eye disorders | Rare | Blurred vision |
| Gastrointestinal disorders | Not known | Dry mouth |
| Rare | Constipation, nausea, vomiting | |
| Renal and urinary disorders | Rare | Dysuria |
| Skin and subcutaneous tissue disorders | Rare | Rash |
| General disorders and administration site conditions | Rare | Fatigue |
| Not known | Thirst |
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme Website: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.
4.9 Overdose
Symptoms
Symptoms of Dicycloverine overdosage are headache, dizziness, nausea, dry mouth, difficulty in swallowing, dilated pupils and hot dry skin.
Management
Treatment may include emetics, gastric lavage and symptomatic therapy if indicated.
5 PHARMACOLOGICAL PROPERTIES
5.1 Pharmacodynamic properties
Pharmacotherapeutic group: Drugs for functional gastrointestinal disorders,
ATC code: A03AA07
Dicycloverine hydrochloride relieves smooth muscle spasm of the gastrointestinal tract.
Animal studies indicate that this action is achieved via a dual mechanism;
(1) a specific anticholinergic effect (antimuscarinic at the ACh-receptor sites) and
(2) a direct effect upon smooth muscle (musculotropic).
5.2 Pharmacokinetic properties
Distribution and Biotransformation
After a single oral 20mg dose of dicycloverine hydrochloride in volunteers, peak plasma concentration reached a mean value of 58ng/ml in 1 to 1.5 hours. 14C labelled studies demonstrated comparable bioavailability from oral and intravenous administration.
Elimination
The principal route of elimination is via the urine.
5.3 Preclinical safety data
5.3 Preclinical safety dataNot relevant.
6.1
Sodium benzoate
Sucrose (40–80#)
Citric acid monohydrate Sodium Citrate
Flavour Cherry – ST4545/25
Flavour Raspberry – AF – 2283
Flavour Vanilla – AF – 2268
Flavour Blackcurrant – AF – 2285
6.2
Not applicable
6.3 Shelf life
24 months
6.4 Special precautions for storage
Do not store above 25°C. Store in the original container.
6.5 Nature and contents of container
Type III, EP amber glass bottles sealed with a polyethylene screw cap equipped with a polyethylene seal and pilferproof closure.
Pack size: 1 bottle containing 120ml syrup.
6.6 Special precautions for disposal
6.6 Special precautions for disposalNo special requirements.