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Bethanechol

Pronunciation

Pronunciation

(be THAN e kole)

Index Terms

  • Bethanechol Chloride

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral, as chloride:

Urecholine: 5 mg, 10 mg [scored]

Urecholine: 25 mg, 50 mg [scored; contains fd&c yellow #10 (quinoline yellow), fd&c yellow #6 (sunset yellow)]

Generic: 5 mg, 10 mg, 25 mg, 50 mg

Brand Names: U.S.

  • Urecholine

Pharmacologic Category

  • Cholinergic Agonist

Pharmacology

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.

Onset of Action

30 to 90 minutes

Duration of Action

~1 hour (with therapeutic doses); up to 6 hours with large doses

Use: Labeled Indications

Neurogenic bladder: Treatment of neurogenic atony of the urinary bladder with retention

Urinary retention: Treatment of acute postoperative and postpartum nonobstructive (functional) urinary retention

Contraindications

Hypersensitivity to bethanechol or any component of the formulation; hyperthyroidism, peptic ulcer disease, epilepsy, asthma, pronounced bradycardia or hypotension, vasomotor instability, coronary artery disease, or parkinsonism; mechanical obstruction of the GI or GU tract or when the strength or integrity of the GI or bladder wall is in question; when increased muscular activity of the GI tract or bladder might prove harmful (eg, following urinary bladder surgery, GI resection and anastomosis, possible GI obstruction); bladder neck obstruction, spastic GI disturbances, acute inflammatory lesions of the GI tract, peritonitis, marked vagotonia.

Dosing: Adult

Urinary retention, neurogenic bladder: Oral: Initial (to determine minimal effective dose): 5 to 10 mg; repeat the same dose hourly until effective response or a maximum of 50 mg is reached; usual dose: 10 to 50 mg 3 to 4 times daily. Cholinergic effects at higher oral dosages may be cumulative.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Renal Impairment

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Hepatic Impairment

There are no dosage adjustments provided in the manufacturer’s labeling.

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):1804-9.9775343Nahata 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. 9066934

Administration

Oral: Should be administered 1 hour before meals or 2 hours after meals (to avoid nausea and vomiting).

Storage

Store at 20°C to 25°C (68°F to 77°F).

Drug Interactions

Acetylcholinesterase Inhibitors: May enhance the adverse/toxic effect of Cholinergic Agonists. 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. Monitor therapy

Cimetropium: Cholinergic Agonists may diminish the anticholinergic effect of Cimetropium. Monitor therapy

Adverse Reactions

Frequency not defined.

Cardiovascular: Flushing, hypotension, tachycardia

Central nervous system: Colic, headache, malaise, seizure

Dermatologic: Diaphoresis

Gastrointestinal: Abdominal cramps, borborygmi, diarrhea, eructation, nausea, salivation, vomiting

Genitourinary: Urinary urgency

Ophthalmic: Lacrimation, miosis

Respiratory: Asthma, bronchoconstriction

Warnings/Precautions

Concerns related to adverse effects:

• Reflux infection: If patient has bacteriuria, there is potential for reflux infection if the sphincter fails to relax as bethanechol contracts the bladder.

Pregnancy Risk Factor

C

Pregnancy Considerations

Animal reproduction studies have not been conducted.

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Have patient report immediately to prescriber severe dizziness, passing out, tachycardia, or shortness of breath (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.

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