Concurent administration of bethanechol with other cholinergic agents can cause additive effects leading to toxicity

Co-administration of bethanechol with ganglion blockers produces a clinical fall in blood pressure

Concomittant administration of bethanechol with sympathomimetic amines like ephidrine antognozies the effect of bethanechol and produces opposite effects.

Bethanechol may be used with antacids, as an adjunct to the treatment of reflux oesophagitis and may prevent the adverse effects of tricyclic antidepressants

Post operative and post-partum non-obstructive urinary retention

Adverse drug reactions are rare following oral administration and are more likely to occur when the usage is increased.

Nausea and vomitting may occur if the drug is taken immediately after food

Other reported adverse effects include Frequency of micturation,

Lower abdominal cramps, and blurred vision.

Hypersensitivity to bethanechol , hypothroidism, peptic ulcer,

latent or active bronchial asthma, pronounced bradycardia or hypotension,

vasomotor instability, coronary artery disease.

epilepsy and Parkinsonism

Bethanechol should not be used when the strength and integrity of the gastrointestinal or bladder wall is in question or in the presence of mechanical obstruction, when increased muscular activity of the gastrointestinal tract or urinary bladder might prove harmful.

 or when there is a possible gastrointestinal obstruction, in bladder neck obstruction, spastic gastrointestinal disturbances, acute inflammatory lesions of the gastrointestinal tract or peritonitis or in marked vagotonia

Special precautions:

In urinary retention, if the sphincter fails to relax, as bethanechol contracts the bladder, urine may be forced in the ureter into the kidney. If there is bacteruria, this may cause reflux infection.

The safety and effectivenss in pregnancy has not been established

It is not known whether the drug is secreted in human milk and because of the potential for serious adverse reactions from bethanechol in nursing infants , a decison should be taken whether to discontinue the drug or whether to discontinue nursing, taking into account the importance of the drug to the mother.

Safety and effectiveness in children not established

Indications:

Post and post-partum non-obstructive (funtional ) urinary retention Neutrogenic atony of the urinary bladder and retention

Dosage:

Adult- 10 to 50 mg three to four times a day. The drug can be administered 5-10 mg initially and the dose repeated at hourly intervals until a satisfactory response occurs or until a maximum of 50mg is reached

Pharmacology:

Bathanechol is a parasympathetic agent that is a quaternary ammonium compound usually formulated as the chloride It is the methyl analogue of carbachol. Bethanechol has a stimulant action on the muscarinic cholinergic receptors. It acts directly on the smooth muscle cells and is in contrast to acetylcholine (Ach) it is not hydrolysed by cholinesterases and is more stable in the blood or tissues. Its action in the urinary bladder and other cholinergic receptors sites include- bladder smooth muscle contration, reducton in bladder capacity, increase in the frequency ureteric peristalisis, increased esophageal peristalsis, increased pancreatic and gastrointestinal secretion of cholinergic stimulation are usually absent or minimal when orally or subcutaneously administered in therapeutic doses.

Pharmacokinetics:

Bethanechol is poorly absorbed from the gastrointestinal tract. Effects on the GI and the uribary tracts sometimes appear within 30 minutes after oral administration of bethanechol, but more often 60-90 minutes are required to reach maximum effectiveness. Following oral administration, the usual duration of action of bethanechol is one hour. High doses of bethanechol may release acetylcholine, which stimulate nicotinic receptors but the effect is minimal at the recommened therapeutic doses. The metabolic fate and mode of excretion of the drug have not been elucidated

Nausea and vomitting may occur if the drug is taken immediately after food
Take on an empty 1 hr before or 2 hrs after meals

The safety and effectivenss in pregnancy has not been established Because of the potential for serious adverse reactions from bethanechol in nursing infants , a decison should be taken whether to discontinue the drug or whether to discontinue nursing, taking into account the importance of the drug to the mother. Safety and effectiveness in children not established