Bethanechol can be of value in certain cases of postoperative abdominal distention and in gastric atony or gastroparesis. Oral administration is preferred; the usual dosage is 10—20 mg, three or four times daily. Bethanechol is given by mouth before each main meal in cases without complete retention; when gastric retention is complete and nothing passes into the duodenum, the subcutaneous route is necessary because of poor stomach absorption. Bethanechol has been used to advantage in certain patients with congenital megacolon and with adynamic ileus secondary to toxic states. prokinetic agents with combined cholinergic-agonist and dopamine-antagonist activity (e.g., metoclopramide) or serotonin-antagonist activity (see Chapter 37) have largely replaced bethanechol in gastroparesis and esophageal reflux disorders.
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