Despite limited evidence supporting its efficacy, bethanechol continues to be prescribed for bladder dysfunction in women, according to a study published the International Journal of Clinical Practice.

While bethanechol, a cholinergic agonist, may “theoretically” improve detrusor contractility in women with underactive bladder (UAB), the evidence supporting its use is limited. To get a better understanding of the prescribing patterns of bethanechol, researchers used the National Ambulatory Medical Care Survey database (2003-2013) to examine the prevalence of its use, as few alternative treatments exist for UAB management.

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A total of 17,321,630 patient visits were included in the analysis; the sample included females ≥18 years old with a diagnosis of lower urinary tract symptoms, neurogenic bladder, or urinary retention. Of these visits, 132,281 patients received a prescription for bethanechol; patients were predominately Caucasian (67%) and had a mean age of 62.3. Within this sample, atony of bladder (35%), urinary retention (20%), neurogenic bladder (18%) and urinary incontinence (16%) were the diagnoses associated with bethanechol prescribing. For 79% of these patients, bethanechol was prescribed as a continued medication, typically by urologists (92%).   

“While bethanechol is not very efficacious, providers may feel that it is benign enough and the psychological benefits great enough to continue to offer it to patients with UAB,” write the authors, adding that “As some providers continue to prescribe bethanechol, improving education and awareness of evidence-based treatments for UAB may be worthwhile.”

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