|
This information has been developed and provided by an independent third-party source. Merck & Co., Inc. does not endorse and is not responsible for the accuracy of the content, or for practices or
standards of non-Merck sources.
Pronunciation
(be THAN e kole)
Generic Available (U.S.)
Yes
Index Terms
Brand Names: U.S.
Brand Names: Canada
Pharmacologic Category
Use: Labeled Indications
Treatment of acute postoperative and postpartum nonobstructive (functional) urinary retention; treatment of neurogenic atony of the urinary bladder with retention
Use: Unlabeled/Investigational
Gastroesophageal reflux
Pregnancy Risk Factor
C
Pregnancy Considerations
Reproduction studies have not been conducted.
Lactation
Excretion in breast milk unknown/not recommended
Contraindications
Hypersensitivity to bethanechol or any component of the formulation; mechanical obstruction of the GI or GU tract or when the strength or integrity of the GI or bladder wall is in question; hyperthyroidism, peptic ulcer disease, epilepsy, asthma, bradycardia, vasomotor instability, coronary artery disease, hypotension, or parkinsonism
Warnings/Precautions
Concerns related to adverse effects:
• Reflux infection: Potential for reflux infection if the sphincter fails to relax as bethanechol contracts the bladder.
Adverse Reactions
Frequency not defined.
Cardiovascular: Hypotension, tachycardia, flushed skin
Central nervous system: Headache, malaise, seizure
Gastrointestinal: Abdominal cramps, belching, borborygmi, colicky pain, diarrhea, nausea, vomiting, salivation
Genitourinary: Urinary urgency
Ocular: Lacrimation, miosis
Respiratory: Asthmatic attacks, bronchial constriction
Miscellaneous: Diaphoresis
Metabolism/Transport Effects
None known.
Drug Interactions
Acetylcholinesterase Inhibitors: May enhance the adverse/toxic effect of Cholinergic Agonists. Risk C: Monitor therapy
Beta-Blockers: May enhance the adverse/toxic effect of Cholinergic Agonists. Of particular concern are the potential for cardiac conduction abnormalities and bronchoconstriction. Management: Administer these agents in combination with caution, and monitor for conduction disturbances. Avoid methacholine with any beta blocker due to the potential for additive bronchoconstriction. Risk C: Monitor therapy
Storage
Store at room temperature of 15°C to 30°C (59°F to 86°F).
Mechanism of Action
Due to stimulation of the parasympathetic nervous system, bethanechol increases bladder muscle tone causing contractions which initiate urination. Bethanechol also stimulates gastric motility, increases gastric tone and may restore peristalsis.
Pharmacodynamics/Kinetics
Onset of action: 30-90 minutes
Duration: Up to 6 hours
Absorption: Variable
Dosage
Oral:
Children:
Urinary retention (unlabeled use): 0.3-0.6 mg/kg/day in 3-4 divided doses
Gastroesophageal reflux (unlabeled use): 0.3-0.6 mg/kg/day in 3-4 divided doses
Adults:
Urinary retention, neurogenic bladder: Initial: 10-50 mg 3-4 times/day (some patients may require dosages of 50-100 mg 4 times/day). To determine effective dose, may initiate at a dose of 5-10 mg, with additional doses of 5-10 mg hourly until an effective cumulative dose is reached. Cholinergic effects at higher oral dosages may be cumulative.
Gastroesophageal reflux (unlabeled): 25 mg 4 times/day
Elderly: Use the lowest effective dose
Administration: Oral
Should be administered 1 hour before meals or 2 hours after meals.
Monitoring Parameters
Observe closely for side effects.
Test Interactions
Increased lipase, amylase (S), bilirubin, aminotransferase [ALT/AST] (S)
Dietary Considerations
Should be taken 1 hour before meals or 2 hours after meals.
Patient Education
Take on an empty stomach to avoid nausea or vomiting. Maintain adequate hydration, unless instructed to restrict fluid intake. May cause dizziness, hypotension, vomiting, or loss of appetite. Report persistent abdominal discomfort; significantly increased salivation, sweating, tearing, or urination; flushed skin; chest pain or palpitations; acute headache; unresolved diarrhea; excessive fatigue, insomnia, dizziness, or depression; increased muscle, joint, or body pain; vision changes or blurred vision; or respiratory difficulty or wheezing.
