{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T01:53:08Z","timestamp":1777859588290,"version":"3.51.4"},"reference-count":31,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2025,3,14]],"date-time":"2025-03-14T00:00:00Z","timestamp":1741910400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Pharmacy Practice"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:p>\n                    <jats:bold>Introduction:<\/jats:bold>\n                    Dicyclomine is an antimuscarinic agent approved for treatment of irritable bowel syndrome-associated abdominal pain. Intravenous (IV) administration should be avoided due to potential for thrombosis, but real-world evidence is generally lacking. This case report presents a thrombotic complication associated with inadvertent IV administration of dicyclomine.\n                    <jats:bold>Case:<\/jats:bold>\n                    A 43-year-old man with chronic colitis and recurrent\n                    <jats:italic toggle=\"yes\">Clostridioides difficile<\/jats:italic>\n                    infections presented to a community hospital complaining of moderate-severe suprapubic abdominal pain and nausea\/vomiting\/diarrhea for 5 days. Computed tomography showed descending colonic wall thickening and proctitis, without perforation or abscess. Initial orders consisted of ketorolac 15\u00a0mg IV and dicyclomine 20\u00a0mg intramuscularly. The nurse inadvertently mixed ketorolac and dicyclomine in the same syringe and administered them simultaneously. Ultrasound subsequently confirmed a non-occlusive right axillary vein thrombosis and an occlusive superficial right basilic vein thrombosis. The patient was started on therapeutic enoxaparin subcutaneously. He was enrolled in a patient assistance program and was discharged on rivaroxaban dispensed from the hospital\u2019s outpatient pharmacy.\n                    <jats:bold>Discussion:<\/jats:bold>\n                    Dicyclomine is more selective for the M\n                    <jats:sub>1<\/jats:sub>\n                    and M\n                    <jats:sub>3<\/jats:sub>\n                    receptors, and the M\n                    <jats:sub>3<\/jats:sub>\n                    receptor causes nitric oxide activation. As dicyclomine was unintentionally administered IV, the inhibition of nitric oxide could potentially lead to clotting. The simultaneous administration of ketorolac promoted a pro-thrombotic state, via cyclo-oxygenase-2-mediation vasoconstriction. Naranjo algorithm assessment indicated \u201cpossible\u201d potential for a drug-induced adverse event. The pharmacist submitted an adverse drug event report and revisions to barcode medication administration were implemented.\n                    <jats:bold>Conclusion:<\/jats:bold>\n                    Thrombotic complications are possible following IV dicyclomine administration and pharmacy personnel must implement safeguards to prevent inadvertent administration.\n                  <\/jats:p>","DOI":"10.1177\/08971900251326808","type":"journal-article","created":{"date-parts":[[2025,3,14]],"date-time":"2025-03-14T17:58:46Z","timestamp":1741975126000},"page":"50-56","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Thrombosis Secondary to Intravenous Dicyclomine Administration: A Case Report and Literature Review"],"prefix":"10.1177","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3514-1279","authenticated-orcid":false,"given":"Melissa","family":"Santiba\u00f1ez","sequence":"first","affiliation":[{"name":"Nova Southeastern University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"Lounsbury","sequence":"additional","affiliation":[{"name":"William Carey University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maricela","family":"Moreno","sequence":"additional","affiliation":[{"name":"Nova Southeastern University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Devada","family":"Singh-Franco","sequence":"additional","affiliation":[{"name":"Nova Southeastern University"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,3,14]]},"reference":[{"key":"e_1_3_4_2_2","volume-title":"Goodman & Gilman's: The Pharmacological Basis of Therapeutics","author":"Brown JH","year":"2023","unstructured":"Brown JH, Brandl K, Wess J. Muscarinic receptor agonists and antagonists. In: Brunton LL, Knollmann BC, eds. Goodman & Gilman's: The Pharmacological Basis of Therapeutics. 14th ed. New York, NY: McGraw-Hill Education; 2023.","edition":"14"},{"key":"e_1_3_4_3_2","unstructured":"Dicyclomine (Drug Information). UpToDate lexidrug. Updated June 4 2024. https:\/\/www-uptodate-com. Accessed June 4 2024."},{"key":"e_1_3_4_4_2","unstructured":"ClinCalc.com. Dicyclomine drug usage statistics. Available at: https:\/\/clincalc.com\/DrugStats\/Drugs\/Dicyclomine. Accessed April 22 2024."},{"key":"e_1_3_4_5_2","volume-title":"Axcan Pharma USA","author":"Dicyclomine [package insert]","unstructured":"Dicyclomine [package insert]. Axcan Pharma USA. Birmingham, AL: Inc. Available at: https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2011\/008370s032lbl.pdf. Accessed May 9, 2024."},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.7453\/gahmj.2013.008"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1038\/clpt.1981.154"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2020001830"},{"key":"e_1_3_4_9_2","unstructured":"Agency for Healthcare Research and Quality. Tool: sbar. Available at: https:\/\/www.ahrq.gov\/teamstepps-program\/curriculum\/communication\/tools\/sbar.html. Accessed July 22 2024."},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v20.i22.6759"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v20.i38.13863"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1080\/00365521.2018.1465118"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.crohns.2013.09.021"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1111\/apt.12294"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.crohns.2012.10.008"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41569-022-00787-6"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/ecco-jcc\/jjx162"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.024507"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0044-1781425"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.025024"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.3390\/metabo12060541"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.123.030178"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.123.032787"},{"key":"e_1_3_4_24_2","unstructured":"National Coordinating Council for Medication Error Reporting and Prevention. Types of medication errors. Available at: https:\/\/www.nccmerp.org\/types-medication-errors. Accessed July 22 2024."},{"key":"e_1_3_4_25_2","unstructured":"United States Food and Drug Administration. Adverse events reporting system (FAERS) database. Available at: https:\/\/fis.fda.gov\/sense\/app\/95239e26-e0be-42d9-a960-9a5f7f1c25ee\/sheet\/7a47a261-d58b-4203-a8aa-6d3021737452\/state\/analysis. Accessed April 22 2024."},{"key":"e_1_3_4_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3565(25)39062-2"},{"issue":"3","key":"e_1_3_4_27_2","first-page":"223","article-title":"The muscarinic receptor subtypes in human blood vessels","volume":"56","author":"Walch L","year":"2001","unstructured":"Walch L, Brink C, Norel X. The muscarinic receptor subtypes in human blood vessels. Therapie. 2001;56(3):223-226.","journal-title":"Therapie"},{"key":"e_1_3_4_28_2","doi-asserted-by":"publisher","DOI":"10.1159\/000139439"},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.1080\/14740338.2021.1965988"},{"key":"e_1_3_4_30_2","volume-title":"Physiology, Thromboxane A2","author":"Rucker D","year":"2024","unstructured":"Rucker D, Dhamoon AS. Physiology, Thromboxane A2. Treasure Island (FL): StatPearls Publishing LLC., 2024:Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK539817\/"},{"key":"e_1_3_4_31_2","doi-asserted-by":"publisher","DOI":"10.1067\/mcp.2002.126501"},{"key":"e_1_3_4_32_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.hyp.0000258106.74139.25"}],"container-title":["Journal of Pharmacy Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08971900251326808","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/08971900251326808","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08971900251326808","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:33:49Z","timestamp":1777509229000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/08971900251326808"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,14]]},"references-count":31,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1177\/08971900251326808"],"URL":"https:\/\/doi.org\/10.1177\/08971900251326808","relation":{},"ISSN":["0897-1900","1531-1937"],"issn-type":[{"value":"0897-1900","type":"print"},{"value":"1531-1937","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,14]]}}}