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Lipika Samal M.D. and Paul A. Pham, Pharm.D.
03-04-2010
- Neurogenic bladder
- Urinary retention
- Treatment of acute postoperative and postpartum nonobstructive (functional) urinary retention, and neurogenic atony of the urinary bladder with retention.
- Parasympathomimetic effects mediated by a direct agonist action on muscarinic (cholinergic) receptors in the urinary tract causing increased bladder contraction.
- Also stimulates GI motility
For atonic neurogenic bladder: initially 5-10 mg at increased at hourly intervals until maximum of 50 mg PO. Usual maintenance dose:10 to 50 mg PO 3 to 4 times daily.
brand
name
| generic
| Mfg
| brand
forms
| cost*
|
| Bethanechol Chloride | Bethanechol Chloride | Abrika Pharmaceuticals and other generic manufacturers. | oral
tablet
5 mg | $0.71 |
|
|
|
| oral
tablet
10 mg | $1.33 |
|
|
|
| oral
tablet
25 mg | $1.78 |
|
|
|
| oral
tablet
50 mg | $2.85 |
*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP).
AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's
information, and the McKesson database.
^Dosage is indicated in mg unless otherwise noted.
- No dosage adjustment needed.
- Specific guidelines not available.
- FDA pregnancy risk category C.
- Not known if bethanechol is excreted into breast-milk.
- Cholinergic agonists can cause flushing and warmth of the skin, miosis, diaphoresis, lacrimation, hypersalivation, and bronchospasm.
- GU: urinary urgency, increased urinary frequency
- GI: abdominal pain/cramps, diarrhea, flatulence, nausea/vomiting, and borborygmi (stomach growling, or rumbling)
- Blurred vision (secondary to myosis)
- Headache
- Retrograde urine flow
- Orthostatic hypotension, or a sudden drop in blood pressure in hypertensive patients.
- Antimuscarinic drugs: Maprotiline, Mecamylamine, Tricyclic antidepressants, Phenothiazines, Amoxapine, Bupropion, Clozapine, Disopyramide, Maprotiline, Olanzapine, Procainamide, and quinidine may significantly decrease the efficacy of bethanechol. Avoid co-administration if possible.
- Antidiarrheal agents , Carbinoxamine, Chlorpromazine, Clemastine, Diphenhydramine, Mesoridazine, Olanzapine, Opiate agonists, Parasympathomimetics, Promazine, Promethazine, Quinidine, and Sympathomimetics can also interfere with the action of bethanechol. Avoid co-administration if possible.
- Can be used for treatment of diabetic neurogenic bladder (Frimodt-Moller).
- An effective treatment of urinary retention when combined with an alpha-blocker, but use of this old drug is limited by cholinergic side effects such as diarrhea and abdominal cramping (Yamanishi).
- Clinicians should rule out bladder or urinary tract obstruction before using bethanechol.
- Contraindicated in patients with bradycardia, hypotension, or CAD. Bethanechol should also be avoided in hyperthyroidism, seizure disorder, and parkinsonism since it may exacerbate these conditions.
- Avoid in patients with asthma or COPD because of potential airway obstruction.
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