Acetylcholine Chloride
Pronunciation: a-SEET-il-KOE-leen
Class: Ophthalmic agent, direct-acting miotic
Trade Names
Miochol-E
- Powder for solution, intraocular 20 mg
Pharmacology
Decreases IOP by constricting pupil and stimulating ciliary muscles to open trabecular meshwork spaces and facilitate outflow of aqueous humor.
Grapefruit and grapefruit juice can react adversely with over 85 prescription medications.
Pharmacokinetics
Onset
Seconds.
Duration
10 min.
Special Populations
Renal Function ImpairmentNo data available.
Hepatic Function ImpairmentNo data available.
Indications and Usage
To obtain miosis of the iris in seconds after delivery of the lens in cataract surgery, in penetrating keratoplasty, iridectomy, and other anterior segment surgery where rapid miosis may be required.
Contraindications
Standard considerations.
Dosage and Administration
MiosisAdults
Intraocular Instill 0.5 to 2 mL into the anterior chamber before or after securing 1 or more sutures. In cataract surgery, use only after delivery of the lens.
General Advice
- Follow manufacturer's instructions for reconstitution of powder with supplied diluent.
- Prepare solution immediately before use.
- Do not use solution that is not clear and colorless.
- Do not aspirate and inject through the same filter.
- Instillation should be gentle and parallel to the iris face and tangential to pupil border.
- Any anatomical hindrance to miosis must be released to permit the desired effect.
- Note: The syringe filter supplied has a priming volume of approximately 0.6 mL.
Storage/Stability
Store at 39° to 77°F. Discard any unused solution. Do not reuse the syringe filter and discard appropriately after use. Do not gas sterilize. If blister or peelable backing is damaged or broken, sterility of the enclosed vial and ampoule cannot be assured. Open under aseptic conditions only.
Drug Interactions
Topical NSAIDsThere have been reports that acetylcholine has been ineffective during coadministration.
Laboratory Test Interactions
None well documented.
Adverse Reactions
Cardiovascular
Bradycardia, flushing, hypotension (rare).
EENT
Corneal edema, clouding, and decompensation (infrequent).
Miscellaneous
Breathing difficulties, sweating (rare).
Precautions
Pregnancy
Category C .
Lactation
Undetermined.
Children
Safety and efficacy not established.
Overdosage
Symptoms
Cardiovascular or bronchoconstrictor responses.
Patient Information
- Advise patient, family, or caregiver that medication will be prepared and administered by a health care provider in a health care setting.
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