Bethanechol is a slowly hydrolyzing muscarinic agonist with no nicotinic effects. Bethanechol is generally used to increase smooth muscle tone, as in the GI tract following abdominal surgery or in urinary retention in the absence of obstruction. It may cause hypotension,[1]
Bethanechol is a synthetic ester structurally and pharmacologically related to acetylcholine. A slowly hydrolyzed muscarinic agonist with no nicotinic effects, bethanechol is generally used to increase smooth muscle tone, as in the GI tract following abdominal surgery or in urinary retention in the absence of obstruction. It may cause hypotension, cardiac rate changes, and bronchial spasms.
Mechanism of Action of Bethanechol
Bethanechol directly stimulates cholinergic receptors in the parasympathetic nervous system while stimulating the ganglia to a lesser extent. Its effects are predominantly muscarinic, inducing the little effect on nicotinic receptors and negligible effects on the cardiovascular system.
Bethanechol is a parasympathomimetic (cholinergic) used for the treatment of acute postoperative and postpartum nonobstructive (functional) urinary retention and for neurogenic atony of the urinary bladder with retention. Bethanechol, a cholinergic agent, is a synthetic ester which is structurally and pharmacologically related to acetylcholine. It increases the tone of the detrusor urinae muscle, usually producing a contraction sufficiently strong to initiate micturition and empty the bladder. It stimulates gastric motility, increases gastric tone, and often restores impaired rhythmic peristalsis. Bethanechol chloride is not destroyed by cholinesterase and its effects are more prolonged than those of acetytcholine.
Indications of Bethanechol
- Urinary Retention
- Neurogenic Bladder
- Neurogenic Bladder Dysfunction
- Postoperative Urinary Retention
- Postpartum urinary retention
- For the treatment of acute postoperative and postpartum nonobstructive (functional) urinary retention and for neurogenic atony of the urinary bladder with retention.
Contra-Indications of Bethanechol
- Parkinson Symptoms
- Increased Tone of Parasympathetic Nervous System
- High blood pressure
- Coronary artery disease
- Atrioventricular Heart Block
- Slow Heartbeat
- Blood Pressure Drop Upon Standing
- Abnormally low blood pressure
- asthma
- Stomach or Intestinal Tract Operation
- Ulcer from Stomach Acid
- Inflammatory Bowel Disease
- Stomach or Intestine Blockage
- Irritable Colon
- Inflammation and Infection of the Abdomen Lining
- Surgical Joining of Two Parts of the Intestine
- Bladder Surgery
- Blockage of Urinary Bladder
- Urinary Tract Blockage
- Instability of the Nerves Which Control the Blood Vessels
- seizures
Dosage of Bethanechol
Strengths: 5 mg; 10 mg; 25 mg; 50 mg; 5 mg/mL
Urinary Retention
- Initial dose: 5 to 10 mg orally once to obtain minimum effective dose; repeat the same amount at hourly intervals until satisfactory response occurs or a maximum of 50 mg has been given
- Maintenance dose: 10 to 50 mg orally 3 to 4 times a day
Neurogenic Bladder
- Initial dose: 5 to 10 mg orally once to obtain minimum effective dose; repeat the same amount at hourly intervals until satisfactory response occurs or a maximum of 50 mg has been given
- Maintenance dose: 10 to 50 mg orally 3 to 4 times a day
Side Effects of Bethanechol
The most common
- xerostomia (dry mouth)
- decreased gastric motility (upset stomach)
- Headache
- constipation
- dry eyes
- sleepiness
- urinary retention
- chest pain, fast or uneven heart rate;
- confusion, hallucinations;
- urinating less than usual or not at all; or
- painful or difficult urination.
More common
- Abnormal vision, including difficulty with adjusting to distances
- bloody or cloudy urine
- difficult, burning, or painful urination
- frequent urge to urinate
- Sensation of pins and needles in the fingers and toes
- Allergic reactions
- Nervousness
- Aware of the heartbeat (palpitations)
- Heart failure
- Irregular heartbeat
- Heart burn
- Memory impairment
Less common
- Chest pain
- Cough
- Diarrhea
- Fever
- The general feeling of discomfort or illness
- Headache
- Joint pain
- Loss of appetite
- Muscle aches and pains
- Nausea
- Pain or tenderness around the eyes and cheekbones
- Shortness of breath or troubled breathing
- Sore throat
- Stuffy or a runny nose
- Sweating
- Tightness of the chest or wheezing
- Trouble with sleeping
Drug Interactions of Bethanechol
Bethanechol may interact with the following drugs,supplyment & may change the efficacy of drugs
- arsenic trioxide
- chloroquine or halofantrine
- cyclosporine
- droperidol
- atropine
- galantamine
- quinidine
- narcotic medication such as levomethadyl or methadone ;
- pentamidine
- hyoscyamine
- oxybutynin
- procainamide
- antibiotics such as (azithromycin , clarithromycin , erythromycin , or telithromycin 😉
- medicines to treat psychiatric disorders, such as chlorpromazine , haloperidol mesoridazine pimozide , or thioridazine ; or
- heart rhythm medicine such as amiodarone , dofetilide , disopyramide , procainamide , quinidine , or sotalol .
Pregnancy & Lactation of Bethanechol
FDA Pregnancy Category C
Pregnancy
This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.
Lactation
It is not known if bethanechol chloride passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding. The safety and effectiveness of using this medication have not been established for children.
References
- https://pubchem.ncbi.nlm.nih.gov/compound/bethanechol
- https://www.webmd.com/drugs/2/drug-10669/bethanechol-chloride-subcutaneous/details/list-contraindications
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http://www.nlm.nih.gov/mesh/meshhome.html
https://www.ncbi.nlm.nih.gov/mesh/68010277
https://www.ncbi.nlm.nih.gov/mesh/68018721http://www.ebi.ac.uk/chebi/userManualForward.do#ChEBI%20Ontology
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