Bethanechol

Bethanechol is primarily used in urological applications for emptying the bladder in patients who have difficulty doing so.

Overview

Bethanechol promotes urination in patients with urinary tract or bladder related disorders. Patients who have trouble urinating following surgery, for example, may be prescribed Bethanechol to stimulate the muscles responsible for emptying the bladder.

Bethanechol is also used in non-surgical cases, except in patients diagnosed with an obstruction in the bladder or gastrointestinal tract.

Bethanechol is available by Rx only under the trade name Urecholine.

It is prescribed in multiple forms, including via an elixir, tablet, or solution. Bethanechol can be taken orally or subcutaneously depending on the form.

Mechanisms of Action

Bethanechol works by selectively stimulating the parasympathetic nervous system in an effort to empty the bladder in patients suffering from certain bladder disorders. On one hand, it strengthens the detrusor urinae muscle while simultaneously spurring a contraction to release urine.

Primary Functions

In general, Bethanechol is recommended for:

  • Improving gastric tone
  • Restoring normal function of the rhythmic peristalsis
  • Activating gastric motility

Rehabilitation

Bethanechol has been found to be clinically effective at restoring decompensated bladders when taken in oral/tablet form.

Bethanechol typically kicks in within 30-90 minutes of use, when taken orally in tablet form. Its effects last for up to 60 minutes on average depending on the medication strength. As the effects are transient, medical providers generally prescribe it three to four times a day – in both pediatric and adult patients – though the total dose may vary.

When injected subcutaneously, Bethanechol generates a more pronounced or expedited reaction as it relates to emptying the bladder.

Condition(s) Treated?

  • Urinary retention
  • Acute postoperative non-obstructive urinary retention
  • Atonic neurogenic bladder

Type of Medicine?

  • Cholinergic agent

Side Effects

As with all medications, Bethanechol carries risks of unwanted and adverse side effects. To reduce the risks, notify your healthcare professional of your full medical history, including any underlying conditions or allergies you’ve experienced.

Less Common Side Effects of Bethanechol

Some less common side effects that may occur when taking Bethanechol include:

  • Burping
  • Changes in vision
  • Diarrhea
  • Fainting
  • Feeling jittery or anxious
  • Flushing
  • Frequent urination
  • Insomnia
  • Pain in the abdomen
  • Queasiness
  • Seizures
  • Springing of water from the mouth

Rare Side Effects of Bethanechol

While taking Bethanechol, some of the rare side effects that may be reported include:

  • Wheezing
  • Chest tightness
  • Difficulty breathing

Dosage

Oral routes of Bethanechol are typically supplied in the following volumes:

  • 5 mg
  • 10 mg
  • 25 mg
  • 50 mg

Average Dose

The following tables outline general doses and do not replace the orders provided by a medical provider. Keep all dosage requirements allotted by a pharmacist unless changes are provided by your doctor:

Tablet Form – Bethanechol Oral Application Dosage

  • Adults: 25-50 mg | 3-4X per Day
  • Children: 0.6 mg/lb. | Reduced Dose | 3-4X per Day

Solution Form – Bethanechol Subcutaneous Application Dosage

  • Adults: 5 mg | 3-4X per Day
  • Children: 0.2 mg/lb. | Reduced Dose | 3-4X per Day

Post-Op Cases – Oral Form

In some cases, such as when a patient has recently undergone surgery, the dosage is distributed over a number of hourly intervals in order to optimize its therapeutic effects.

In such cases, the daily maximum dose should not exceed 50 mg in adult patients. The dosage in children under the age of 18 years of age is generally calculated based on bodily weight.

Post-Op Cases – Subcutaneous Form

Similarly, medical providers may administer Bethanechol subcutaneously as needed for post-op therapy. The standard dose of 5 mg for three to four times per day is generally given. However, healthcare teams may opt for minimum dosages instead. In such events, this includes:

  • Adults: 2.5 mg | Every 15-30 Minutes (10 mg Maximum)

Larger doses should be gradually introduced after carefully monitoring the effects of smaller doses.

