Bethanechol is used in the treatment of acute postoperative and postpartum nonobstructive urinary retention and neurogenic atony of the bladder with retention. Bethanechol is preferred to other parasympathomimetic drugs for these indications because of its relatively localized effect on the urinary tract and lack of adverse cardiovascular effects.
Bethanechol has been used to prevent and treat phenothiazine-induced bladder dysfunction and to antagonize the bladder and salivary gland inhibition caused by tricyclic antidepressants (e.g., amitriptyline, imipramine, protriptyline). Bethanechol should be used with extreme caution, if at all, to antagonize the effects of ganglionic blocking agents on the GI and urinary tracts because severe hypotension may result.
(See Drug Interactions.)
Bethanechol has been recommended in the past for treatment of selected cases of postoperative GI atony and gastric retention; adynamic ileus resulting from trauma, infection, toxic states, or psychic causes; postoperative abdominal distention; and congenital megacolon. However, the effectiveness of the drug for these indications has not been established.
Bethanechol has been shown to produce symptomatic improvement and decrease antacid use in some patients with chronic refractory heartburn and gastroesophageal reflux disease (GERD), including vagotomized and antrectomized patients. However, use of the drug has decreased because of adverse CNS effects, and acid suppression therapy with other agents (e.g., proton-pump inhibitors, histamine H2-receptor antagonists) is principally used.
Bethanechol has been shown to increase eye moisture, reduce gastric distention and vomiting, and improve esophageal motility and bladder control in a limited number of children with familial dysautonomia. The long-term effects of the drug on children are unknown.
Bethanechol has been used as a diagnostic test for cystic infantile fibrosis (although pilocarpine generally is considered to be the drug of choice) and for neurogenic bladder. The drug has been used in diagnosing flaccid or atonic neurogenic bladder disease and in restoring bladder function in some of these patients.