Ch3

CH3 11 Bethanechol

Drug therapy in individuals with SUI involves the use of a-adrenergic agonists that increase bladder outlet resistance via actions on the bladder neck and base, and proximal urethra. Nonselective a-adrenoceptor agonists like phenylpropanolamine (10) and midodrine (12) have limited clinical efficacy in stress incontinence due to effects on blood pressure and heart rate that occur at doses comparable to those improving urethral function. a-Adrenoceptor agonists selective for the a1A subtype versus the a1B subtype, e.g., ABT-866 (13), represented one conceptual approach to urethral selectivity but proved to be only modestly uroselective with blood pressure increases being observed at doses only 3-10-fold higher than those eliciting effects on urethral pressure.1

NH2 ch3

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