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Pathophysiology of Detrusor Underactivity/Acontractile Detrusor
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
Juan José Andino, John T. Stoffel
Despite the existence of muscarinic agonists and cholinesterase inhibitors, very few studies have shown efficacy of these agents in DU/AD.41 Bethanechol has been studied and showed no improvement in patients with detrusor underactivity.42,43 These medications also have undesirable side effects including nausea, vomiting, diarrhea, visual impairment, headaches, bronchospasms, and even severe cardiovascular events that limit their use. Alpha-1 blockers may have some benefit if concomitant BOO is present.44
Gastrointestinal Aspects of Eating Disorders
Published in Kevin W. Olden, Handbook of Functional Gastrointestinal Disorders, 2020
Bruce D. Waldholtz, Arnold E. Andersen
Bethanechol at a dose of 10-25 mg q.i.d. has also been shown to increase gastric emptying in anorexia nervosa (37). Neither domperidone nor cisapride, a recently released prokinetic drug, crosses the blood-brain barrier, causing fewer central-nervous-system side effects than metoclopramide. Domperidone acts via an antidopaminergic mechanism. Cisapride works by increasing the release of acetylcholine from postganglionic neurons, and is taken 15 minutes before meals and at bedtime. This medication was approved for the symptomatic relief of nocturnal heartburn due to gastroesophageal reflux and not specifically for anorexic gastroparesis.
Cholinergic Agonists
Published in Sahab Uddin, Rashid Mamunur, Advances in Neuropharmacology, 2020
Rupali Patil, Aman Upaganlawar
Bethanechol is very occasionally used to stimulate GI motility or to assist bladder emptying (Brunton, 2011). Its use is restricted in conditions with the absence of organic obstruction with urinary retention and incomplete bladder emptying as in cases of postoperative urinary retention, diabetic autonomic neuropathy, and certain cases of chronic hypotonic, myogenic, or neurogenic bladder (Wein, 1991); catheterization can thus be avoided. When used chronically, 10–50 mg/day 3–4 times may be given orally. When given 1 h before or 2 h after the meal on an empty stomach, it minimizes nausea and vomiting. Bethanechol formerly was used to treat postoperative abdominal distention, gastric atony, gastroparesis, adynamic ileus, and gastroesophageal reflux (Brunton, 2011).
Safety considerations when managing gastro-esophageal reflux disease in infants
Published in Expert Opinion on Drug Safety, 2021
Melina Simon, Elvira Ingrid Levy, Yvan Vandenplas
Historically, bethanechol was one of the first agents used in children with reflux. The effect of bethanechol is mainly due to increase of the lower esophageal sphincter pressure. Bethanechol stimulates muscarinic acetylcholine receptors peripherally at the neuromuscular junction of smooth muscle. Results from studies suggest that bethanechol should not be first-line treatment in infants with GERD because of limited efficacy and because of the adverse effects [166]. Normally bethanechol does not pass the blood–brain barrier. However, as with other peripherally acting medication such as domperidone, there are reports of neurologic side effects in children. There is one case report of a 10 month old infant with an acute dystonic reaction [167]. The serious side effects are due to this stimulation of muscarine receptors in all organs. There is a risk for cardiac arrythmias and sudden death, bronchospasm, diarrhea, extensive sweating and other symptoms. In adults the therapeutic range seems to be small and side effects are frequent [168].
The role of the pediatrician in caring for children with tracheobronchomalacia
Published in Expert Review of Respiratory Medicine, 2020
Manisha Ramphul, Andrew Bush, Anne Chang, Kostas N Prifits, Colin Wallis, Jayesh Mahendra Bhatt
Cholinergic stimulation with muscarinic agonists may improve the tone of the trachealis muscle and a decrease in airway compliance; thereby improving the overall airway mechanics, including the forced expiratory flows [57]. Options include inhaled methacholine, a short acting agent, and bethanechol, a long-acting oral agent. After initiation of bethanechol, half of patients with TBM report an improved quality of life, with an improvement in cough, and a decreased frequency of emergency medical reviews and hospitalizations [59]. Experience from one center suggests that the use of bethanechol in TBM resulted in a decrease in cough frequency and hospital stays [60]. A trial of bethanechol may be considered in children with very troublesome symptoms; however, further research in this field is required to determine which children (if any) are most likely to benefit from bethanechol and this is not routinely used in current practice [11].
Pharmacological treatments available for the management of underactive bladder in neurological conditions
Published in Expert Review of Clinical Pharmacology, 2018
Seyedeh-Sanam Ladi-Seyedian, Behnam Nabavizadeh, Lida Sharifi-Rad, Abdol-Mohammad Kajbafzadeh
One of the approaches toward medical therapy in UAB is stimulation of muscarinic receptors on the detrusor cells which can be done by muscarinic receptor agonists such as bethanechol or carbachol. Randomized clinical trials have reported usage of parasympathomimetic agents for prevention and treatment of UAB [67]. Bethanechol is a parasympathetic agonist which helps to increase bladder muscle tone and contractility. It works within an hour after administration. Hence, it takes a few days to find whether this medication is efficient for a patient or not [68]. In a study by Kemp et al., the efficacy of betanechol chloride (50 mg × 3 oral from 3 days after surgery) as the prophylaxis of detrusor hypotonia after Wertheim-Meigs operation was evaluated. This study revealed a prophylactic application of the parasympathomimetic drug diminished the postoperative complications for the bladder, shorten hospital stay, and decrease the rate of cystitis [69]. In the treatment setting of UAB, parasympathomimetic agents were used in a variety of conditions such as prostatectomy [70], after general surgery [71], anorectal surgery [72], patients with urodynamically confirmed DUA [73,74], and in women with no neurological disease but excessive residual urine [75].