Comprehensive medication guide to Bethanechol including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$0–$30 copay for generic; typically Tier 1–2 on most commercial plans and Medicare Part D; no prior authorization generally required.
Estimated Cash Pricing
$17–$130 retail for generic depending on strength; as low as $25.55 with GoodRx or $9.00 with GoodRx Companion for a 30-day supply.
Medfinder Findability Score
72/100
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Bethanechol chloride (formerly sold as Urecholine) is a cholinergic agonist — a prescription medication that mimics acetylcholine to stimulate smooth muscle contractions in the bladder and gastrointestinal tract. It is the only FDA-approved oral medication specifically indicated for nonobstructive urinary retention and neurogenic atony of the urinary bladder.
First synthesized in 1935, bethanechol belongs to the parasympathomimetic drug class. It is available only in generic form (the brand name Urecholine is no longer actively marketed) in oral tablet strengths of 5 mg, 10 mg, 25 mg, and 50 mg. A subcutaneous injection formulation is also available for clinical settings.
Bethanechol is FDA-approved for acute postoperative and postpartum nonobstructive urinary retention and neurogenic atony of the urinary bladder with retention. It is also used off-label for GERD, abdominal distension, and certain pediatric conditions. It is not a controlled substance.
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Bethanechol is a direct-acting muscarinic agonist that binds primarily to M3 muscarinic receptors on the detrusor muscle (the smooth muscle of the bladder wall), causing it to contract. This contraction generates enough pressure to initiate urination. Unlike acetylcholine, bethanechol is resistant to cholinesterase degradation, so its effects last approximately one hour after an oral dose.
Because bethanechol carries a positive charge (quaternary amine structure), it does not cross the blood-brain barrier at therapeutic doses. This limits its effects to the peripheral nervous system — specifically the bladder and GI tract — without affecting the brain or central nervous system. It also stimulates GI motility by activating muscarinic receptors in the stomach and intestines.
Bethanechol is selective for muscarinic receptors over nicotinic receptors, meaning it primarily targets smooth muscle and glandular tissue rather than skeletal muscle or autonomic ganglia. This selectivity reduces (but does not eliminate) unwanted cardiovascular and ganglionic side effects.
5 mg — tablet
Starting dose used during initiation to determine minimum effective dose
10 mg — tablet
Common maintenance dose; taken 3–4 times daily on empty stomach
25 mg — tablet
Frequently prescribed maintenance dose for moderate retention
50 mg — tablet
Higher strength; sometimes split for 25 mg doses; max single dose is 50 mg
5 mg/mL — subcutaneous injection
Clinical use only; produces faster onset (5–15 min) and more intense effect; NOT for IV or IM use
Bethanechol is not in an active FDA shortage as of 2026, but it is a low-volume generic medication that is not routinely stocked at every pharmacy. Because the brand name Urecholine is no longer actively marketed, there is no commercial momentum driving broad retail availability. Chain pharmacies with automated inventory systems may not reorder bethanechol unless they receive a certain number of prescriptions — which means some locations never stock it at all.
Patients often need to call multiple pharmacies or ask for a special order (typically available within 24–48 hours). Independent pharmacies tend to carry a broader range of specialty generics and may be more reliable sources for bethanechol. For patients on long-term therapy, establishing a relationship with a pharmacy that regularly stocks bethanechol is recommended.
If you're struggling to find bethanechol at your pharmacy, medfinder calls pharmacies near you to check which ones have it in stock and texts you the results — saving you hours of phone calls.
Bethanechol is not a DEA-controlled substance, so it can be prescribed by any licensed prescriber without special DEA registration or controlled substance documentation requirements. A standard prescription is all that is required to obtain bethanechol at a pharmacy.
Urologists — most common specialty prescriber for urinary retention and neurogenic bladder
Primary Care Physicians (PCPs) — for uncomplicated postoperative or postpartum retention
OB-GYNs — frequently prescribe for postpartum urinary retention following childbirth
Neurologists — for neurogenic bladder related to MS, Parkinson's disease, or spinal cord injury
Physiatrists (PM&R physicians) — for rehabilitation patients with spinal cord or neurological injuries
Nurse Practitioners (NPs) and Physician Assistants (PAs) — prescribing authority in most U.S. states for non-controlled medications
Because bethanechol is not a controlled substance, it can be prescribed via telehealth in most U.S. states without an in-person visit requirement. Telehealth platforms that provide urology, neurology, or primary care services can prescribe bethanechol following a standard virtual consultation.
