Urecholine

Urecholine,

trademark for a cholinergic (bethanechol chloride).

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bethanechol chloride

Duvoid (CA), Myotonachol (CA), Myotonine (UK), PMS-Bethanecol Chloride (CA), Urecholine

Pharmacologic class: Cholinergic

Therapeutic class: Urinary and GI tract stimulant

Pregnancy risk category C

Action

Stimulates parasympathetic nervous system and cholinergic receptors, leading to increased muscle tone in bladder and increased frequency of ureteral peristaltic waves. Also stimulates gastric motility, increases gastric tone, and restores rhythmic GI peristalsis.

Availability

Injection: 5 mg/ml

Tablets: 5 mg, 10 mg, 25 mg, 50 mg

⊘Indications and dosages

➣ Postpartal and postoperative nonobstructive urinary retention; urinary retention caused by neurogenic bladder

Adults: 10 to 50 mg P.O. three to four times daily; dosage may be determined by giving 5 or 10 mg q hour until response occurs or a total of 50 mg has been given. Alternatively, 5 mg subcutaneously three to four times daily; dosage may be determined by giving 2.5 mg subcutaneously q 15 to 30 minutes until response occurs or a total of four doses has been given.

Contraindications

• Hypersensitivity to drug
• GI or GU tract obstruction
• Hyperthyroidism
• Active or latent asthma
• Bradycardia
• Hypotension
• Hypertension
• Atrioventricular conduction defects
• Coronary artery disease
• Seizure disorders
• Parkinsonism
• Peptic ulcer disease

Precautions

Use cautiously in:
• sensitivity to cholinergics or their effects
• pregnant or breastfeeding patients
• children.

Administration

• Give drug on empty stomach 1 hour before or 2 hours after a meal to help prevent nausea and vomiting.
☞ Don't give I.M or I.V. Doing so may cause severe symptoms of cholinergic overstimulation, including circulatory collapse and cardiac arrest.
• Keep atropine on hand to counteract severe adverse effects.

Route	Onset	Peak	Duration
P.O.	30-90 min	1 hr	6 hr
Subcut.	5-15 min	15-30 min	2 hr

Adverse reactions

CNS: headache, malaise

CV: bradycardia, hypotension, heart block, syncope with cardiac arrest

EENT: excessive lacrimation, miosis

GI: nausea, vomiting, diarrhea, abdominal discomfort, belching

GU: urinary urgency

Respiratory: increased bronchial secretions, bronchospasm

Skin: diaphoresis, flushing

Other: hypothermia

Interactions

Drug-drug. Anticholinergics: decreased bethanechol efficacy

Cholinesterase inhibitors: additive cholinergic effects

Depolarizing neuromuscular blockers: decreased blood pressure

Ganglionic blockers: severe hypotension

Procainamide, quinidine: antagonism of cholinergic effects

Drug-diagnostic tests. Amylase, hepatic enzymes, lipase: increased levels

Drug-herbs. Angel's trumpet, jimsonweed, scopolia: antagonism of cholinergic effects

Patient monitoring

• Monitor blood pressure. Be aware that hypertensive patients may experience sudden blood pressure drop.
• Stay alert for orthostatic hypotension, a common adverse effect.
• Monitor vital signs and respiration for 30 to 60 minutes after subcutaneous injection.
• Monitor fluid intake and output and residual urine volume.

Patient teaching

• Tell patient that drug is usually effective within 90 minutes of administration.
• Advise patient to take oral dose on empty stomach 1 hour before or 2 hours after a meal to avoid GI upset.
• Instruct patient to move slowly when sitting up or standing, to avoid dizziness or light-headedness from blood pressure decrease.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above.