Bethanechol Chloride is used for the management of acute postoperative and postpartum non-obstructive (functional) urinary retention, as well as for neurogenic bladder atony associated with urinary retention.

Bethanechol primarily works by stimulating the parasympathetic nervous system. It enhances the tone of the detrusor muscle of the bladder, leading to a strong enough contraction to initiate urination and facilitate bladder emptying. It also promotes gastric motility, increases gastric tone, and helps restore normal peristaltic movements. Activation of the parasympathetic system causes the release of acetylcholine at nerve endings. Although acetylcholine can be administered when natural stimulation is insufficient, it is rapidly broken down by cholinesterase, resulting in short-lived effects. In contrast, Bethanechol is resistant to cholinesterase, making its action longer-lasting and more predictable. It mainly produces muscarinic effects with minimal nicotinic activity. The doses that stimulate urination and bowel movements do not significantly activate ganglia or voluntary muscles. At therapeutic doses, it has little to no impact on heart rate, blood pressure, or peripheral circulation.

Dosage must be individualized, depending on the type and severity of the condition to be treated. Preferably give the drug when the stomach is empty. If taken soon after eating, nausea and vomiting may occur. The usual adult oral dose ranges from 10 to 50 mg three or four times a day. The minimum effective dose is determined by giving 5 to 10 mg initially and repeating the same amount at hourly intervals until satisfactory response occurs, or until a maximum of 50 mg has been given. The effects of the drug sometimes appear within 30 minutes and are usually maximal within 60 to 90 minutes. The drug effects persist for about one hour.

Pediatric Use: Safety and effectiveness in pediatric patients have not been established.

Bethanechol Chloride should not be used in patients with hyperthyroidism, pregnancy, lactation, peptic ulcer, latent or active bronchial asthma, marked bradycardia or hypotension, vasomotor instability, coronary artery disease, epilepsy, or parkinsonism. It is also contraindicated in situations where the strength or integrity of the gastrointestinal or bladder wall is compromised, or where mechanical obstruction is present. Increased muscular activity of the gastrointestinal tract or urinary bladder may be harmful, such as after recent bladder surgery, gastrointestinal resection or anastomosis, or when gastrointestinal obstruction is suspected. Additionally, it should be avoided in cases of bladder neck obstruction, spastic gastrointestinal disorders, acute inflammatory conditions of the gastrointestinal tract, peritonitis, or pronounced vagotonia.

Pregnancy: Animal studies on reproduction have not been conducted with bethanechol chloride. It is unknown whether this drug can cause harm to the fetus or affect reproductive ability when administered during pregnancy. Therefore, it should be used in pregnant women only if clearly necessary.

Nursing Mothers: It is not known whether bethanechol chloride is excreted in human milk. Since many drugs are excreted in breast milk and there is a potential for serious adverse effects in nursing infants, a decision should be made whether to discontinue breastfeeding or to stop the medication, considering the importance of the drug to the mother.

Careful monitoring is necessary when bethanechol is given along with other medications that may interact pharmacologically. Drugs such as quinidine and procainamide may reduce cholinergic effects, while cholinergic agents, especially cholinesterase inhibitors, can enhance these effects. In patients receiving ganglionic blocking agents, bethanechol may cause a significant drop in blood pressure, often preceded by severe abdominal discomfort. In cases of urinary retention, if the urinary sphincter does not relax while the bladder contracts, urine may be pushed backward into the ureters and kidney pelvis, increasing the risk of reflux infection, particularly when bacteriuria is present.

Store at temperatures below 30°C, protected from light and moisture. Keep the medicine out of reach of children.