Maximum Dosage

The maximum dose of Bethanechol should not exceed the following table. The maximum dose differs for subcutaneous and oral routes of administration:

Subcutaneous Maximum Daily Doses

  • Divided Doses: 40 mg (Adults and Seniors Only)
  • Single Maximum Dose: 10 mg (Adults and Seniors Only)

Oral Maximum Daily Doses

  • Divided Doses: 200 mg (Adults and Seniors Only)
  • Single Maximum Dose: 50 mg (Adults and Seniors Only)

Factors to Consider

Average doses are generally determined by:

  • Body weight (for children)
  • Daily dose
  • Length of treatment
  • Medical condition
  • Medication strength
  • Scheduled times between doses

Directions for Use

Your pharmacist may tell you to take this medicine on an empty stomach to reduce the risk of certain side effects, such as nausea or vomiting for example. Wait up to 2 hours after eating before taking the prescribed amount with a full glass of water. This applies to oral routes of Bethanechol.

Missed Dose

If you accidentally miss a dose, take Bethanechol as soon as you remember. For your safety, do not double by taking it near to the time of the next scheduled dose. Skip it altogether in these events and restart the normal routine.

Overdose

In the event of an overdose or accidental dosage, contact the American Association of Poison Control Centers immediately at (800) 222-1222. Additional emergency medical help should be solicited by dialing 911.

Other Notes

Take Bethanechol for as long as prescribed even if your symptoms improve and you no longer have difficulty urinating. It is important to never cease taking the medicine unless directed by your doctor.

Interactions

It is not recommended that Bethanechol be prescribed concurrently with Betel Nut, based on studies demonstrating negative contraindications. Other medications that could possibly trigger moderate to major side effects when used in conjunction with Bethanechol include:

  • Acetaminophen
  • Acrivastine
  • Alosetron
  • Ambenonium Chloride
  • Amoxapine
  • Amphetamine
  • Anticholinergics
  • Articaine
  • Atropine
  • Belladonna
  • Benzoic Acid
  • Benztropine
  • Bismuth Subsalicylate
  • Brompheniramine
  • Bupropion
  • Carbetapentane
  • Cetirizine
  • Cevimeline
  • Chlophedianol
  • Chlordiazepoxide
  • Chlorpheniramine
  • Chlorpromazine
  • Cholinesterase Inhibitors
  • Clemastine
  • Clozapine
  • Codeine
  • Darifenacin
  • Desloratadine
  • Dexchlorpheniramine
  • Dexmethylphenidate
  • Dextroamphetamine
  • Dextromethorphan
  • Dicyclomine
  • Diethylpropion
  • Dihydrocodeine
  • Diphenhydramine
  • Disopyramide
  • Dobutamine
  • Donepezil
  • Dopamine
  • Edrophonium
  • Ephedrine
  • Epinephrine
  • Fesoterodine
  • Fexofenadine
  • Flavoxate
  • Fluoxetine
  • Fosfomycin
  • Galantamine
  • Glycopyrrolate
  • Guaifenesin
  • Guanidine
  • Homatropine
  • Hydrocodone
  • Hyoscyamine
  • Hyoscyamine
  • Ibuprofen
  • Indacaterol
  • Isoproterenol
  • Lisdexamfetamine
  • Loperamide
  • Loratadine
  • Maprotiline
  • Mepenzolate
  • Meperidine
  • Mepivacaine
  • Mesoridazine
  • Methamphetamine
  • Methenamine
  • Methscopolamine
  • Methylphenidate
  • Midodrine
  • Naproxen
  • Neostigmine
  • Norepinephrine
  • Olanzapine
  • Opiate Agonists
  • Oxybutynin
  • Pemoline
  • Phendimetrazine
  • Phentermine
  • Phenylephrine
  • Physostigmine
  • Pilocarpine
  • Pralidoxime
  • Prilocaine
  • Procainamide
  • Promethazine
  • Propantheline
  • Pseudoephedrine
  • Pyridostigmine
  • Quinidine
  • Racepinephrine
  • Ritodrine
  • Rivastigmine
  • Scopolamine
  • Sincalide
  • Sympathomimetics
  • Tacrine
  • Thioridazine
  • Tricyclic antidepressants
  • Trihexyphenidyl
  • Trospium

OTC Drug Interactions

Additionally, patients should inform their primary medical provider of any over-the-counter drugs in use, including herbal supplements or vitamins, for example.

