DUVOID
Clinical safety rating: caution
Comprehensive clinical and safety monograph for DUVOID (DUVOID).
Selective alpha-1A adrenergic receptor antagonist; relaxes smooth muscle in the bladder neck and prostate, reducing outflow resistance.
| Metabolism | Extensively metabolized in the liver primarily by CYP2D6 and CYP3A4, with possible minor contributions from other CYPs. |
| Excretion | Renal elimination accounts for approximately 90% of a dose as unchanged drug; biliary/fecal excretion is minor (<10%). |
| Half-life | Terminal elimination half-life is 12–15 hours in patients with normal renal function; prolonged to 24 hours or more in moderate-to-severe renal impairment. |
| Protein binding | Approximately 50–70% bound to plasma proteins, primarily albumin. |
| Volume of Distribution | Vd approximately 0.6 L/kg, indicating distribution into total body water. |
| Bioavailability | Oral: 75–85% (may be decreased with food); subcutaneous: nearly 100%. |
| Onset of Action | Oral: 30–60 minutes; subcutaneous: 15–30 minutes. |
| Duration of Action | Oral: 6–8 hours; subcutaneous: 4–6 hours. |
100 mg orally three times daily.
| Dosage form | TABLET |
| Renal impairment | GFR 30-89 mL/min: no adjustment; GFR <30 mL/min: avoid use. |
| Liver impairment | Child-Pugh A: no adjustment; Child-Pugh B: reduce dose to 50 mg twice daily; Child-Pugh C: avoid use. |
| Pediatric use | Not recommended for use in pediatric patients. |
| Geriatric use | Initial dose 50 mg twice daily; titrate cautiously due to increased anticholinergic sensitivity. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for DUVOID (DUVOID).
| Breastfeeding | It is not known whether bethanechol is excreted in human milk. Caution should be exercised when administered to a nursing woman. M/P ratio is unknown. |
| Teratogenic Risk | DUVOID (bethanechol) is classified as FDA Pregnancy Category C. No adequate studies in pregnant women. Animal reproduction studies have not been conducted. Fetal risk cannot be ruled out. Use only if potential benefit justifies potential risk to fetus. No known specific trimester risks. |
| Fetal Monitoring |
■ FDA Black Box Warning
None.
| Serious Effects |
["Hypersensitivity to DUVOID or any component","Moderate to severe hepatic impairment (Child-Pugh class B or C)","Use with potent CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, ritonavir)"]
| Precautions | ["Orthostatic hypotension (especially dose-related; syncope reported)","Intraoperative floppy iris syndrome (IFIS) during cataract surgery","Priapism (rare)","Dizziness, somnolence, and fatigue may occur","Use caution with hepatic impairment","Avoid use with strong CYP3A4 inhibitors or inducers"] |
| Food/Dietary | Take on an empty stomach; food may decrease absorption. Avoid alcohol as it may increase cholinergic side effects. |
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| Monitor maternal vital signs, urinary output, and signs of cholinergic excess (e.g., abdominal cramps, diarrhea, salivation). Fetal monitoring not specifically required but assess fetal heart rate if cholinergic effects occur. |
| Fertility Effects | No known effects on human fertility. Animal studies have not been conducted to evaluate fertility impairment. |
| Clinical Pearls |
| DUVOID (bethanechol) is a cholinergic agonist used for urinary retention. Monitor for cholinergic crisis (excessive salivation, sweating, bradycardia). Administer on an empty stomach to reduce GI upset. Avoid in patients with asthma, hyperthyroidism, peptic ulcer disease, or epilepsy. Atropine is the antidote for overdose. |
| Patient Advice | Take this medication on an empty stomach, 1 hour before or 2 hours after meals. · Report any signs of excessive sweating, salivation, or bradycardia to your healthcare provider. · Avoid driving or operating machinery until you know how this drug affects you. · Do not stop taking this medication abruptly; consult your doctor for dose adjustments. · Keep a list of all medications you take and share with your healthcare provider. |