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Put on a new med. Bethanechol

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So in addition to taking carvedilol, my autonomic specialist prescribed me Bethanechol 10mg 3 times a day. She explained the purpose but I forgot everything she said lol. My wife probably remembers but I want to get y'all's experiences with it and what the purpose is. 


I took a test which showed my adrenaline levels are still high. They attach 3 electrodes to your body and tell you to hold your breath for so long etc. And somehow it determines adrenaline levels. The first time I did the test I scored an 11. A normal person is a 1. This time I scored a 4. Which according to the results, that's a lot better but I'm still not normal.


the weird thing is, I felt way worse during this test than I did the first time. My hands and arms got super red like fruit punch red, my face got flushed where my forehead got moist a bit. I had a jump scare feeling happen during the test. I also felt like garbage after the test.

according to the results, I'm supposed to be feeling better. But I haven't noticed a change. In fact I feel worse I think because of the heat. 

Anyways what's your experience and knowledge on this medicine. And if you any thoughts on everything else I said, I would be interested to hear about it. Thanks!

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@Derek1987 - this is curious b/c I also never heard of it being used for POTS. Here is what the bethanechol pamphlet states: 


Bethanechol chloride acts principally by producing the effects of stimulation of the parasympathetic nervous system. It increases the tone of the detrusor urinae muscle, usually producing a contraction sufficiently strong to initiate micturition and empty the bladder. It stimulates gastric motility, increases gastric tone and often restores impaired rhythmic peristalsis.

Therapeutic test doses in normal human subjects have little effect on heart rate, blood pressure or peripheral circulation.

Bethanechol chloride tablets should preferably be taken one hour before or two hours after meals to avoid nausea or vomiting. Dizziness, lightheadedness or fainting may occur, especially when getting up from a lying or sitting position.


These are the comments I thought might be what your doc is thinking - if your sympathetic NS is overactive maybe if the parasympathetic NS gets stimulated it might counteract the over reaction …? I am brain storming here trying to find out why he put you on this med. Did he not explain anything to you? ----------- The last sentence I copied b/c it lists a side effect that could be a deal breaker for you - watch for this. Although it might be difficult since you already have dizziness, lightheadedness and fainting. 🙄

Regarding the adrenaline level - our levels go up and down, so what the test shows my not be n accurate reflection.  Have you asked them to do a blood level of your catecholamines? That is way more accurate. The reaction you describe sounds typical for fight-or-flight reaction - adrenaline dump. I hate that feeling - it is downright scary!!!!


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I had to look this med up, as I'd never heard of it . . . below is precaution info from a site called "PDR - Prescriber's Digital Reference".  I *believe* it's the on-line version to the hard-copy "Physician's Desk Reference", so it's reputable if that's the case. Check out the second paragraph, where it says that the subcutaneous version should be used with caution in patients at risk for syncope.  I'm guessing what you were prescribed is not the subcutaneous version, but I'd still be careful and call your doc and ask her why she prescribed it and how she believes it will work.  Don't be afraid or embarrassed to question your doctor about this.  It's your body and your peace of mind, and any decent doctor should get that.  Edited to add:  Not sure how you normally communicate with your doc but, if you're on a "patient portal" with your doc's office, a lot of them have a function where you can email your doc from there.  

@Pistol - I would be interested to know the doc's logic behind the script, and this is a really good thought.

2 hours ago, Pistol said:

if your sympathetic NS is overactive maybe if the parasympathetic NS gets stimulated it might counteract the over reaction …?




Bladder obstruction, GI obstruction, ileus, inflammatory bowel disease, peptic ulcer disease, peritonitis, surgery, urinary tract obstruction

Bethanechol use is contraindicated when the strength or integrity of the gastrointestinal or bladder wall is questionable. Increased muscular activity of the GI tract or bladder may prove harmful, worsening the underlying condition and risking rupture or perforation. Conditions that contraindicate bethanechol use include: GI obstruction (ileus) and bladder obstruction or urinary tract obstruction. Bethanechol is contraindicated in patients with inflammatory bowel disease, peritonitis, marked vagotonia, or who have undergone recent gastrointestinal or bladder surgery. Increased stimulation of gastric acid also contraindicates bethanechol use in peptic ulcer disease.


Bradycardia, coronary artery disease, driving or operating machinery, hypertension, hypotension, intramuscular injections, intravenous administration, orthostatic hypotension, syncope

Bethanechol use is contraindicated in patients with pronounced bradycardia, pronounced hypotension, or coronary artery disease. Bethanechol can cause orthostatic hypotension, specifically after subcutaneous administration, and should be used with caution in patients at risk for syncope. Bethanechol should never be given by intramuscular injections or intravenous administration. Administration by either of these routes can precipitate cholinergic over-stimulation, causing circulatory collapse, sudden hypotension, abdominal cramps, bloody diarrhea, shock, or sudden cardiac arrest. A more precipitous drop in blood pressure can be seen in patients with hypertension. Administration by the oral or subcutaneous route can have a mild negative chronotropic effect. Due to potential for orthostatic hypotension, patients may be warned to avoid driving or operating machinery until the effects of bethanechol are known.


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