BETHANECHOL CHLORIDE 
(be-than'e-kole)
Duvoid, Urabeth, Urecholine
Classifications: autonomic nervous system agent; direct-acting cholinergic (parasympathomimetic) agent
Pregnancy Category: C
|
5 mg, 10 mg, 25 mg, 50 mg tablets; 5 mg/mL injection
Synthetic choline ester with effects similar to those of acetylcholine (ACh). Acts directly on postsynaptic receptors, and
since it is not hydrolyzed by cholinesterase, its actions are more prolonged than those of ACh.
Produces muscarinic effects primarily on GI tract and urinary bladder. Increases tone and peristaltic activity of esophagus,
stomach, and intestine; contracts detrusor muscle of urinary bladder, usually enough to initiate micturition.
Acute postoperative and postpartum nonobstructive (functional) urinary retention, and for neurogenic atony of urinary bladder
with retention.
In selected cases of adynamic ileus, gastric atony and retention, reflux esophagitis, congenital megacolon, familial dysautonomia;
for prevention and treatment of bladder and salivary gland inhibition induced by tricyclic antidepressants, and for prophylaxis
and treatment of phenothiazine-induced bladder dysfunction.
COPD; history of or active bronchial asthma; hyperthyroidism; recent urinary bladder surgery, cystitis, bacteriuria, urinary
bladder neck or intestinal obstruction, peptic ulcer, recent GI surgery, peritonitis; marked vagotonia, pronounced vasomotor
instability, AV conduction defects, severe bradycardia, hypotension or hypertension, coronary artery disease, recent MI; epilepsy,
parkinsonism. Safety during pregnancy (category C), lactation, or in children <8 y is not established.
Urinary retention; bacteriemia.
Urinary Retention
Adult: PO 10–50 mg b.i.d. to q.i.d. (max: 120 mg/d) SC 2.5–5 mg t.i.d. or q.i.d. prn
Child: PO 0.2 mg/kg or 0.6 mg/m2 t.i.d.
|
Oral
- Give on an empty stomach (1 h before or 2 h after meals) to lessen possibility of nausea and vomiting, unless otherwise advised
by physician.
- Determine minimum effective dose: Give 5–10 mg initially and repeat this dose at 1–2 h (max: 50 mg), until a satisfactory
response occurs. Alternatively, give 10 mg followed, at 6 h intervals, by 25 mg, then 50 mg, until desired response obtained.
Subcutaneous
- Determine minimum effective dose: Give 2.5 mg initially and repeat this dose at 15–30 min intervals (max: 4 doses), or
until a satisfactory response occurs.
- After inserting needle, aspirate carefully before injecting drug to avoid inadvertent entry into a blood vessel.
-
DO NOT give by IM or IV; life-threatening symptoms of cholinergic stimulation can occur.
- Overdose management: Atropine sulfate 0.6–1.2 mg for adults administered IM, slow IV, or SC; and 0.01 mg/kg for infants
and children repeated every 2 h, if necessary.
- Store at 15°–30° C (59°–86° F), unless otherwise directed.
Body as a Whole: Dose-related. Increased sweating, malaise, headache, substernal pain or pressure, hypothermia. CV: Hypotension with dizziness, faintness, flushing, orthostatic hypotension (large doses); mild reflex tachycardia, atrial fibrillation
(hyperthyroid patients), transient complete heart block. Special Senses: Blurred vision, miosis, lacrimation. GI: Nausea, vomiting, abdominal cramps, diarrhea, borborygmi, belching, salivation, fecal incontinence (large doses), urge to
defecate (or urinate). Respiratory: Acute asthmatic attack, dyspnea (large doses).
Bethanechol may cause increases in serum amylase and serum lipase, by stimulating pancreatic secretions, and may increase AST,
serum bilirubin, and BSP retention by causing spasms in sphincter of Oddi.
Drug:
Ambenonium,
neostigmine, other cholinesterase inhibitors compound cholinergic effects and toxicity; mecamylamine may cause abdominal symptoms and hypotension; procainamide,
quinidine,
atropine,
epinephrine antagonize effects of bethanechol.
Absorption: Well absorbed PO. Onset: 30 min PO; 5–15 min SC. Peak: 60–90 min PO; 15–30 min SC. Duration: 1–6 h PO; 2 h SC. Distribution: Does not cross blood–brain barrier. Metabolism: Unknown. Elimination: Unknown.
Assessment & Drug Effects
- Monitor BP and pulse. Observe patient for at least 1 h following SC administration. Report early signs of overdosage: Salivation,
sweating, flushing, abdominal cramps, nausea.
- Monitor I&O. Observe and record patient's response to bethanechol, and report any failure of the drug to relieve the particular
condition for which it was prescribed.
- Monitor respiratory status. Promptly report dyspnea or any other indication of respiratory distress.
- Supervise ambulation as indicated by patient response to drug.
Patient & Family Education
- Make position changes slowly and in stages, particularly from lying down to standing.
- Do not stand still for prolonged periods; sit or lie down at first indication of faintness.
- Do not drive or engage in potentially hazardous activities until response to drug is known.
-
Note: Drug may cause blurred vision; take appropriate precautions.
- Do not breast feed while taking this drug without consulting physician.
1%)
Canadian drug name;