|Trade names||Urecholine, Myotonine, others|
|Other names||Bethanechol chloride, 2-[(aminocarbonyl)oxy]- N,N,N-trimethyl- 1-propanaminium|
|Drug class||Muscarinic agonist|
|Main uses||Urinary retention, heartburn|
|Side effects||Crampy abdominal pain, flushing, sweating, nausea, diarrhea|
|Chemical and physical data|
|Molar mass||161.225 g·mol−1|
|3D model (JSmol)|
Bethanechol, sold under the brand name Urecholine, is a medication used to treat urinary retention and heartburn. Specifically it is used for urinary retention due to a lack of contraction of the urinary bladder. It is taken by mouth, half an hour before food, 3-4 times daily.
Common side effects include crampy abdominal pain, flushing, sweating, nausea, and diarrhea. It should not be used in people with a very slow heart rate, epilepsy, stomach ulcer, intestinal obstruction, parkinsonism, recent heart attack, COPD, or overactive thyroid. Its effects in pregnancy are not known. It is a parasympathomimetic that directly stimulates muscarinic receptors without any effect on nicotinic receptors.
Bethanechol was approved for medical use in the United States in 1948. In the United Kingdom, one month costs the NHS up to £30 as of 2022. This amount in the United States is about 25 USD. It is not often used, and in the United Kingdom is deemed less suitable.
It is used to treat urinary retention resulting from general anesthetic, diabetic neuropathy of the bladder, or a side effect of antidepressants; or to treat gastrointestinal lack of muscular tone. The muscarinic receptors in the bladder and gastrointestinal tract stimulate contraction of the bladder and expulsion of urine, and increased gastrointestinal motility, respectively. Bethanechol should be used to treat these disorders only after mechanical obstruction is ruled out as a possible cause.
Atropine is given preoperatively to prevent voiding of the bowel/bladder during surgery, Bethanechol is then given postoperatively to revert this action.
The dose is around 10-25 mg 3-4 times a day by mouth on an empty stomach.
It is contraindicated in people with bradycardia, epilepsy, peptic ulcer, intestinal obstruction, parkinsonism, recent myocardial infarction, obstructive airways disease and hyperthyroidism. The parasympathomimetic action of this drug will exacerbate the symptoms of these disorders.
It is a parasympathomimetic that selectively stimulates muscarinic receptors without any effect on nicotinic receptors. Unlike acetylcholine, bethanechol is not hydrolyzed by cholinesterase and will therefore have a long duration of action.
Society and culture
In the UK, one month treatment of urinary retention with bethanechol can cost the NHS up to £30.
Bethanechol is sold under the brand names Duvoid (Roberts), Myotonachol (Glenwood), Urecholine (Merck Frosst) and Urocarb (Hamilton). The name bethanechol refers to its structure as the urethane of beta-methylcholine.
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