Bethanechol

Key facts

• Bethanechol (sold as Urecholine and generics) is a cholinergic agonist that mimics acetylcholine, stimulating the bladder and gut muscles to contract.
• It is taken by mouth on an empty stomach to help you pass urine when the bladder has lost normal tone, often after surgery, childbirth or nerve injury, rather than because of a physical blockage.
• It must never be used if there is any mechanical obstruction of the urinary tract or bowel, or soon after bowel surgery with a fresh join, because forcing the muscle to contract against a blockage can cause rupture or perforation.
• Seek urgent care for severe abdominal pain, wheezing or difficulty breathing, or a very slow or irregular heartbeat after a dose.

What bethanechol treats

Bethanechol treats urinary retention caused by an underactive bladder, most often after surgery, childbirth, or nerve injury affecting the bladder (neurogenic bladder), when nothing is physically blocking urine flow. It is occasionally used to stimulate a sluggish gut after abdominal surgery. It does not treat retention caused by an enlarged prostate or any other mechanical obstruction, and it will not help incontinence.

How bethanechol works

Bethanechol binds muscarinic receptors on smooth muscle, the same receptors acetylcholine normally activates. This makes the bladder wall contract and its internal sphincter relax, so urine passes more easily, and it increases contraction and movement in the stomach and intestines.

Before you take it

• Do not take it if you have a mechanical obstruction of the bladder or bowel, active peptic ulcer disease, asthma, a very slow heart rate or low blood pressure, or if you have recently had bowel surgery.
• Tell your prescriber about Parkinson's disease, epilepsy, an overactive thyroid, or coronary artery disease, since bethanechol's effects on muscle tone and heart rate can worsen these.
• Other cholinergic drugs add to its effects, while anticholinergic medicines, including many antihistamines and some antidepressants, block them; tell your prescriber about all your medicines.

Side effects

Common effects are stomach cramping, nausea, flushing, sweating and a runny nose, all related to bethanechol's action on the same receptors throughout the body.

Stop and seek urgent medical care for:

• Severe abdominal pain.
• Wheezing, chest tightness, or difficulty breathing.
• A very slow, fast or irregular heartbeat, or fainting.

Safety essentials

• Never take bethanechol if a doctor has told you there is a blockage in your bladder or bowel, or within a few weeks of bowel surgery with a fresh join: contracting muscle against an obstruction can rupture it.
• Take it on an empty stomach, an hour before or two hours after food, since food increases nausea and vomiting.
• If you develop signs of a cholinergic crisis after a dose, such as excess salivation, sweating, cramping or wheezing, seek medical help promptly; atropine is the antidote a care team can give.

This page is educational and does not replace advice from a doctor or pharmacist who knows your health history.