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Cholinergic agonist (muscarinic)

Bethanechol chloride

Brand names: Myotonine

Bethanechol chloride is the chloride salt of the muscarinic cholinergic agonist bethanechol, used to promote bladder emptying in non-obstructive urinary retention.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It directly stimulates detrusor muscarinic receptors, increasing bladder smooth muscle tone and contraction to aid voiding.

Prescribing in practice

  • Contraindicated where enhanced cholinergic activity is hazardous, including mechanical urinary or gastrointestinal obstruction, asthma, peptic ulcer disease and certain cardiac disorders.
  • Cholinergic adverse effects including sweating, salivation, bradycardia, abdominal cramps and bronchospasm may occur.
  • Atropine should be available as an antidote for severe cholinergic toxicity.

Monitoring

Monitor heart rate, gastrointestinal and respiratory symptoms, and the bladder response to treatment.

Counselling the patient

  • Report sweating, flushing, abdominal cramps, wheeze or palpitations.
  • Take on an empty stomach to reduce nausea and vomiting.

Evidence & guidelines

Use reflects established cholinergic pharmacology and the SPC; mechanical obstruction must be excluded before treatment.

Reference: NICE NG123; BAUS; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.