Yes: Tablet

Cholinergic Agonist

Nonobstructive urinary retention and retention due to neurogenic bladder; treatment and prevention of bladder dysfunction caused by phenothiazines; diagnosis of flaccid or atonic neurogenic bladder; gastroesophageal reflux

C

Hypersensitivity to bethanechol; do not use in patients with mechanical obstruction of the GI or GU tract or when the strength or integrity of the GI or bladder wall is in question. It is also contraindicated in patients with hyperthyroidism, peptic ulcer disease, epilepsy, obstructive pulmonary disease, bradycardia, vasomotor instability, atrioventricular conduction defects, hypotension, or parkinsonism; contraindicated for I.M. or I.V. use due to a likely severe cholinergic reaction

Potential for reflux infection if the sphincter fails to relax as bethanechol contracts the bladder; avoid use in breast-feeding women; safety and efficacy in children <5 years of age have not been established; syringe containing atropine should be readily available for treatment of serious side effects; for S.C. injection only; do not administer I.M. or I.V.

Oral: <1%: Hypotension, cardiac arrest, flushed skin, abdominal cramps, diarrhea, nausea, vomiting, salivation, bronchial constriction, diaphoresis, vasomotor response

Subcutaneous: 1% to 10%:

Cardiovascular: Hypotension, cardiac arrest, flushed skin

Gastrointestinal: Abdominal cramps, diarrhea, nausea, vomiting, salivation

Respiratory: Bronchial constriction

Miscellaneous: Diaphoresis, vasomotor response

Symptoms of overdose include nausea, vomiting, abdominal cramps, diarrhea, involuntary defecation, flushed skin, hypotension, bronchospasm

Atropine is the treatment of choice for intoxications manifesting with significant muscarinic symptoms; atropine I.V. 0.6 mg every 3-60 minutes (or 0.01 mg/kg I.V. every 2 hours if needed for children) should be repeated to control symptoms and then continued as needed for 1-2 days following the acute ingestion. Epinephrine 0.1-1 mg S.C. may be useful in reversing severe cardiovascular or pulmonary sequel.

Decreased effect: Procainamide, quinidine

Increased toxicity: Bethanechol and ganglionic blockers critical fall in blood pressure; cholinergic drugs or anticholinesterase agents

Stimulates cholinergic receptors in the smooth muscle of the urinary bladder and gastrointestinal tract resulting in increased peristalsis, increased GI and pancreatic secretions, bladder muscle contraction, and increased ureteral peristaltic waves

Onset of action: Oral: 30-90 minutes; S.C.: 5-15 minutes

Duration of action: Oral: Up to 6 hours; S.C.: 2 hours

Absorption: Oral: Variable

Metabolism and elimination have not been determined

Children:

Oral:

Abdominal distention or urinary retention: 0.6 mg/kg/day divided 3-4 times/day

Gastroesophageal reflux: 0.1-0.2 mg/kg/dose given 30 minutes to 1 hour before each meal to a maximum of 4 times/day

S.C.: 0.15-0.2 mg/kg/day divided 3-4 times/day

Adults:

Oral: 10-50 mg 2-4 times/day

S.C.: 2.5-5 mg 3-4 times/day, up to 7.5-10 mg every 4 hours for neurogenic bladder

Should be administered 1 hour before meals or 2 hours after meals

Observe closely for side effects

lipase, AST, amylase (S), bilirubin, aminotransferase [ALT (SGPT)/AST (SGOT)] (S)

None reported

Contraindicated in Parkinson's disease

No information available to require special precautions

This is a cholinergic agent similar to pilocarpine and expect to see salivation and sweating in patients

Oral: Take as directed, on an empty stomach to avoid nausea or vomiting. Do not discontinue without consulting prescriber. Maintain adequate hydration (2-3 L/day of fluids unless instructed to restrict fluid intake). May cause dizziness or hypotension (rise slowly from sitting or lying position and use caution when driving or climbing stairs); vomiting or loss of appetite (frequent small meals, frequent mouth care, sucking lozenges, or chewing gum may help). Report persistent abdominal discomfort; significantly increased salivation, sweating, tearing, or urination; flushed skin; chest pain or palpitations; acute headache; unresolved diarrhea; excessive fatigue, insomnia, dizziness, or depression; increased muscle, joint, or body pain; vision changes or blurred vision; or respiratory difficulty or wheezing. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to be pregnant. Do not breast-feed.

Have bedpan readily available, if administered for urinary retention

Injection, as chloride: 5 mg/mL (1 mL)

Tablet, as chloride: 5 mg, 10 mg, 25 mg, 50 mg

Andersson KE, "Current Concepts in the Treatment of Disorders of Micturition," Drugs, 1988, 35(4):477-94.

Guerra MF and Ives TJ, "Bethanechol and Hypothermia," Ann Intern Med, 1983, 99(2):279-80.

Romanowski GL, Shimp LA, Balson AB, et al, "Urinary Incontinence in the Elderly: Etiology and Treatment," Drug Intell Clin Pharm, 1988, 22(7-8):525-33.