Names and pronunciation
(be-than′e-kole) Duvoid
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Drug reference
(be-than′e-kole) Duvoid
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Func. class.: Urinary tract stimulant, cholinergic
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Chem. class.: Synthetic choline ester
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ACTION: Stimulates muscarinic ACH receptors directly; mimics effects of parasym- pathetic nervous system stimulation; stimu- lates gastric motility, micturition; increases lower esophageal sphincter pressure
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USES: Urinary retention (postopera- tive, postpartum), neurogenic atony of bladder with retention
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Unlabeled uses: Ileus, GERD, anticho- linergic syndrome
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CONTRAINDICATIONS: Hyper- sensitivity, severe bradycardia, asthma, severe hypotension, hyperthyroidism, pep- tic ulcer, parkinsonism, seizure disorders, CAD, COPD, coronary occlusion, mechan- ical obstruction, peritonitis, recent urinary/GI surgery, GI/GU obstruction Precautions: Pregnancy, breastfeeding, children <8 yr, hypertension
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SIDE EFFECTS CNS: Dizziness, headache, malaise CV: Hypotension, bradycardia, reflex tachy- cardia, cardiac arrest, circulatory collapse EENT: Miosis, increased salivation, lacri- mation, blurred vision GI: Nausea, bloody diarrhea, belching, vomiting, cramps, fecal incontinence GU: Urgency INTEG: Rash, urticaria, flushing, increased sweating RESP: Acute asthma, dyspnea, broncho- constriction
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INTERACTIONS Increase: severe hypotension—ganglionic blockers; avoid concurrent use Increase: action or toxicity—cholinergic agonists, anticholinesterase agents; avoid concurrent use Decrease: action of anticholinergics, procainamide, quiNIDine, belladonna; monitor for adequate effect Drug/Lab Test Increase: AST, lipase/amylase, bilirubin
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TREATMENT OF OVERDOSE: Administer atropine 0.6-1.2 mg IV or IM (adult) HIGH ALERT
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DOSAGE AND ROUTES • Adult: PO/SUBCUT 10-50 mg bid-qid • Child (unlabeled): PO 0.5 mg/kg/day in 3-4 divided doses Ileus (unlabeled) B • Adult: PO 10-20 mg tid-qid
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Available forms: Tablets 5, 10, 25, 50 mg
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Administer: • To avoid nausea, vomiting, take on an empty stomach • Only after all other cholinergics have been discontinued; cholinergic effects at higher doses may be cumulative • Store at room temperature
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Assess: • Urinary patterns: retention, urgency • B/P, pulse: observe after parenteral dose for 1 hr; may need to use atropine SUBCUT 0.6 mg or IV push slowly for bronchoconstriction • I&O ratio: check for urinary retention, urge incontinence • Toxicity: bradycardia, hypotension, bronchospasm, headache, dizziness, sei- zures, respiratory depression; product should be discontinued if toxicity occurs • Orthostatic hypotension: monitor fre- quently, monitor ambulation to prevent falling • Pregnancy/breastfeeding: use only if clearly needed; discontinue breastfeed- ing or product
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Evaluate: • Therapeutic response: absence of uri- nary retention, abdominal distention
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To take product exactly as prescribed; 1 hr before meals or 2 hr after meals to avoid nausea • To make position changes slowly; or- thostatic hypotension may occur • To avoid driving, hazardous activities until effects are known
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PHARMACOKINETICS PO: Onset 30-90 min, peak 60-90 min, duration 6 hr
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• Child (unlabeled): PO 0.5 mg/kg/day in 3-4 divided doses Ileus (unlabeled) B
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