Actions of Betheran in details
Betheran belongs to choline esters class of parasympathomimetics medicines. It functions similar to a natural chemical (neurotransmitter) named acetylcholine in the body. It relives urinary retention (holding urine in the bladder) by increasing the detrusor muscle (muscle which forms a layer of the wall of the bladder) contraction thereby facilitating urination.
How should I take Betheran?
Take Betheran on an empty stomach (either 1 hour before or 2 hours after meals) to lessen the possibility of nausea and vomiting, unless otherwise directed by your doctor.
Take Betheran only as directed. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance of side effects.
Dosing
The dose of Betheran will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of Betheran. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
- To empty the bladder:
- For oral dosage form (tablets):
- Adults—25 to 50 milligrams (mg) three or four times a day.
- Children—Dose is based on body weight and must be determined by your doctor. The usual dose is 0.6 mg per kilogram (kg) (0.27 mg per pound) of body weight a day. This dose is divided into smaller doses and taken three or four times a day.
- For injection dosage form:
- Adults—5 mg injected under the skin three or four times a day.
- Children—Dose is based on body weight and must be determined by your doctor. The usual dose is 0.2 mg per kg (0.09 mg per pound) of body weight a day. This dose is divided into smaller doses, which are injected under the skin three or four times a day.
- For oral dosage form (tablets):
Missed Dose
If you miss a dose of Betheran, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Storage
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.
Betheran administration
Take Betheran exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.
Take each dose with a full glass of water.
Take Betheran on an empty stomach 1 hour before or 2 hours after meals to prevent nausea and vomiting.
Store Betheran at room temperature away from moisture and heat.
Betheran pharmacology
Betheran acts principally by producing the effects of stimulation of the parasympathetic nervous system. It increases the tone of the detrusor urinae muscle, usually producing a contraction sufficiently strong to initiate micturition and empty the bladder. It stimulates gastric motility, increases gastric tone and often restores impaired rhythmic peristalsis.
Stimulation of the parasympathetic nervous system releases acetylcholine at the nerve endings. When spontaneous stimulation is reduced and therapeutic intervention is required, acetylcholine can be given, but it is rapidly hydrolyzed by cholinesterase and its effects are transient. Betheran is not destroyed by cholinesterase and its effects are more prolonged than those of acetylcholine.
Effects on the GI and urinary tracts sometimes appear within 30 minutes after oral administration of Betheran, but more often SO to 90 minutes are required to reach maximum effectiveness. Following oral administration, the usual duration of action of Betheran is one hour, although large doses (300 to 400 mg) have been reported to produce effects for up to six hours. Subcutaneous injection produces a more intense action on bladder muscle than does oral administration of the drug.
Because of the selective action of Betheran, nicotinic symptoms of cholinergic stimulation are usually absent or minimal when orally or subcutaneously administered in therapeutic doses, while muscarinic effects are prominent. Muscarinic effects usually occur within 5 to 15 minutes after subcutaneous injection, reach a maximum in 15 to 30 minutes, and disappear within two hours. Doses that stimulate micturition and defecation and increase peristalsis do not ordinarily stimulate ganglia or voluntary muscles. Therapeutic test doses in normal human subjects have little effect on heart rate, blood pressure or peripheral circulation.
Betheran does not cross the blood-brain barrier because of its charged quaternary amine moiety. The metabolic rate and mode of excretion of the drug have not been elucidated.
A clinical study (Diokno, A.C., Lapides, J.; Urol 10 : 23-24, July 1977) was conducted on the relative effectiveness of oral and subcutaneous doses of Betheran on the stretch response of bladder muscle in patients with urinary retention. Results showed that 5 mg of the drug given subcutaneously stimulated a response that was more rapid in onset and of larger magnitude than an oral dose of 50 mg, 100 mg, or 200 mg. All the oral doses, however, had a longer duration of effect than the subcutaneous dose. Although the 50 mg oral dose caused little change in intravesical pressure in this study, this dose has been found in other studies to be clinically effective in the rehabilitation of patients with decompensated bladders.
References
- EPA DSStox. "Bethanechol parent: DSSTox provides a high quality public chemistry resource for supporting improved predictive toxicology.". https://comptox.epa.gov/dashboard/ds... (accessed September 17, 2018).
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Information checked by Dr. Sachin Kumar, MD Pharmacology