Warnings

Pay attention to the following warnings to reduce adverse reactions when taking Bethanechol.

Subcutaneous Applications

When administering Bethanechol via an injection, this should be done subcutaneously under the skin and never into a muscle or IV (intramuscular or intravenous). Doing so could potentially result in overstimulation and ultimately a host of other serious side effects such as:

  • Circulatory collapse
  • Sudden cardiac arrest
  • Sudden drops or increases in blood pressure

Post-Op Applications

Larger doses of Bethanechol may increase the risk of side effects, especially in cases where it has been administered subcutaneously or injected under the skin. As an extra precaution, medical teams on duty are advised to always keep an atropine dose ready on hand in the event of a serious major side effect.

Allergies

As Bethanechol is a cholinergic agent, this medicine is not recommended for patients with a history of hypersensitivity to bethanechol chloride. Patients should also disclose any past incidences of allergic reactions to foods, dyes, preservatives, or animal products before commencing treatment with Bethanechol.

Underlying Conditions

Bethanechol could aggravate certain underlying medical conditions, including:

  • Bronchial asthma
  • Coronary artery disease
  • Hypertension
  • Hyperthyroidism
  • Hypotension
  • Parkinson's disease
  • Peptic ulcer
  • Seizures
  • Stomach or intestinal issue
  • Surgery
  • Vasomotor instability

Fainting Spells

As fainting and dizziness have been reported while taking Bethanechol, patients should avoid sitting or standing suddenly during use.

When Bethanechol is Not Recommended

Bethanechol is not recommended when patients are deemed to have:

  • Acute inflammatory lesions
  • Gastrointestinal or bladder obstruction
  • Gastrointestinal resection
  • Peritonitis

Pregnant and Nursing Women

If you are pregnant, nursing, or plan to be, speak with your doctor before taking Bethanechol.

Responsible Use

Never give this medicine to someone else in your household. The dose is customized for each patient’s safety, based on age and weight in many instances. Use without a prescription and/or consultation from a medical provider could increase the risk of side effects.

Medical Workers

Medical workers who administer this medicine should follow all outlined safety protocols to keep both patients and the medical team safe. Dispose of all needles following each subcutaneous use in a biohazardous container and always wear gloves when handling sterile medical equipment and gear.

Storage

Store Bethanechol in a cool and dry area, and away from:

  • Direct sunlight
  • Freezing temperatures
  • Heat
  • Moisture

This medicine should never be stored in a bathroom or refrigerator.

Protect children and pets by storing this medicine in a hard-to-reach area at all times.

Patients should observe the expiration date while taking this medicine and dispose of any unused portions in a safe manner. Healthcare workers recommend taking any unused portions of prescription medications to a local pharmacy where it can be safely discarded out of the reach of non-patients.

Summary

Bethanechol is primarily used to stimulate urination in patients experiencing urinary retention with or without surgery. It is only recommended when there is no obstruction detected. Moreover, Bethanechol is not intended for all patients, as the medicine may cause certain underlying conditions to worsen, such as asthma, high or low blood pressure, or coronary artery disease.

Available by prescription only, Bethanechol has also been demonstrated to improve muscle tone in decompensated bladders.

Injection doses generally spur more rapid reactions of urinary output compared to oral tablet administrations. However, tablet routes are generally recommended for strengthening muscle tone over time.

Due to the fleeting effects of Bethanechol, meaning it only works for up to 60 minutes, doctors may prescribe this medicine up to four times per day.

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Last Reviewed:
December 23, 2017
Last Updated:
December 22, 2017
Content Source: