Bethanechol Chloride

(BAN)
Bethanechol Chloride Chemical formula

💊 Chemical information

Betanecol, cloruro de; Betanekolikloridi; Betanekolklorid; Bethanecholi Chloridum; Carbamylmethylcholine Chloride. (2Carbamoyloxypropyl)trimethylammonium chloride.
Chemical formula: C7H17ClN2O2 = 196.7.
CAS — 674-38-4 (bethanechol); 590-63-6 (bethanechol chloride).
ATC — N07AB02.
ATC Vet — QN07AB02.

Pharmacopoeias.

In Jpn and US.

USP 31

(Bethanechol Chloride). Colourless or white crystals, or white crystalline powder, usually having a slight, amine-like odour. It is hygroscopic and exhibits polymorphism. Freely soluble in water and in alcohol; insoluble in chloroform and in ether. pH of a 1% solution in water is between 5.5 and 6.5. Store in airtight containers.

Stability.

References to the stability of oral liquid preparations of bethanechol chloride prepared extemporaneously from tablets. 1. Schlatter JL, Saulnier J-L. Bethanechol chloride oral solutions: stability and use in infants. Ann Pharmacother 1997; 31: 294–6. 2. Allen LV, Erickson MA. Stability of bethanechol chloride, pyrazinamide, quinidine sulfate, rifampin, and tetracycline hydrochloride in extemporaneously compounded oral liquids. Am J Health-Syst Pharm 1998; 55: 1804–9.

Sterilisation.

The US manufacturers state that solutions of bethanechol chloride may be autoclaved at 120° for 20 minutes without discoloration or loss of potency.

💊 Adverse Effects and Treatment

As described for choline esters under Acetylcholine Chloride.

💊 Precautions

As described for choline esters under Acetylcholine Chloride. Bethanechol should not be given by the intravenous or intramuscular routes as very severe muscarinic adverse effects are liable to occur, calling for emergency use of atropine.

Autonomic neuropathy.

Patients with autonomic neuropathy might be more susceptible to the adverse effects of bethanechol and they should be started on low-dosage regimens and observed closely for signs of toxicity.1
1. Caraco Y, et al. Bethanechol-induced cholinergic toxicity in diabetic neuropathy. DICP Ann Pharmacother 1990; 24: 327–8.

💊 Interactions

As for Neostigmine.

💊 Pharmacokinetics

Bethanechol chloride is poorly absorbed from the gastrointestinal tract. It is not hydrolysed by cholinesterases. At standard doses bethanechol does not cross the blood-brain barrier.

💊 Uses and Administration

Bethanechol chloride, a choline ester, is a quaternary ammonium parasympathomimetic that mainly exhibits the muscarinic actions of acetylcholine. It is not inactivated by cholinesterases so its actions are more prolonged than those of acetylcholine. Bethanechol chloride has little if any nicotinic activity and is used for its actions on the bladder and gastrointestinal tract. It has been used as an alternative to catheterisation in the treatment of urinary retention and has also been used for gastric atony and retention, abdominal distension following surgery, congenital megacolon, and gastro-oesophageal reflux disease. Bethanechol chloride is given in usual doses of 5.15 mg subcutaneously or 10 to 50 mg orally, both up to 4 times daily, but dosage must be adjusted individually. Oral doses should be taken on an empty stomach. The effects usually occur within 5 to 15 minutes of a subcutaneous dose, or 30 to 90 minutes of an oral dose, and disappear within about 1 to 2 hours depending on the dose and route. However, large oral doses (300 to 400 mg) may produce effects for up to 6 hours. For a warning to avoid intravenous or intramuscular use, see under Precautions, above.

Decreased gastrointestinal motility.

Parasympathomimetics such as bethanechol enhance gastric contractions and increase intestinal motility and form just one of many treatments that have been used in conditions associated with decreased gastrointestinal motility.

Gastro-oesophageal reflux disease.

Prokinetic drugs such as bethanechol have been tried in gastro-oesophageal reflux disease.
1. Thanick KD, et al. Reflux esophagitis: effect of oral bethanechol on symptoms and endoscopic findings. Ann Intern Med 1980; 93: 805–8
2. Saco LS, et al. Double-blind controlled trial of bethanechol and antacid versus placebo and antacid in the treatment of erosive esophagitis. Gastroenterology 1982; 82: 1369–73
3. Thanick K, et al. Bethanechol or cimetidine in the treatment of symptomatic reflux esophagitis: a double-blind control study. Arch Intern Med 1982; 142: 1479–81
4. Strickland AD, Chang JHT. Results of treatment of gastroesophageal reflux with bethanechol. J Pediatr 1983; 103: 311–15.

Stuttering.

A double-blind placebo-controlled study1 in 10 patients with stuttering on the whole failed to confirm an earlier report2 of benefit using bethanechol although 2 patients who did respond elected to continue treatment after the study.
1. Kampman K, Brady JP. Bethanechol in the treatment of stuttering. J Clin Psychopharmacol 1993; 13: 284–5
2. Hays P. Bethanechol chloride in treatment of stuttering. Lancet 1987; i: 271.

Urinary incontinence and retention.

Bethanechol is one of the parasympathomimetics that have been given to increase detrusor activity in patients with overflow incontinence, but there have been doubts about the effectiveness of such treatment. Bethanechol was also one of the parasympathomimetics used in the management of postoperative urinary retention but they have generally been superseded by catheterisation.
1. Finkbeiner AE. Is bethanechol chloride clinically effective in promoting bladder emptying: a literature review. J Urol (Baltimore) 1985; 134: 443–9
2. Kemp B, et al. Prophylaxis and treatment of bladder dysfunction after Wertheim-Meigs operation: the positive effect of early postoperative detrusor stimulation using the cholinergic drug betanecholchloride. Int Urogynecol J Pelvic Floor Dysfunct 1997; 8: 138–41
3. Riedl CR, et al. Electromotive administration of intravesical bethanechol and the clinical impact on acontractile detrusor management: introduction of a new test. J Urol (Baltimore) 2000; 164: 2108–11.

💊 Preparations

USP 31: Bethanechol Chloride Injection; Bethanechol Chloride Oral Solution; Bethanechol Chloride Oral Suspension; Bethanechol Chloride Tablets.

Proprietary Preparations

Arg.: Miotonachol; Austral.: Urocarb; Austria: Myocholine; Belg.: Myocholine; Braz.: Liberan; Canad.: Duvoid; Myotonachol†; Ger.: Myocholine; India: Urotone; Urotonine†; Israel: Urecholine†; Switz.: Myocholine; Thai.: Ucholine; Urecholine†; UK: Myotonine; USA: Myotonachol; Urecholine.
Published January 16, 2019.