Bethanechol is a medication that is primarily used to treat urinary retention, a condition where the bladder does not empty completely. It is classified as a muscarinic receptor agonist, which means it stimulates certain receptors in the body that are responsive to acetylcholine, a neurotransmitter.

By stimulating the muscarinic receptors in the bladder, bethanechol helps to increase the muscle tone of the bladder and improve its ability to contract. This leads to increased bladder emptying and can relieve symptoms of urinary retention.

Bethanechol is a parasympathomimetic drug that activates the parasympathetic nervous system. It activates the muscarinic receptors without affecting the nicotinic receptors. It is used to treat the following conditions:

• Treatment of urinary retention as a result of urinary bladder atony secondary to a neurogenic cause. 
• Treatment of functional urinary retention following delivery or post-operatively.

Bethanechol Dose in Adults

Bethanechol Dose in the treatment of Urinary retention in patients with a neurogenic bladder:  

• When using bethanechol to treat urinary retention or neurogenic bladder, the initial dose is usually 5 to 10 mg taken by mouth.
• If needed, this dose can be repeated every hour until there is a noticeable improvement or until a maximum of 50 mg is reached.
• The usual dose after that is 10 to 50 mg, taken 3 to 4 times per day.
• It's important to note that the cholinergic effects of higher oral doses can add up over time.

Bethanechol Dose in Children

Bethanechol Dose in the treatment of non-obstructive Urinary retention:

• When using bethanechol to treat nonobstructive urinary retention in children and adolescents, the available data is limited.
• The recommended dose is typically 0.3 to 0.6 mg per kilogram of body weight per day, taken orally and divided into 3 to 4 doses throughout the day.
• The maximum dose for children is usually 10 mg per dose.

Note: In adults, the typical dose of bethanechol is 10 to 50 mg, taken 3 to 4 times per day. This information is based on commonly followed guidelines from medical sources such as Gearhart 2010, Goldman 2012, and Kliegman 2007. It's important to note that individual dosing may vary depending on the specific circumstances

Pregnancy Risk Factor C

• Bethanechol is classified as Pregnancy Risk Factor C, which means that there have not been sufficient animal reproduction studies conducted to determine its effects on pregnancy.

Use of Bethanechol during breastfeeding

• The presence of bethanechol in breast milk is currently unknown.
• Since there is a possibility of serious adverse reactions in nursing infants, a decision should be made after weighing the importance of treatment for the mother.

Bethanechol Dose in Renal Disease:

According to available information, no specific dose adjustments have been recommended by the manufacturer for patients with kidney disease when using bethanechol.

Bethanechol Dose in Liver Disease:

According to available information, no specific dose adjustments have been recommended by the manufacturer for patients with liver disease when using bethanechol.

Side Effects of Bethanechol Frequency not defined.

• Respiratory:
  • Asthma
  • Bronchoconstriction
• Central Nervous System:
  • Colic
  • Headache
  • Malaise
  • Seizure
• Cardiovascular:
  • Flushing
  • Hypotension
  • Tachycardia
• Dermatologic:
  • Diaphoresis
• Genitourinary:
  • Urinary Urgency
• Gastrointestinal:
  • Eructation
  • Nausea
  • Abdominal Cramps
  • Borborygmi
  • Diarrhea
  • Salivation
  • Vomiting
• Ophthalmic:
  • Lacrimation
  • Miosis

Contraindication to Bethanechol include:

