BANTHINE
Clinical safety rating: caution
Comprehensive clinical and safety monograph for BANTHINE (BANTHINE).
Anticholinergic; competitively blocks muscarinic acetylcholine receptors, inhibiting parasympathetic impulses.
| Metabolism | Hepatic metabolism (hydrolysis); active metabolite (methylscopolamine). |
| Excretion | BANTHINE (methantheline) is primarily eliminated via renal excretion (approximately 70% unchanged) with the remainder as metabolites. Biliary/fecal elimination accounts for less than 15%. Total recovery in urine and feces is nearly complete. |
| Half-life | Terminal elimination half-life is approximately 2.5–3 hours in adults with normal renal function. In elderly or those with renal impairment, half-life may be prolonged to 6–8 hours, requiring dose adjustment. |
| Protein binding | Approximately 50% bound to plasma proteins (primarily albumin). |
| Volume of Distribution | Vd approximately 1.5–3.0 L/kg, indicating extensive tissue distribution. Large Vd due to lipophilicity and binding to muscarinic receptors. |
| Bioavailability | Oral bioavailability is low and erratic, ranging from 5% to 20% due to extensive first-pass metabolism. IM bioavailability is nearly 100%. |
| Onset of Action | Oral: 30–60 minutes. Parenteral (IM/IV): 5–10 minutes. |
| Duration of Action | Oral: 4–6 hours (variable based on dose and anticholinergic tolerance). Parenteral: 2–4 hours. Clinical anticholinergic effects (e.g., decreased secretions, tachycardia) may persist longer. |
Adults: 50 mg orally four times daily, before meals and at bedtime.
| Dosage form | TABLET |
| Renal impairment | No specific guidelines; use caution in severe renal impairment (GFR <30 mL/min) due to potential accumulation. Reduce dose if anticholinergic side effects occur. |
| Liver impairment | No specific guidelines; use caution in severe hepatic impairment (Child-Pugh class C) due to reduced clearance. |
| Pediatric use | Children: 0.5 mg/kg orally four times daily; maximum single dose 25 mg. |
| Geriatric use | Initiate at lower dose (e.g., 25 mg three times daily) and titrate slowly due to increased sensitivity to anticholinergic effects; monitor for confusion, constipation, and urinary retention. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for BANTHINE (BANTHINE).
| Breastfeeding | Excreted into breast milk in small amounts; M/P ratio unknown. Anticholinergic effects unlikely in infant at therapeutic doses, but caution advised. Manufacturer recommends discontinuation of nursing or drug due to potential for decreased milk production and infant anticholinergic symptoms. |
| Teratogenic Risk | Teratogenic effects not established in humans; animal studies insufficient. In first trimester, no structural anomalies consistently associated. Third trimester use may cause transient neonatal bradycardia or hypotonia due to anticholinergic effects. No documented risk of spontaneous abortion or preterm delivery. |
■ FDA Black Box Warning
None.
| Serious Effects |
Glaucoma, GI obstruction, paralytic ileus, toxic megacolon, myasthenia gravis, severe ulcerative colitis, obstructive uropathy, tachycardia due to thyrotoxicosis or heart failure.
| Precautions | May precipitate glaucoma, urinary retention, or tachycardia. Caution in GI obstruction, myasthenia gravis, and autonomic neuropathy. |
| Food/Dietary | Avoid alcohol and caffeine-containing beverages as they may increase gastric acid secretion and reduce drug efficacy. Take on an empty stomach for optimal absorption; food may delay absorption. |
| Clinical Pearls |
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| Fetal Monitoring | Monitor maternal heart rate and blood pressure for anticholinergic effects (tachycardia, hypertension). Assess fetal heart rate pattern if maternal hypotension occurs. Monitor for signs of urinary retention or constipation in mother. No routine fetal monitoring mandated absent maternal compromise. |
| Fertility Effects | Anticholinergic effects may reduce vaginal lubrication. No direct impairment of ovulation or spermatogenesis documented. Theoretical risk of decreased sperm motility from impaired cholinergic transmission in seminal tract. Clinical significance unknown. |
| BANTHINE (methantheline bromide) is an anticholinergic used primarily for peptic ulcer disease. Onset of action is 30-60 minutes orally; avoid in patients with glaucoma, myasthenia gravis, or obstructive uropathy. Monitor for anticholinergic side effects: dry mouth, blurred vision, constipation, urinary retention. Tachycardia may occur; use cautiously in elderly and patients with cardiac disease. Discontinue if paralytic ileus or severe allergic reaction occurs. |
| Patient Advice | Take BANTHINE 30 minutes before meals and at bedtime for best effect on ulcer pain. · Avoid driving or operating machinery if you experience blurred vision or dizziness. · Drink plenty of water to help prevent constipation. · Do not crush or chew tablets; swallow whole. · Report severe dry mouth, difficulty urinating, or eye pain immediately. |