General Articles

Acetylcholine

U.S. BRAND NAMES — Miochol®-E
CANADIAN BRAND NAMES — Miochol®-E
THERAPEUTIC CATEGORY Cholinergic Agent, OphthalmicOphthalmic Agent, Miotic
DOSING — Ophthalmic: Adults: Instill 0.5-2 mL of 1% injection (5-20 mg)
(For additional information see “Acetylcholine: Drug information”)
DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Powder for solution, intraocular, as chloride: Miochol®-E: 1:100 [20 mg; packaged with diluent (2 mL)]GENERIC AVAILABLE — No
ADMINISTRATION — Ophthalmic: Instill into anterior chamber before or after securing one or more sutures; instillation should be gentle and parallel to the iris face and tangential to the pupil border; in cataract surgery, acetylcholine should be used only after delivery of the lens
USE — Produces complete miosis in cataract surgery, keratoplasty, iridectomy and other anterior segment surgery where rapid miosis is required
ADVERSE REACTIONS Cardiovascular: Transient bradycardia and hypotension
Central nervous system: Headache
Ocular: Iris atrophy, temporary lens opacities (attributed to osmotic effect of 5% mannitol present in preparation)
Respiratory: Dyspnea
Miscellaneous: Diaphoresis
CONTRAINDICATIONS — Hypersensitivity to acetylcholine chloride or any component; acute iritis and acute inflammatory disease of the anterior chamber
PRECAUTIONS — Systemic effects rarely occur, but can cause problems for patients with acute CHF, bronchial asthma, peptic ulcer, hyperthyroidism, GI spasm, and urinary tract obstruction
WARNINGS — Open under aseptic conditions only
DRUG INTERACTIONS — Flurbiprofen decreases effectiveness; sodium nitrate antagonizes acetylcholine’s effects
PREGNANCY RISK FACTOR — C (show table)
STABILITY — Prepare solution immediately before use; do not use solution which is not clear and colorless
MECHANISM OF ACTION — Causes contraction of the sphincter muscles of the iris, resulting in miosis and contraction of the ciliary muscle, leading to accommodation
PHARMACODYNAMICS Onset of action: Miosis occurs promptly
Duration: ~10-20 minutes

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January 2008
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