Geriatric Considerations
Urinary incontinence in elderly patients should be investigated. Bethanechol may be used for overflow incontinence (ie, dribbling) caused by an atonic or hypotonic bladder, but clinical efficacy is variable.
Dental Health: Effects on Dental Treatment
This is a cholinergic agent similar to pilocarpine; expect to see salivation and sweating in patients.
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Mental Health: Effects on Mental Status
None reported
Mental Health: Effects on Psychiatric Treatment
Contraindicated in Parkinson's disease
Nursing: Physical Assessment/Monitoring
Assess bladder and sphincter adequacy prior to administering medication.
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Tablet, oral, as chloride: 5 mg, 10 mg, 25 mg, 50 mg
Urecholine®: 5 mg, 10 mg, 25 mg, 50 mg [scored]
Pricing: U.S. (www.drugstore.com)
Tablets (Bethanechol Chloride)
5 mg (90): $59.99
10 mg (90): $89.99
25 mg (90): $128.99
50 mg (90): $179.99
Tablets (Urecholine)
10 mg (90): $119.99
50 mg (90): $381.84
Extemporaneously Prepared
A 1 mg/mL solution may be made with tablets. Crush twelve 10 mg tablets in a mortar and reduce to a fine powder. Add small portions of sterile water and mix to a uniform paste; mix while adding sterile water in incremental proportions to almost 120 mL; transfer to a calibrated bottle, rinse mortar with sterile water, and add quantity of sterile water sufficient to make 120 mL. Label “shake well” and “refrigerate”. Stable for 30 days (Schlatter, 1997).
A 5 mg/mL suspension may be made with tablets and either a 1:1 mixture of Ora-Plus® and Ora-Sweet® or Ora-Plus® and Ora-Sweet® SF or 1:4 concentrated cherry syrup and simple syrup, NF mixture. Crush twelve 50 mg tablets in a mortar and reduce to a fine powder. Add small portions of chosen vehicle and mix to a uniform paste; mix while adding the vehicle in incremental proportions to almost 120 mL; transfer to a calibrated bottle, rinse mortar with vehicle, and add quantity of vehicle sufficient to make 120 mL. Label “shake well” and “refrigerate”. Stable for 60 days refrigerated (preferred) or at room temperature (Allen, 1998; Nahata, 2004).
Allen LV Jr and Erickson MA, "Stability of Bethanechol Chloride, Pyrazinamide, Quinidine Sulfate, Rifampin, and Tetracycline Hydrochloride in Extemporaneously Compounded Oral Liquids," Am J Health Syst Pharm, 1998, 55(17):1804-9.
Nahata MC, Pai VB, and Hipple TF, Pediatric Drug Formulations, 5th ed, Cincinnati, OH: Harvey Whitney Books Co, 2004.
Schlatter JL and Saulnier JL, "Bethanechol Chloride Oral Solutions: Stability and Use in Infants," Ann Pharmacother, 1997, 31(3):294-6.
References
Andersson KE, “Current Concepts in the Treatment of Disorders of Micturition,” Drugs, 1988, 35(4):477-94.
Borzyskowski M and Mundy AR, “The Management of the Neuropathic Bladder in Childhood,” Pediatr Nephrol, 1988, 2(1):56-66
Farrell RL, Roling GT, and Castell DO, “Cholinergic Therapy of Chronic Heartburn. A Controlled Trial,” Ann Intern Med, 1974, 80(5):573-6.
Holloway RH, McCallum RW. “A Practical Approach to Gastroesophageal Reflux,” Drug Ther, 1983, 13(3):151-60.
Guerra MF and Ives TJ, “Bethanechol and Hypothermia,” Ann Intern Med, 1983, 99(2):279-80.
Romanowski GL, Shimp LA, Balson AB, et al, “Urinary Incontinence in the Elderly: Etiology and Treatment,” Drug Intell Clin Pharm, 1988, 22(7-8):525-33.
Sher PP, “Drug Interferences With Clinical Laboratory Tests,” Drugs, 1982, 24(1):24-63.
Sondheimer JM, Mintz, HL, and Michaels M. “Bethanechol Treatment of Gastroesophageal Reflux in Infants: Effect on Continuous Esophageal pH Records.,” J Pediatr, 1984, 104(1):128-31.
International Brand Names
Lexi-Comp.com
Last full review/revision December 2011
Content last modified December 2011
| 
