Dicyclomine and Mefenamic Acid Dependence: A Case Report and Review of Literature

Abstract

Anticholinergic medicines, such as dicyclomine, are frequently prescribed as antispasmodics. In addition to its effects on the peripheral nervous system, dicyclomine also induces central anticholinergic effects due to its high penetration into the central nervous system. There have been reports of abuse or misuse of anticholinergic medicines, such as procyclidine, biperiden, benztropine, and trihexyphenidyl (Benzhexol). In this case report and review, we describe a case of an adolescent female who came to us with complaints of right lower quadrant abdominal pain, with imaging and other tests ruling out any structural cause for the last 7 years. She even underwent appendectomy 12–16 months before presenting to the hospital with complaints of pain which shifted to the left lower quadrant post appendicectomy. At the time of presentation, she was taking 200 mg of Tramadol and 3–4 tablets of fixed dose combination (FDC) of 250 mg mefenamic acid and 10 mg dicyclomine by a local chemist without any prescription. According to ICD-10, patient met criteria for abuse of non-psychoactive substances with co-morbid mental and behavioral disorders due to the use of opioids-dependence and moderate depression without somatic syndrome. This case illustrates the need to give attention toward the addiction potential of anticholinergics and the need to formulate a treatment plan for effective outcome.

Keywords

• anticholinergics
• dependence
• dicyclomine