From the Guidelines
Bethanechol should not be used to treat underactive detrusor function in children due to its lack of effectiveness, as evidenced by the 2010 study published in The Journal of Urology 1. The management of dysfunctional voiding in children is a complex issue, and pharmacological therapies have focused on promoting bladder emptying by targeting the bladder outlet using a-adrenergic antagonists (a-blockers) rather than muscarinic and cholinergic agonists like bethanechol. Key points to consider when evaluating the use of bethanechol include:
- The lack of demonstrated effectiveness in treating underactive detrusor function 1
- The potential for side effects, such as increased salivation, abdominal cramps, diarrhea, nausea, and sweating
- The availability of alternative treatments, such as a-blockers and botulinum-A toxin (Botox), which have shown promise in facilitating improved emptying in children with dysfunctional voiding 1 It is essential to prioritize the use of evidence-based treatments and to carefully consider the potential benefits and risks of any pharmacological intervention in the management of dysfunctional voiding in children. In clinical practice, the focus should be on promoting bladder emptying through the use of a-blockers or other alternative treatments, rather than relying on bethanechol, which has not been shown to be effective in this context 1.
From the FDA Drug Label
Bethanechol chloride tablets are indicated for the treatment of acute postoperative and postpartum nonobstructive (functional) urinary retention and for neurogenic atony of the urinary bladder with retention. Bethanechol Chloride Tablets, USP are indicated for the treatment of acute postoperative and postpartum nonobstructive (functional) urinary retention and for neurogenic atony of the urinary bladder with retention. The main use of Bethanechol is for the treatment of:
- Acute postoperative nonobstructive (functional) urinary retention
- Postpartum nonobstructive (functional) urinary retention
- Neurogenic atony of the urinary bladder with retention 2 3.
From the Research
Bethanechol Use
- Bethanechol is a cholinergic agonist that may improve detrusor contractility in conditions such as detrusor underactivity or urinary retention in women 4.
- According to a study published in 2019, Bethanechol continues to be prescribed in elderly women primarily for detrusor atony, urinary retention, or incomplete bladder emptying 4.
- The primary diagnosis associated with Bethanechol prescription includes atony of bladder, urinary retention, neurogenic bladder, urinary incontinence, and incomplete bladder emptying 4.
- Bethanechol can be used in patients with neurogenic bladder dysfunction, particularly in cases with incomplete bladder emptying due to feeble or unsustained detrusor contractions 5.
- The medication is typically prescribed as a continued medication, most often by urologists, for chronic conditions such as detrusor underactivity or urinary retention 4.
Patient Characteristics
- Patients prescribed Bethanechol have a mean age of 62.3 years and are predominantly Caucasian, followed by African American 4.
- The majority of visits for Bethanechol prescription are for chronic conditions, indicating the long-term nature of the treatment 4.
Treatment Regimen
- The Bethanechol regimen may vary depending on the type of bladder being treated, such as coordinated reflex neurogenic bladder or sensory paralytic bladder 5.
- Determination of the activity of the periurethral striated muscle is crucial in selecting patients for Bethanechol therapy 5.
Note: The study published in 1977 6 is not relevant to the topic of Bethanechol use.