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 (Gal 2007; Gearhart 2010; Goldman 2012)
There are no dosage adjustments provided in the manufacturer’s labeling.
There are no dosage adjustments provided in the manufacturer’s labeling.
(For additional information see "Bethanechol: Drug information")
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.
There are no dosage adjustments provided in the manufacturer’s labeling.
There are no dosage adjustments provided in the manufacturer’s labeling.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Tablet, Oral, as chloride:
Urecholine: 5 mg [DSC], 10 mg [DSC] [scored]
Urecholine: 25 mg [DSC], 50 mg [DSC] [scored; contains fd&c yellow #10 (quinoline yellow), fd&c yellow #6 (sunset yellow)]
Generic: 5 mg, 10 mg, 25 mg, 50 mg
Yes
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Tablet, Oral, as chloride:
Duvoid: 10 mg, 25 mg, 50 mg
Generic: 10 mg, 25 mg, 50 mg
Oral: Administer 1 hour before meals or 2 hours after meals to reduce nausea and vomiting
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).
Treatment of acute postoperative and postpartum nonobstructive (functional) urinary retention and retention due to neurogenic atony of the urinary bladder with retention (All indications: FDA approved in adults)
Bethanechol may be confused with betaxolol
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. 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
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.
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.
As a cholinergic, prokinetic agent, bethanechol was historically used to treat infants and children with GERD. However, the risk of adverse effects risks outweigh efficacy benefits and use is no longer recommended (AAP [Lightdale 2013], NASPGHAN/ESPGHAN [Vandenplas 2009].
None known.
Acetylcholinesterase Inhibitors: May enhance the adverse/toxic effect of Cholinergic Agonists. Specifically, cholinergic effects may be enhanced or increased. Risk C: 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. Risk C: Monitor therapy
Cimetropium: Cholinergic Agonists may diminish the anticholinergic effect of Cimetropium. Risk C: Monitor therapy
Sincalide: Drugs that Affect Gallbladder Function may diminish the therapeutic effect of Sincalide. Management: Consider discontinuing drugs that may affect gallbladder motility prior to the use of sincalide to stimulate gallbladder contraction. Risk D: Consider therapy modification
Animal reproduction studies have not been conducted.
Monitor for signs of bronchoconstriction or urinary tract infection
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: ~1 hour (with therapeutic doses); up to 6 hours with large doses (300 to 400 mg)
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).
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).
Tablets (Bethanechol Chloride Oral)
5 mg (per each): $0.71 - $0.90
10 mg (per each): $1.31 - $2.00
25 mg (per each): $0.97 - $2.67
50 mg (per each): $2.89 - $4.27
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