• Hypersensitivity: If there is a known hypersensitivity or allergic reaction to bethanechol or any component of the formulation, the medication should not be used.
• Hyperthyroidism: Bethanechol is contraindicated in individuals with hyperthyroidism, a condition characterized by an overactive thyroid gland.
• Peptic Ulcer Disease: Individuals with peptic ulcer disease, which involves ulcers in the stomach or duodenum, should not use bethanechol due to the potential for worsening symptoms.
• Epilepsy: Bethanechol should not be used in individuals with epilepsy, as it may increase the risk of seizures.
• Asthma: Individuals with asthma, a chronic respiratory condition, should avoid using bethanechol due to the potential for worsening of asthma symptoms.
• Pronounced Bradycardia or Hypotension: Bethanechol is contraindicated in individuals with significantly low heart rate (bradycardia) or low blood pressure (hypotension).
• Vasomotor Instability: Individuals with vasomotor instability, which refers to the inability to maintain stable blood vessel tone, should not use bethanechol.
• Coronary Artery Disease: Bethanechol is contraindicated in individuals with coronary artery disease, a condition that affects blood flow to the heart.
• Parkinsonism: Individuals with parkinsonism, a group of neurological disorders characterized by movement difficulties, should avoid using bethanechol.
• Mechanical Obstruction: Bethanechol should not be used when there is a mechanical obstruction in the gastrointestinal (GI) or genitourinary (GU) tract or when the strength or integrity of the GI or bladder wall is in question.
• Harmful Muscular Activity: In situations where increased muscular activity of the GI tract or bladder might be harmful, bethanechol should be avoided. This includes conditions such as urinary bladder surgery, GI resection and anastomosis, and possible GI obstruction.
• Bladder Neck Obstruction: Bethanechol is contraindicated in individuals with bladder neck obstruction, a condition that affects the flow of urine from the bladder.
• Spastic GI Disturbances: Bethanechol should not be used in individuals with spastic GI disturbances, which are characterized by abnormal contractions of the gastrointestinal muscles.
• Acute Inflammatory Lesions of the GI Tract or Peritonitis: Bethanechol is contraindicated in individuals with acute inflammatory lesions of the GI tract or peritonitis.
• Marked Vagotonia: Individuals with marked vagotonia, a condition characterized by excessive activity of the vagus nerve, should not use bethanechol.

Warnings and Precautions

Reflux infection:

• If a patient has bacteriuria (bacterial infection in the urine) and is prescribed bethanechol, there is a potential risk for reflux infection if the sphincter fails to relax properly.
• Bethanechol contracts the bladder muscles, which can potentially cause urine to flow backward into the kidneys if the sphincter does not relax adequately.
• This can lead to a reflux infection, where bacteria from the bladder enter the kidneys and cause an infection.

Monitoring Parameters:

Monitor heart rate, Blood pressure, and ECG especially in cardiac patients. 

How to administer Bethanechol?

• Bethanechol is usually taken by mouth.
• It is recommended to take the medication either one hour before meals or two hours after meals.
• This timing helps to avoid or minimize the occurrence of nausea and vomiting that may be associated with taking bethanechol.
• Adhering to the recommended timing can help improve medication effectiveness and reduce the risk of unpleasant side effects.

Mechanism of action of Bethanechol:

Bethanechol works by stimulating the parasympathetic nervous system, which leads to several effects in the body:

Increased Bladder Muscle Tone:

• By stimulating the bladder muscles, bethanechol enhances their tone and promotes contractions.
• This helps to initiate and improve the process of urination, making it easier for the bladder to empty.

Gastric Motility Stimulation:

• Bethanechol also stimulates the movement and contractions of the muscles in the stomach, known as gastric motility.
• This can help to improve the overall function of the digestive system.

Increased Gastric Tone:

• Bethanechol enhances the tone of the stomach muscles, leading to increased muscle activity and improved digestion.
• This effect can be beneficial for individuals with conditions that involve decreased gastric tone or motility.

Restoration of Peristalsis:

• Peristalsis refers to the coordinated wave-like contractions of the muscles in the digestive tract that help to propel food through the system.
• Bethanechol can aid in restoring and regulating peristalsis, which can be beneficial in cases of impaired gastrointestinal motility.

Onset of Action:

• The onset of action for bethanechol, meaning the time it takes for the medication to start working, is typically around 30 minutes after administration.

Peak Effect:

• The peak effect, or the point of maximum effectiveness, is usually reached approximately 60 to 90 minutes after taking the medication.

Duration:

• The duration of action for bethanechol can vary depending on the dosage.
• With therapeutic doses, the effects typically last for about 1 hour.
• However, when larger doses of 300 to 400 mg are used, the duration of action can extend up to 6 hours.

International Brands of Bethanechol:

• Duvoid
• PHL-Bethanechol Chloride
• PMS-Bethanechol Chloride
• Dampurine
• Hinecol
• Mesacol
• Miotonoachol
• Muscaran
• Myo Hermes
• Myocholine Glenwood
• Myocholine-Glenwood
• Myotonin
• Myotonine
• Chloride
• Ucholine
• Uninechol
• Urecholine
• Uriflow
• Urocarb
• Wecoli

Bethanechol Brands in Pakistan:

No brands available in Pakistan.