BENTYLOL®
(dicyclomine hydrochloride)
on the phenomenon there seems an urgent need to check two simple hypotheses: (a) Cumming and Glenn need a new record player, or (b) one of their assistants has made the classic beginner's error in pulse counting - that of omitting a zero for the first beat of the music! Ro. J. SHEPHARD, MD, PH D Professor of applied physiology Department of preventive medicine and biostatistics University of Toronto Toronto, Ont.
Reference 1. SHEPHARD
RJ,
BAILEY
DA,
MIRWALD
RL:
Development of the Canadian Home Fitness Test. Can Med Assoc J 114: 675, 1976
To the editor: We thank Dr. Shephard for pointing out the error of approximately one step per minute in some of the counts in our report, an error that does not significantly alter the findings. Notwithstanding Shephard's comments the CHFT has two serious problems: (a) the considerable limitation of all submaximal heart rate predictions of fitness and (b) the fact that many individuals have demonstrated that they cannot count their heart rates accurately in 10 seconds. Experience with the CHFT in testing some ambulance drivers certified in cardiopulmonary resuscitation and accustomed to counting pulses illustrates these problems. Mr. Unfit, fat and totally sedentary, was recorded as having a low heart rate and was pronounced superior in fitness, while his neighbour, Mr. Fit, a lean jogger, performed the CHFT and was pronounced below average. Mr. Fit left the gymnasium muttering about the foolishness of some fitness tests and their designers. GORDON R. CUMMING, MD J. GLENN, BPE Health Sciences Centre Winnipeg, Man.
Training centres in physical medicine To the editor: Further to the letter from Dr. R.G. Holmes concerning the training in physical medicine obtainable in Ontario (Can Med Assoc J 116: 345, 1977), I have additional information to pass on to readers of the Journal. The department of rehabilitation medicine, faculty of medicine, University of Toronto has been training physicians in physical medicine for many years. Five years ago a formal postgraduate training program was established within this department in order to train specialists in the fields of physical medicine and rehabilitation. The department has also established annual refresher courses for practising physicians within the province. Each year a spe-
cific area is chosen, following discussions with local family physicians, in order to present information that will be useful and practical in an office practice. Last year, in association with rheumatologists, a course in office management of musculoskeletal disorders was presented. In 1976 the care of chronic respiratory disease was chosen as the subject, and in the spring of 1978 we hope to offer a course in the continuing care of the stroke patient. We also have held courses in manipulative medicine presented by Dr. Charles M. Godfrey, a member of our staff. We also offer preceptor courses for physicians who wish to spend a week or two in a clinical setting in a teaching hospital in order that they may learn more about the practical application of physical medicine and rehabilitation in an office and family practice. We are constantly trying to improve and alter our method of presentation of courses to physicians and welcome suggestions and advice with regard to the timing, subject matter and methods of presentation. There are three other training centres for specialists in physical medicine and rehabilitation in Ontario - Queen's University, Kingston; McMaster University, Hamilton; and the University of Western Ontario, London. JOHN S. CRAWFORD, MD, FRcP[c] Professor and chairman Department of rehabilitative medicine Faculty of medicine University of Toronto Toronto, Ont.
University of Ottawa graduates To the editor: I have an announcement to make to all graduates of the faculty of medicine, University of Ottawa. Professor L.E. B6langer is presently engaged in writing the history of the faculty of medicine, founded in 1945, with an account of its earlier days. Anyone who has memorabilia or any material that refers to these events is requested to send the articles to Professor B6langer at the University of Ottawa without delay. W.N.P. ALBI, MD St. Boniface Clinic Winnipeg, Man.
BOOKS continued from page 1124 DICTIONARY OF MEDICAL ETHICS. Edited by A.S. Duncan, G.R. Dunstan and R.B. Welbourn. 336 pp. Darton, Longman & Todd Ltd., London, 1977. $9, approx. ISBN 0-232-51302-3 DRUG ABUSE IN PREGNANCY AND NEONATAL EFFECTS. Edited by Jos6 Luis Rementeria. 299 pp. Illust. The c.v. Mosby company. Saint Louis, 1977. $19.90. ISBN 0-8016-4108-X
1138 CMA JOURNAL/NOVEMBER 19, 1977/VOL. 117
continued on page 1154
Tablets, Capsules, Syrup, Injection Antispasmodic DESCRIPTION For antispasmodic action alone 1. Bentylol 10 mg capsules: 10 mg dicyclomine hydrochloride in each blue caPsule.mgicycom me hydrochloride in each 2. Bentylol s ru lOdI teaspoonf.ul .5 ml) pink syrup. 3. Bentylol 20 mtblt 20mg each blue tab.et.es. dicyclomine hydrochloride in 4. Bentylol Injection: Ampoule-2 ml. Each ml contains 10 mg dicyclomine hydrochloride, in water for injection, made isotonic with sodium chloride. Vial-lO ml. Each ml contains 10mg dicyclomine hydrochloride,. in water for injection, made isotonic with sodium chloride. 0.5% chlorobutanol hydrous (chloral derivative) added as a preservative. For antispasmodic action us sedation 1. * Bentylol 10mg with l?henobarbital capsules: 10mg dicyclomine hydrochloride and 15 mg phenobarbital in each blue and white capsule. 2. *Bentylol2O mg with Phenobarbital tablets: 20mg dlcyclomine hydrochloride and 15 mg phenobarbita in each white tablet. 3. *Bentylol with Phenobarbital syrup:l0mgdicyclomine hydrochloride and 15 mg phenobarbital in each teaspoonful (5 ml) of amber syrup. Alcohol 19%. ACTIONS Antispasmodic. Bentylol has a direct relaxant effect on the smooth muscle of the gastrointestinal tract as well as a depressant effect on parasympathetic function. These dual actions prod uce relief of spasmwith minimum atropine-like effects. Phenobarbital exerts a sedative effect.
INDICATIONS AND CLINICAL USE Oral dosage forms
1. Symptomatic control of functional gastrointestinal disorders. Primary condition diagnosed as: chronic irritable colon, spastic constipation, mucous colitis, pylorospas m, biliary dyskinesia, or spastic colitis. Bentylol is effectively used to treat symptoms of these conditions such as: abdominal cramps and pain, gas or belching, flatulence, and diarrhoea. 2. Gastrointestinal spasm secondary to organic diseases, such as: peptic ulcer, hiatal hernia, esopha gitis, gastr itis, duodenitis, cholecystitis, diverticulitis, and chronic ulcerative colitis. 3. Infant colic. (syrup form only) injectable form Symptomatic treatment of the above conditions in adults when a rapid onset of therapeutic action is desired or when persistent nausea and vomiting preclude the use of oral administration. CONTRAINDICATIONS Dicyclomine hydrochloride is contraindicated in patients with frank urinary retention, stenosing peptic ulcer, and pyloric or duodenal obstruction. WARNING Phenobarbital may be habit forming. PRECAUTION
Although studies have failed to demonstrate adverse effects of dicyclomine hydrochloride in glaucoma, it should be prescribed glaucoma. patients known to have or suspected of having ADVERSE REACTIONS
Adverse reactions seldom occur with dicyclomine hydrochloride; however, in susceptible individuals, atropinelike effects such as dry mouth or thirst and dizziness may occur. On rare occasions, fatigue, sedation, blurred vision, rasn, constipation, anorexia, nausea and vomiting, headache, impotence, and urinary retention have also been reported. With the injectable form there may beatemporary sensation of light-headedness and occasionally local irritation. SYMPTOMS AND TREATMENT OF OVERDOSE The signs and symptoms of overdose are headache, nausea, vomiting, blurred vision, dilated pupils, hot, dry skin, dizziness, dryness of the mouth, difficulty in swallowing, CNS stimulation. Treatment should consist of gastric lavage, emetics, and activated charcoal. Barbiturates may be used either orally or intramuscularly for sedation but they should not be used if Bentylol with Ph enobarbital has been ingested. If indicated, parenteral cholinerg ic agents such as Urecholine5 (bethanecol chloride USP) should be used. DOSAGE AND ADMINISTRATION Bentylol 10 mg capsules and syrup (plain and with * phenobarbita I): Adults: 1 or 2 capsules or teaspoonfuls of syrup three or four .Ir.".capsule or 1 teaspoonful of syrup three or four times daily. Infants: 1/. teaspoonful of syrup three or four times daily. (May be diluted with an equal volume of water.) Bentylol2omgta b lets (plain and with . phenobarbital): Adults:ltablet three or four times daily. Bent.iIoIlnjection: NOT FOR INTRAVErI.?USU.E. to six hours intramuscularly only.
DOSAGE FORMS
Bottl.s o/'100, 500, and 5000 *lOmg Capsules with Phenobarbital Bottles of 100, 500, and 5000 20mg Tablets Bottles of 100 *20 mg Tablets with Phenobarbital Bottles of 100 Syrup (plain and with .phenobarbital) 250 ml bottles Injection 2 ml ampoules and 10 ml multiple dose vials Product Information as of March, 1976 Packalf ation amended as of February, 1977) urescribinglnformation available upon request.
Merrell
THE WM. S. MERRELL COMPANY Division of Richardson-Merrell (Canada) Ltd., Weston, Ontario. M9L 1R9 MEMBER 7.019 (WOO6A) Printed July, 1977
(dicyclomine hydrochloride)
on the phenomenon there seems an urgent need to check two simple hypotheses: (a) Cumming and Glenn need a new record player, or (b) one of their assistants has made the classic beginner's error in pulse counting - that of omitting a zero for the first beat of the music! Ro. J. SHEPHARD, MD, PH D Professor of applied physiology Department of preventive medicine and biostatistics University of Toronto Toronto, Ont.
Reference 1. SHEPHARD
RJ,
BAILEY
DA,
MIRWALD
RL:
Development of the Canadian Home Fitness Test. Can Med Assoc J 114: 675, 1976
To the editor: We thank Dr. Shephard for pointing out the error of approximately one step per minute in some of the counts in our report, an error that does not significantly alter the findings. Notwithstanding Shephard's comments the CHFT has two serious problems: (a) the considerable limitation of all submaximal heart rate predictions of fitness and (b) the fact that many individuals have demonstrated that they cannot count their heart rates accurately in 10 seconds. Experience with the CHFT in testing some ambulance drivers certified in cardiopulmonary resuscitation and accustomed to counting pulses illustrates these problems. Mr. Unfit, fat and totally sedentary, was recorded as having a low heart rate and was pronounced superior in fitness, while his neighbour, Mr. Fit, a lean jogger, performed the CHFT and was pronounced below average. Mr. Fit left the gymnasium muttering about the foolishness of some fitness tests and their designers. GORDON R. CUMMING, MD J. GLENN, BPE Health Sciences Centre Winnipeg, Man.
Training centres in physical medicine To the editor: Further to the letter from Dr. R.G. Holmes concerning the training in physical medicine obtainable in Ontario (Can Med Assoc J 116: 345, 1977), I have additional information to pass on to readers of the Journal. The department of rehabilitation medicine, faculty of medicine, University of Toronto has been training physicians in physical medicine for many years. Five years ago a formal postgraduate training program was established within this department in order to train specialists in the fields of physical medicine and rehabilitation. The department has also established annual refresher courses for practising physicians within the province. Each year a spe-
cific area is chosen, following discussions with local family physicians, in order to present information that will be useful and practical in an office practice. Last year, in association with rheumatologists, a course in office management of musculoskeletal disorders was presented. In 1976 the care of chronic respiratory disease was chosen as the subject, and in the spring of 1978 we hope to offer a course in the continuing care of the stroke patient. We also have held courses in manipulative medicine presented by Dr. Charles M. Godfrey, a member of our staff. We also offer preceptor courses for physicians who wish to spend a week or two in a clinical setting in a teaching hospital in order that they may learn more about the practical application of physical medicine and rehabilitation in an office and family practice. We are constantly trying to improve and alter our method of presentation of courses to physicians and welcome suggestions and advice with regard to the timing, subject matter and methods of presentation. There are three other training centres for specialists in physical medicine and rehabilitation in Ontario - Queen's University, Kingston; McMaster University, Hamilton; and the University of Western Ontario, London. JOHN S. CRAWFORD, MD, FRcP[c] Professor and chairman Department of rehabilitative medicine Faculty of medicine University of Toronto Toronto, Ont.
University of Ottawa graduates To the editor: I have an announcement to make to all graduates of the faculty of medicine, University of Ottawa. Professor L.E. B6langer is presently engaged in writing the history of the faculty of medicine, founded in 1945, with an account of its earlier days. Anyone who has memorabilia or any material that refers to these events is requested to send the articles to Professor B6langer at the University of Ottawa without delay. W.N.P. ALBI, MD St. Boniface Clinic Winnipeg, Man.
BOOKS continued from page 1124 DICTIONARY OF MEDICAL ETHICS. Edited by A.S. Duncan, G.R. Dunstan and R.B. Welbourn. 336 pp. Darton, Longman & Todd Ltd., London, 1977. $9, approx. ISBN 0-232-51302-3 DRUG ABUSE IN PREGNANCY AND NEONATAL EFFECTS. Edited by Jos6 Luis Rementeria. 299 pp. Illust. The c.v. Mosby company. Saint Louis, 1977. $19.90. ISBN 0-8016-4108-X
1138 CMA JOURNAL/NOVEMBER 19, 1977/VOL. 117
continued on page 1154
Tablets, Capsules, Syrup, Injection Antispasmodic DESCRIPTION For antispasmodic action alone 1. Bentylol 10 mg capsules: 10 mg dicyclomine hydrochloride in each blue caPsule.mgicycom me hydrochloride in each 2. Bentylol s ru lOdI teaspoonf.ul .5 ml) pink syrup. 3. Bentylol 20 mtblt 20mg each blue tab.et.es. dicyclomine hydrochloride in 4. Bentylol Injection: Ampoule-2 ml. Each ml contains 10 mg dicyclomine hydrochloride, in water for injection, made isotonic with sodium chloride. Vial-lO ml. Each ml contains 10mg dicyclomine hydrochloride,. in water for injection, made isotonic with sodium chloride. 0.5% chlorobutanol hydrous (chloral derivative) added as a preservative. For antispasmodic action us sedation 1. * Bentylol 10mg with l?henobarbital capsules: 10mg dicyclomine hydrochloride and 15 mg phenobarbital in each blue and white capsule. 2. *Bentylol2O mg with Phenobarbital tablets: 20mg dlcyclomine hydrochloride and 15 mg phenobarbita in each white tablet. 3. *Bentylol with Phenobarbital syrup:l0mgdicyclomine hydrochloride and 15 mg phenobarbital in each teaspoonful (5 ml) of amber syrup. Alcohol 19%. ACTIONS Antispasmodic. Bentylol has a direct relaxant effect on the smooth muscle of the gastrointestinal tract as well as a depressant effect on parasympathetic function. These dual actions prod uce relief of spasmwith minimum atropine-like effects. Phenobarbital exerts a sedative effect.
INDICATIONS AND CLINICAL USE Oral dosage forms
1. Symptomatic control of functional gastrointestinal disorders. Primary condition diagnosed as: chronic irritable colon, spastic constipation, mucous colitis, pylorospas m, biliary dyskinesia, or spastic colitis. Bentylol is effectively used to treat symptoms of these conditions such as: abdominal cramps and pain, gas or belching, flatulence, and diarrhoea. 2. Gastrointestinal spasm secondary to organic diseases, such as: peptic ulcer, hiatal hernia, esopha gitis, gastr itis, duodenitis, cholecystitis, diverticulitis, and chronic ulcerative colitis. 3. Infant colic. (syrup form only) injectable form Symptomatic treatment of the above conditions in adults when a rapid onset of therapeutic action is desired or when persistent nausea and vomiting preclude the use of oral administration. CONTRAINDICATIONS Dicyclomine hydrochloride is contraindicated in patients with frank urinary retention, stenosing peptic ulcer, and pyloric or duodenal obstruction. WARNING Phenobarbital may be habit forming. PRECAUTION
Although studies have failed to demonstrate adverse effects of dicyclomine hydrochloride in glaucoma, it should be prescribed glaucoma. patients known to have or suspected of having ADVERSE REACTIONS
Adverse reactions seldom occur with dicyclomine hydrochloride; however, in susceptible individuals, atropinelike effects such as dry mouth or thirst and dizziness may occur. On rare occasions, fatigue, sedation, blurred vision, rasn, constipation, anorexia, nausea and vomiting, headache, impotence, and urinary retention have also been reported. With the injectable form there may beatemporary sensation of light-headedness and occasionally local irritation. SYMPTOMS AND TREATMENT OF OVERDOSE The signs and symptoms of overdose are headache, nausea, vomiting, blurred vision, dilated pupils, hot, dry skin, dizziness, dryness of the mouth, difficulty in swallowing, CNS stimulation. Treatment should consist of gastric lavage, emetics, and activated charcoal. Barbiturates may be used either orally or intramuscularly for sedation but they should not be used if Bentylol with Ph enobarbital has been ingested. If indicated, parenteral cholinerg ic agents such as Urecholine5 (bethanecol chloride USP) should be used. DOSAGE AND ADMINISTRATION Bentylol 10 mg capsules and syrup (plain and with * phenobarbita I): Adults: 1 or 2 capsules or teaspoonfuls of syrup three or four .Ir.".capsule or 1 teaspoonful of syrup three or four times daily. Infants: 1/. teaspoonful of syrup three or four times daily. (May be diluted with an equal volume of water.) Bentylol2omgta b lets (plain and with . phenobarbital): Adults:ltablet three or four times daily. Bent.iIoIlnjection: NOT FOR INTRAVErI.?USU.E. to six hours intramuscularly only.
DOSAGE FORMS
Bottl.s o/'100, 500, and 5000 *lOmg Capsules with Phenobarbital Bottles of 100, 500, and 5000 20mg Tablets Bottles of 100 *20 mg Tablets with Phenobarbital Bottles of 100 Syrup (plain and with .phenobarbital) 250 ml bottles Injection 2 ml ampoules and 10 ml multiple dose vials Product Information as of March, 1976 Packalf ation amended as of February, 1977) urescribinglnformation available upon request.
Merrell
THE WM. S. MERRELL COMPANY Division of Richardson-Merrell (Canada) Ltd., Weston, Ontario. M9L 1R9 MEMBER 7.019 (WOO6A) Printed July, 1977