No. Bethanechol chloride is not a DEA-scheduled controlled substance. It is not listed under any DEA schedule (Schedule I through V). This means there are no federal restrictions on the number of refills, no special DEA registration requirements for prescribers, and no federal limitations on prescribing via telehealth.
Bethanechol can be prescribed by any licensed prescriber — including primary care physicians, urologists, neurologists, nurse practitioners (NPs), and physician assistants (PAs) — without the additional requirements that apply to controlled substances. It can also be prescribed via telehealth in most U.S. states without in-person visit requirements.
Side effects of bethanechol are related to its cholinergic mechanism and are dose-dependent. They are more common after subcutaneous injection than with oral tablets. Taking bethanechol on an empty stomach significantly reduces GI side effects.
Abdominal cramps or colicky pain
Nausea and vomiting (especially if taken with food)
Diarrhea
Urinary urgency
Excessive salivation (drooling)
Flushing and sweating
Headache
Dizziness or lightheadedness (from hypotension — stand up slowly)
Watery eyes (lacrimation)
Bronchospasm / difficulty breathing (call 911 immediately)
Severe low blood pressure or fainting
Very slow heart rate
Signs of kidney infection (fever, flank pain, blood in urine)
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Tamsulosin (Flomax)
Alpha-1 blocker that reduces urethral resistance; used for BPH-related retention and sometimes off-label for other retention causes. Works differently from bethanechol — reduces outlet resistance rather than increasing bladder contraction.
Neostigmine
Indirect-acting cholinergic agent (AChE inhibitor); used in hospital settings for postoperative retention. Primarily parenteral; not a practical oral outpatient substitute for bethanechol.
Clean Intermittent Catheterization (CIC)
Non-pharmacological gold standard for neurogenic bladder management. Highly reliable for patients with significant detrusor atony where bethanechol may be insufficient.
Mirabegron (Myrbetriq)
Beta-3 adrenergic agonist used for overactive bladder (urinary urgency/frequency) — treats a different condition than bethanechol. Used when the bladder contracts too much rather than too little.
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Anticholinergic medications (oxybutynin, tolterodine, diphenhydramine, amitriptyline)
majorBlock muscarinic receptors, directly opposing bethanechol's mechanism. Concurrent use negates bethanechol's therapeutic benefit.
Acetylcholinesterase inhibitors (donepezil, rivastigmine, galantamine, pyridostigmine)
majorAdditive cholinergic stimulation increases risk of severe side effects including bradycardia, bronchospasm, and excessive secretions.
Ganglion-blocking agents (mecamylamine)
majorRisk of severe hypotension when combined with bethanechol.
Sympathomimetics (phenylephrine, pseudoephedrine, ephedrine)
moderateOpposing cholinergic and adrenergic effects may reduce effectiveness of one or both drugs.
General anesthetics
moderateUnpredictable interactions possible; inform anesthesiologist before surgery and discuss whether to temporarily hold bethanechol.
Bethanechol chloride remains the only FDA-approved oral cholinergic agonist for nonobstructive urinary retention, a role it has held since its introduction in 1935. Despite its long history, it occupies a niche market — prescribed infrequently enough that pharmacy stocking can be inconsistent, but important enough for patients with neurogenic bladder or postoperative retention that access gaps have real clinical consequences.
The drug is generally affordable — with GoodRx coupons, patients can pay as little as $9–$25 for a 30-day supply — and is not a controlled substance, making prescribing and refilling relatively straightforward. The primary challenge is pharmacy availability, which requires proactive pharmacy sourcing from patients and their care teams.
If you're struggling to fill your bethanechol prescription, medfinder can take the guesswork out of the process — we call pharmacies near you to check which ones have bethanechol in stock and text you the results. All medications, all pharmacies, no guessing.
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Our medication guides are researched and written to help patients make informed decisions. All content is reviewed for accuracy and updated regularly. Learn more about our standards
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Medfinder is actively checking pharmacy inventory for Bethanechol. We don't publish a number until we have enough verified pharmacy checks to be accurate — start a search and our team confirms current availability near you, usually within 24 hours.
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