What is the recommended dosing for Bethanechol (Urecholine) in treating urinary retention?

Bethanechol (Urecholine) Dosing for Urinary Retention

For treating urinary retention, bethanechol should be administered at a dose of 10-30 mg orally three to four times daily, or 5-10 mg subcutaneously for acute cases. 1

Oral Administration

• Initial dose: 10-30 mg three to four times daily 1
• Maximum daily dose: 120 mg 1
• Administer on an empty stomach to maximize absorption 1

Subcutaneous Administration

• For acute urinary retention: 5-10 mg subcutaneously 2
• Subcutaneous administration (10 mg) has been shown to significantly reduce the need for catheterization in postoperative urinary retention 2
• Response to subcutaneous administration typically occurs within 30-90 minutes 2

Clinical Applications

• Most commonly prescribed for:

  • Bladder atony (35% of prescriptions) 3
  • Urinary retention (20% of prescriptions) 3
  • Neurogenic bladder (18% of prescriptions) 3
  • Incomplete bladder emptying (10% of prescriptions) 3

• Bethanechol has demonstrated effectiveness in reducing the duration of urethral catheterization in post-surgical patients 4

• It works by enhancing detrusor muscle contraction, resulting in higher maximum flow rate and lower post-void residual urine volume 4

Monitoring Parameters

• Assess voiding pattern and post-void residual volume to evaluate effectiveness 4
• Monitor for common side effects, including:
  • Nausea (most common) 4
  • Abdominal distension 4
  • Abdominal cramping 4
  • Excessive salivation 1

Precautions and Contraindications

• Use with caution in patients with:

  • Cardiovascular disease (may cause hypotension) 1
  • Peptic ulcer disease (may increase gastric acid secretion) 1
  • Parkinson's disease 1
  • Hyperthyroidism 1

• Avoid in patients with:

  • Mechanical obstruction of the urinary tract 1
  • Active bronchial asthma 1
  • Severe cardiovascular instability 1

Treatment Duration

• For acute postoperative urinary retention: Short-term use (3-7 days) is typically sufficient 4
• For chronic conditions: May require ongoing therapy with regular evaluation of effectiveness 3
• Most prescriptions (79%) are for continued medication rather than new starts 3

Special Considerations

• A positive response to bethanechol is not diagnostic of neurogenic bladder and should be interpreted in the context of a complete neurourologic evaluation 5
• Bethanechol is primarily prescribed by urologists (92%), followed by internal medicine clinicians (8%) 3