Ubretid (Distigmine)

How does it work?

Ubretid tablets contain the active ingredient distigmine bromide, which is a type of medicine called an anticholinesterase. It works by prolonging the action of a neurotransmitter called acetylcholine.

Neurotransmitters are chemicals that are stored in nerve cells in the brain and nervous system. They are involved in transmitting messages between nerve cells. Acetylcholine is involved in transmitting nerve messages that control many of the processes that happen automatically in the body, ie without our voluntary control. It is also involved in transmitting the nerve messages to muscles that cause them to contract.

In order for the nerves to pass a message to a muscle, acetylcholine is released from the end of the nerve cell. It fits into acetylcholine receptors that are found on the muscle cells like a key into a lock. This causes changes in the muscle cells that cause the muscle to contract. The acetylcholine is then rapidly broken down by an enzyme called cholinesterase.

Distigmine stops cholinesterase from breaking down acetylcholine at the junctions between the nerves and the muscle cells. This prolongs the action of acetylcholine at the nerve endings and gives it more chance to act on the acetylcholine receptors. Distigmine thus increases the likelihood of a nerve signal being successfully transmitted to the muscle. It improves nerve transmission both to muscles that are under voluntary control, as well as those that are not, for example the muscle in the gut. It thus allows these muscles to function normally.

Distigmine is used mainly in conditions where there is difficulty emptying the bladder, for example following surgery, or when there is a problem with the nerve supply to the bladder. Distigmine increases the amount of acetylcholine acting on the receptors in the muscle of the bladder wall. This helps the muscle in the bladder to contract and makes it easier to pass urine.

Distigmine can also be used to improve nerve transmission to the muscle in the gut in people whose intestine is not working properly following surgery. Inactivity or temporary paralysis of the muscle in the intestine prevents the passage of food through the intestine and can lead to a blockage in the gut. Distigmine increases the nerve messages to the gut that make it contract and helps it move food along.

Distigmine may rarely be used to treat a condition called myasthenia gravis, in which the body's immune system destroys many of the acetylcholine receptors on the muscle cells. This means that muscles become less responsive to nerve messages and as a result, the person experiences muscle weakness, particularly when they repeatedly try to use the same muscle. Distigmine increases the amount of acetylcholine that is available to stimulate the remaining receptors and this allows the muscles to function normally.

What is it used for?

  • Assisting bladder emptying where there is a problem with the nerve supply to the bladder (neurogenic bladder), for example in diseases or injuries of the spinal cord.
  • Difficulty passing urine (urinary retention) following surgery.
  • Temporary paralysis of the muscle in the intestines (paralytic ileus) following surgery.
  • Myasthenia gravis.

How do I take it?

  • Ubretid tablets should be swallowed with a drink of water. The tablets should be taken 30 minutes before breakfast on an empty stomach.
  • The dose prescribed and how often the medicine needs to be taken depends on the condition being treated. Follow the instructions given by your doctor.

Use with caution in

  • People with breathing difficulties due to a narrowing of the airways (bronchospasm).
  • Heart failure.
  • Epilepsy.
  • Peptic ulcer.
  • Inflammation of the food pipe (oesophagitis).
  • Parkinson's disease.

Not to be used in

  • People with a physical blockage in the urinary tract (urethral obstruction).
  • People with a physical blockage in the gut (intestinal obstruction).
  • People with an obstruction in the gut due to spasm of the muscle in the intestinal wall (spastic ileus).
  • Severe constipation.
  • Asthma.
  • People with inadequate blood circulation around the body (severe shock) following surgery.
  • People with serious blood circulation problems.

This medicine should not be used if you are allergic to any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

  • The manufacturer recommends that this medicine should not be used during pregnancy. Seek medical advice from your doctor.
  • There is no information available regarding the safety of this medicine during breastfeeding. Seek medical advice from your doctor.

Label warnings

  • Take this medication half to one hour before food.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

  • Abdominal cramps.
  • Diarrhoea.
  • Involuntary muscle movements such as tremors or twitching.
  • Increased salivation.
  • Sweating.
  • Watery eyes.
  • Slow heart rate (bradycardia).
  • Blockade of the electrical pathways which control the pumping action of the heart (heart block).
  • Low blood pressure (hypotension).
  • Increased need to pass urine.
  • Shortness of breath (dyspnoea).
  • Breathing difficulties due to a narrowing of the airways (bronchospasm).
  • Constriction of the pupils (miosis).

The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to make sure that the combination is safe.

Distigmine could enhance the side effects of medicines such as beta-blockers that act on the heart, for example propranolol. It may increase the risk of side effects such as a slow heart rate.

The following medicines may oppose the effects of distigmine:

  • antimuscarinic medicines for Parkinson's symptoms, eg procyclidine, orphenadrine, trihexiphenidyl
  • antimuscarinic medicines for urinary incontinence, eg oxybutynin, trospium, tolterodine
  • atropine
  • hyoscine.

Other medicines containing the same active ingredient

There are currently no other medicines available in the UK that contain distigmine bromide as the active ingredient.