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Pharmacologic class: Cholinergic
Therapeutic class: Urinary and GI tract stimulant
Pregnancy risk category C
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.
Tablets: 5 mg, 10 mg, 25 mg, 50 mg
Indications and dosages
➣ Postpartal and postoperative non-obstructive 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.
• Hypersensitivity to drug
• GI or GU tract obstruction
• Active or latent asthma
• Atrioventricular conduction defects
• Coronary artery disease
• Seizure disorders
• Peptic ulcer disease
Use cautiously in:
• sensitivity to cholinergics or their effects and tartrazine (some products)
• pregnant or breastfeeding patients
• Give drug on empty stomach 1 hour before or 2 hours after a meal to help prevent nausea and vomiting.
CNS: headache, malaise, seizures
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
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-herbs. Angel's trumpet, jimson-weed, scopolia: antagonism of cholinergic effects
• Monitor blood pressure. Be aware that hypertensive patients may experience sudden blood pressure drop.
• Stay alert for orthostatic hypotension, a common adverse effect.
• Monitor fluid intake and output and residual urine volume.
• Tell patient that drug is usually effective within 90 minutes of administration.
• Advise patient to take drug 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.
ClassificationTherapeutic: urinary tract stimulant
- Contraction of the urinary bladder,
- Decreased bladder capacity,
- Increased frequency of ureteral peristaltic waves,
- Increased tone and peristalsis in the GI tract,
- Increased pressure in the lower esophageal sphincter,
- Increased gastric secretions.
Time/action profile (response on bladder muscle)
|PO||30–90 min||1 hr||6 hr|
|Subcut||5–15 min||15–30 min||2 hr|
Adverse Reactions/Side Effects
Central nervous system
Ear, Eye, Nose, Throat
- heart block (life-threatening)
- syncope/cardiac arrest (life-threatening)
- abdominal discomfort (most frequent)
- diarrhea (most frequent)
- nausea (most frequent)
- salivation (most frequent)
- vomiting (most frequent)
- urgency (most frequent)
- flushing (most frequent)
- sweating (most frequent)
Drug-Drug interactionQuinidine and procainamide may antagonize cholinergic effects.Additive cholinergic effects with cholinesterase inhibitors.Use with ganglionic blocking agents may result in severe hypotension.Do not use with depolarizing neuromuscular blocking agents.Effectiveness will be decreased by anticholinergics.Cholinergic effects may be antagonized by angel's trumpet, jimson weed, or scopolia.
Availability (generic available)
- Monitor BP, pulse, and respirations before administering and for at least 1 hr after subcut administration.
- Monitor intake and output ratios. Palpate abdomen for bladder distention. Notify physician or other health care professional if drug fails to relieve condition for which it was prescribed. Catheterization may be ordered to assess postvoid residual.
- Lab Test Considerations: May cause an increase in serum AST, amylase, and lipase concentrations. Observe patient for drug toxicity (sweating, flushing, abdominal cramps, nausea, salivation). If overdosage occurs, treatment includes atropine sulfate (specific antidote).
Potential Nursing DiagnosesImpaired urinary elimination (Indications)
- A test dose is usually employed before maintenance to determine minimum effective dose.
- Oral and subcut doses are not interchangeable.
- Oral: Administer medication on an empty stomach, 1 hr before or 2 hr after meals, to prevent nausea and vomiting.
- Subcutaneous: Parenteral solution is intended only for subcut administration. Do not give IM or IV. Inadvertent IM or IV administration may cause cholinergic overstimulation (circulatory collapse, drop in BP, abdominal cramps, bloody diarrhea, shock, and cardiac arrest).
- Do not use if solution is discolored or contains a precipitate.
- Instruct patient to take medication exactly as directed. Missed doses should be taken as soon as possible within 2 hr; otherwise, return to regular dosing schedule. Do not double doses.
- Caution patient to change positions slowly to minimize orthostatic hypotension.
- Advise patient to report abdominal discomfort, salivation, sweating, or flushing to health care professional.
- Increase in bladder function and tone.