Medically reviewed on Feb 10, 2019
(be THAN e kole)
- Bethanechol Chloride
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.
- Cholinergic Agonist
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 minutes; Peak effect: ~60 to 90 minutes
Duration of Action
~1 hour (with therapeutic doses); up to 6 hours with large doses (300 to 400 mg)
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
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.
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.
Refer to adult dosing.
Urinary retention, nonobstructive: Limited data available: Children and Adolescents: Oral: 0.3 to 0.6 mg/kg/day in 3 to 4 divided doses; maximum dose: 10 mg/dose for children. Note: Usual adult dose is 10 to 50 mg 3 to 4 times daily (Gearhart 2010; Goldman 2012; Kliegman 2007)
5 mg/mL Oral Suspension (ASHP Standard Concentration) (ASHP 2017)
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 2014).Allen LV Jr, 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):1804-1809.9775343Nahata MC and Pai VB. Pediatric Drug Formulations. 6th ed. Cincinnati, OH: Harvey Whitney Books Co; 2014.
1 mg/mL Oral Suspension
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).Schlatter JL, Saulnier JL. Bethanechol chloride oral solutions: stability and use in infants. Ann Pharmacother. 1997;31(3):294-296.9066934
Oral: Should be administered 1 hour before meals or 2 hours after meals (to avoid nausea and vomiting).
Store at 20°C to 25°C (68°F to 77°F).
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
Frequency not defined.
Cardiovascular: Flushing, hypotension, tachycardia
Central nervous system: Colic, headache, malaise, seizure
Gastrointestinal: Abdominal cramps, borborygmi, diarrhea, eructation, nausea, salivation, vomiting
Genitourinary: Urinary urgency
Ophthalmic: Lacrimation, miosis
Respiratory: Asthma, bronchoconstriction
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
Animal reproduction studies have not been conducted.
• 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.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
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- Drug class: miscellaneous genitourinary tract agents
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Other brands: Urecholine