Miochol-E Side Effects

Please note - some side effects for Miochol-E may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA at http://www.fda.gov/medwatch/ or 1-800-FDA-1088 (1-800-332-1088).

Miochol-E Side Effects - for the Professional

Miochol-E

Infrequent cases of corneal edema, corneal clouding, and corneal decompensation have been reported with the use of intraocular acetylcholine.

      Adverse reactions have been reported rarely which are indicative of systemic absorption. These include bradycardia, hypotension, flushing, breathing difficulties and sweating.

Side Effects by Body System

General

The toxicity of acetylcholine is relatively low because of its rapid metabolism by acetylcholine esterase. The incidence of any adverse reaction has been estimated to be less than 1 in 1 million uses.

Cardiovascular

Cardiovascular side effects have rarely included hypotension, bradycardia, flushing, and sweating.

Approximately 5 to 10 cases of hot flushes, sweating, dyspnea, bradycardia, and hypotension have been reported. A common denominator appears to be advanced age; on the other hand, most patients with cataracts are elderly.

Ocular

A 14-year-old boy presented following trauma to his left eye. Because repositioning of the prolapsed iris with a spatula did not completely remove the iris from the wound, acetylcholine was injected into the anterior chamber in an attempt to pull the iris away from the wound by constricting the pupil and deepening the anterior chamber. While suturing the cornea, multiple small dots, then a diffuse white opacity appeared in the anterior lens cortex. The cataract began to clear up within one hour, and follow-up slit lamp examination revealed a completely clear lens.

While corneal edema after cataract extraction is usually caused by mechanical or chemical injury to the corneal endothelium, a single case in which the use of acetylcholine has been associated with the rapid development of corneal endothelial clouding and edema has been reported. Inspection of the bottle disclosed that the upper compartment failed to deliver the distilled water to the lower chamber despite complete depression of the bottle's plunger. As a result, sterile water alone was drawn up and subsequently injected into the anterior chamber.

Ocular side effects have rarely included corneal clouding, corneal decompensation, corneal edema, and transient cataract formation. The manufacturer recommends gentle intraocular irrigation since more forceful administration may rupture the hyaloid, cause vitreous loss, or traumatize or cause perforation of the iris, especially if it is atrophic.

Respiratory

Respiratory side effects have included a case report bronchospasm in a patient on concomitant metoprolol therapy.

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