Diabetic Neuropathy
Jack L. Leahy, Nathaniel G. Clark, William T. Cefalu in Medical Management of Diabetes Mellitus, 2000
Proper management of urinary dysfunction requires information available only through appropriate urological and urodynamic testing. Those studies are needed to determine whether decreased or increased bladder contractility is the primary problem and whether the bladder outlet is over- or undercontracted. Blind prescription of pharmacological agents often results in the wrong drug for the underlying pathology. If urodynamic testing confirms a spastic bladder, the most commonly prescribed agent is oxybutynin, 5-mg three times daily. Occasionally, patients with diabetic neuropathy will comment on improved bladder control after taking tricyclic antidepressants for neuropathic pain. This improvement is attributed to the anticholinergic properties of tricyclic antidepressants which, in the case of bladder function, decrease contractility and increase bladder oudet resistance. Bethanechol chloride, a muscarinic cholinergic agonist, is prescribed for an underactive bladder.
Parasympathomimetic Amines
Kenneth J. Broadley in Autonomic Pharmacology, 2017
The M3 receptor-mediated stimulation of gastrointestinal motility is utilized in cases of postoperative gastric distension and atony and non-obstructive adynamic (paralytic) ileus. Bethanechol is used orally, except where complete gastric retention occurs and absorption from the stomach is impaired, when the subcutaneous route is used. Bethanechol may also be used to expel gas from the intestine prior to X-ray examinations. In reflux oesophagitis, bethanechol improves the tone of the lower oesophageal sphincter and oesophageal peristalsis. Agents that promote gastric emptying in cases of gastric hypomotility are known as prokinetic agents, but bethanechol is not particularly effective in accelerating gastric emptying. Metoclopramide (ReglanUS, MaxalonUK) and cisapride (AlimixUK) are prokinetic agents used for gastric hypomotility and reflux oesophagitis. Their action is prevented by muscarinic antagonists and is therefore attributed to the release of Ach from the myenteric neurones of the gastric wall (see Figure 1.5). This improves co-ordinated contractile activity rather than merely increased tone, which is the case with bethanechol (Goyal 1989).
Peripheral Autonomic Neuropathies
David Robertson, Italo Biaggioni in Disorders of the Autonomic Nervous System, 2019
The treatment of diabetic cystopathy includes use of an indwelling catheter for 10 days together with appropriate antibiotics. Thereafter, the patient should void every 3 h, aided by manual compression of the suprapubic area (Crede manoeuvre) and receive parasympathomimetic drugs. About 40% of patients respond to this therapy, at least temporarily, until urinary tract infection recurs. Transurethral surgery and bladder neck resection in those without obvious mechanical obstruction may also be useful. Initially, the parasympathomimetic drug can be given parenterally, for example, bethanechol twice weekly and may be continued orally in a dose of 40-50 mg every 6 or 8 h. Cholinergic treatment is withdrawn when residual volumes are less than 100 ml for at least a week (Ellenberg, 1980a).
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].
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].
Transurethral resection of the prostate achieves favorable outcomes in stroke patients with symptomatic benign prostate hyperplasia
Published in The Aging Male, 2018
Chen-Pang Hou, Yu-Hsiang Lin, Tien-Hsing Chen, Phei-Lang Chang, Horng-Heng Juang, Chien-Lun Chen, Pei-Shan Yang, Ke-Hung Tsui
Figure 1 displays the proportions of patients using urologic drugs after TURP. During the first 3 months after TURP, a higher proportion of patients with stroke had taken α-blockers (OR, 1.41; 95% CI, 1.18–1.68). However, borderline significant differences were observed in this proportion between the two groups during 4–12 months postoperatively (p = .071). A higher proportion of patients with stroke had taken bethanechol during 0–3 months postoperatively (OR, 1.39; 95% CI, 1.12–1.74) and 4–12 months postoperatively (OR, 1.55; 95% CI, 1.14–2.11). Finally, considering all urologic drugs, a higher proportion of patients with stroke had taken drugs during 0–3 months postoperatively (OR, 1.43; 95% CI, 1.19–1.72) and 4–12 months postoperatively (OR, 1.27; 95% CI, 1.06–1.52; Figure 1).
Related Knowledge Centers
- Choline
- Cholinesterase
- Hydrolysis
- Nicotinic Acetylcholine Receptor
- Parasympathomimetic Drug
- Carbamate
- Muscarinic Acetylcholine Receptor
- Acetylcholine
- Oral Administration
- Subcutaneous Administration