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Bethanechol chloride
Bethanechol chloride (Urecholine)
Bethanechol chloride
(beh-THAN-eh-kohl)
Pregnancy Category: C Duvoid Myotonachol PMS-Bethanechol Chloride Urecholine (Rx)

Classification: Cholinergic (parasympathomimetic), direct-acting

Action/Kinetics: Directly stimulates cholinergic receptors, primarily muscarinic type. This results in stimulation of gastric motility, increases gastric tone, and stimulates the detrusor muscle of the urinary bladder. Produces a slight transient fall of DBP, accompanied by minor reflex tachycardia. Is resistant to hydrolysis by acetylcholinesterase, which increases its duration of action. PO: Onset, 30-90 min; maximum: 60-90 min; duration: 1 hr (large doses up to 6 hr). SC: Onset, 5-15 min; maximum: 15-30 min; duration: 2 hr.

Uses: Postpartum or postoperative urinary retention, neurogenic atony of the bladder with urinary retention. Investigational: Reflux esophagitis in adults and gastroesophageal reflux in infants and children.

Contraindications: Hypotension, hypertension, CAD, coronary occlusion, AV conduction defects, vasomotor instability, pronounced bradycardia, peptic ulcer, bronchial asthma (latent or active), hyperthyroidism, parkinsonism, epilepsy, obstruction of the bladder or bladder neck, if the strength or integrity of the GI or bladder wall is questionable, peritonitis, GI spastic disease, acute inflammatory lesions of the GI tract, when increased muscular activity of the GI tract or urinary bladder might be harmful (e.g., following recent urinary bladder surgery), GI resection and anastomosis, GI obstruction, marked vagotonia. Lactation. Not to be used IM or IV.

Special Concerns: Safety and effectiveness have not been determined in children.

Side Effects: Serious side effects are uncommon with PO dosage but more common following SC use. GI: Nausea, diarrhea, salivation, GI upset, involuntary defecation, cramps, colic, belching, rumbling/gurgling of stomach. CV: Hypotension with reflex tachycardia, vasomotor response. CNS: Headache, malaise. Other: Flushing, sensation of heat about the face, sweating, urinary urgency, attacks of asthma, bronchial constriction, miosis, lacrimation.

Overdose Management: Symptoms: Early signs include N&V;, abdominal discomfort, salivation, sweating, flushing. Treatment: Atropine, 0.6 mg SC for adults; a dose of 0.01 mg/kg atropine SC (up to a maximum of 0.4 mg) is recommended for infants and children up to 12 years of age. IV atropine may be used in emergency situations.

Drug Interactions: Cholinergic inhibitors / Additive cholinergic effects Ganglionic blocking agents / Critical hypotensive response preceded by severe abdominal symptoms Procainamide / Antagonism of cholinergic effects Quinidine / Antagonism of cholinergic effects

How Supplied: Injection: 5 mg/mL; Tablet: 5 mg, 10 mg, 25 mg, 50 mg

Dosage
•Tablets Urinary retention.
Adults, usual: 10-50 mg t.i.d.-q.i.d. The minimum effective dose can be determined by giving 5-10 mg initially and repeating this dose q 1-2 hr until a satisfactory response is observed or a maximum of 50 mg has been given.

Treat reflux esophagitis in adults.
25 mg q.i.d.
Gastroesophageal reflex in infants and children.
3 mg/m²/dose t.i.d.
•SC Urinary retention.
Adults, usual: 5 mg t.i.d.-q.i.d. The minimum effective dose is determined by giving 2.5 mg initially and repeating this dose at 15-30-min intervals to a maximum of four doses or until a satisfactory response is obtained.
Diagnosis of reflux esophagitis in adults.
Two 50-mcg/kg doses 15 min apart.