Bethanechol Dosage

Usual Adult Dose for Urinary Retention

Oral: 10 to 50 mg 3 to 4 times a day.

Subcutaneous: 2.5 to 5 mg 3 to 4 times a day. Doses up to 7.5 to 10 mg every 4 hours have been used for neurogenic bladder. Such large doses may cause severe reactions and should only be used after adequate trial of single doses (2.5 to 5 mg) has established that smaller doses are not sufficient.

Usual Pediatric Dose for Urinary Retention

The safety and efficacy of bethanechol in pediatric patients has not been established. However, bethanechol may be appropriate for use in some situations.

Oral:
>1 year: 0.6 mg/kg/day divided 3 to 4 times a day.
Subcutaneous: 0.12 to 2 mg/kg/day divided 3 to 4 times a day.

Usual Pediatric Dose for Gastroesophageal Reflux Disease

The safety and efficacy of bethanechol in pediatric patients has not been established. However, bethanechol may be appropriate for use in some situations

Oral:
>1 year: 0.1 to 0.2 mg/kg/dose 30 minutes to 1 hour before meals and at bedtime to a maximum of 4 times a day.

Usual Pediatric Dose for Abdominal Distension

The safety and efficacy of bethanechol in pediatric patients has not been established. However, bethanechol may be appropriate for use in some situations.

Oral:
>1 year: 0.6 mg/kg/day divided 3 to 4 times a day.
Subcutaneous: 0.12 to 2 mg/kg/day divided 3 to 4 times a day.

Renal Dose Adjustments

No adjustments recommended

Liver Dose Adjustments

No adjustments recommended

Dose Adjustments

The minimum effective oral dose may be determined by giving 5 to 10 mg initially, then repeating the dose at hourly intervals until satisfactory response occurs or a max of 50 mg has been given.

The minimum effective subcutaneous dose may be determined by injecting 2.5 mg, then repeating the same dose at 15 to 30 minutes intervals until satisfactory response is obtained (maximum of four doses). Do not repeat dose if side effects appear.

Precautions

The use of bethanechol is contraindicated in patients with hyperthyroidism, peptic ulcer disease, latent or active asthma, coronary insufficiency or conduction defects, epilepsy, or parkinsonism.

In urinary retention, if the sphincter fails to relax as bethanechol contracts the bladder, urine may be forced up the ureter into the kidney pelvis. If there is bacteriuria, this may cause reflux infection.

The injectable sterile solution is for subcutaneous use only. Do not give IV or IM

If necessary, the effects of bethanechol can be abolished promptly by atropine.

Cholinergic overstimulation with symptoms of circulatory collapse, fall in blood pressure, abdominal cramps, bloody diarrhea, shock, or sudden cardiac arrest has been reported rarely with subcutaneous administration of bethanechol. Atropine sulfate should be available to treat symptoms of toxicity when bethanechol is administered subcutaneously. The adult dose of atropine is 0.6 mg administered subcutaneously every 2 hours, according to patient response.

Dialysis

Data not available

Other Comments

Oral bethanechol tablets should be taken 1 hour before or 2 hours after meals to avoid nausea or vomiting.