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|Bethanechol Chloride

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Bethanechol Chloride

Pronouncation: (beth-AN-ih-kole KLOR-ide)
Class: Urinary cholinergic

Trade Names:
Urecholine
- Tablets 5 mg
- Tablets 10 mg
- Tablets 25 mg
- Tablets 50 mg
- Injection 5 mg/mL

Trade Names:
Duvoid
- Tablets 10 mg
- Tablets 25 mg
- Tablets 50 mg

Trade Names:
Myotonachol
- Tablets 10 mg
- Tablets 25 mg

PMS-Bethanechol (Canada)

Mechanism of Action

Pharmacology

Stimulates parasympathetic nervous system, increasing tone to muscles of urinary bladder, stimulates gastric motility and tone and may restore rhythmic peristalsis.

Pharmacokinetics

Distribution

Does not cross blood-brain barrier.

Onset

Oral

30 min.

Subcutaneous

5 to 15 min.

Peak

Oral

60 to 90 min.

Duration

Oral

1 h, up to 6 h for larger doses.

Subcutaneous

2 h.

Indications and Usage

Treatment of acute postoperative and postpartum nonobstructive urinary retention and neurogenic atony of the urinary bladder with retention.

Unlabeled Uses

Diagnosis and treatment of reflux esophagitis.

Contraindications

Hyperthyroidism; peptic ulcer; latent or active asthma; pronounced bradycardia; AV conduction defects; vasomotor instability; coronary artery disease; epilepsy; parkinsonism; coronary occlusion; hypotension; hypertension; bladder neck obstruction; spastic GI disturbances; acute inflammatory lesions of the GI tract; peritonitis; marked vagotonia. Not used when strength or integrity of GI or bladder wall is in question or in presence of mechanical obstruction, when increased muscular activity of GI tract or urinary tract may prove harmful (eg, after recent urinary bladder surgery, GI resection and anastomosis, possible GI obstruction).

Dosage and Administration

Adults

PO 10 to 50 mg 3 times daily to 4 times daily on empty stomach.

Subcutaneous 2.5 to 5 mg at 15 to 30 min intervals for max of 4 doses; then minimum effective dose may be repeated 3 times daily to 4 times daily as needed.

Storage/Stability

Store tablets at controlled room temperature (59° to 86°F). Keep tightly closed. Avoid storage of injection at less than -4°F and more than 104°F.

Drug Interactions

Cholinergic agents

Possible toxicity because of additive effects.

Ganglionic blocking compounds

Severe hypotension, usually preceded by severe abdominal symptoms.

Quinidine or procainamide

Antagonism of anticholinergic effects of bethanechol.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Fall in BP with reflex tachycardia; vasomotor response.

CNS

Headache.

Dermatologic

Flushing with feeling of warmth; sensation of heat about face; sweating.

EENT

Lacrimation; miosis.

GI

Abdominal cramps or discomfort; colicky pain; nausea; belching; diarrhea; rumbling and gurgling of stomach; salivation.

Genitourinary

Urinary urgency.

Respiratory

Bronchial constriction; asthmatic attacks.

Miscellaneous

Malaise.

Precautions

Monitor

Establish baseline BP and pulse and monitor BP, pulse, and voiding patterns. Notify health care provider if urinary retention persists.

Pregnancy

Category C .

Lactation

Undetermined.

Children

Safety and efficacy not established.

Tartrazine Sensitivity

Some products contain tartrazine, which may cause allergic-type reactions (eg, bronchial asthma) in susceptible individuals.

Reflux infection

May occur if bethanechol administration fails to relax urinary sphincter and urine is forced back into renal pelvis.

Overdosage

Symptoms

Abdominal discomfort, salivation, flushing of skin, sweating, nausea, vomiting, low BP, shock, cardiac arrest.

Patient Information

Caution patient about potential side effects such as increased salivation, sweating, flushing, or stomach discomfort.
Instruct patient to take medication on empty stomach.
Show patient how to monitor I&O, and to report abdominal distention or urinary retention to health care provider.
Instruct patient to report the following symptoms to health care provider: abdominal pain or discomfort, diarrhea, visual disturbances, dizziness, any other disturbing response to medication.

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