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Miochol-E (acetylcholine ophthalmic) Disease Interactions

There is 1 disease interaction with Miochol-E (acetylcholine ophthalmic):


Miotics (Includes Miochol-E) ↔ Systemic Vagotonic Effects

Moderate Potential Hazard, Low plausibility

Applies to: Asthma, Chronic Obstructive Pulmonary Disease, Dyspepsia, Heart Block, Hypotension, Irritable Bowel Syndrome, Myocardial Infarction, Parkinsonism, Peptic Ulcer, Post MI Syndrome, Seizures, Sinus Node Dysfunction, Corneal Abrasion, Urinary Tract Obstruction, Hypertension, Congestive Heart Failure

Topically applied cholinergic agents are systemically absorbed, with the potential for producing rare but clinically significant systemic effects, including urinary incontinence, tightness of the bladder, increased gastric contractility and acid secretion, bradycardia, severe hypotension, bronchospasm, seizures, and coma. Increases in blood pressure may occur rarely due to a nicotinic effect on sympathetic ganglia. Therapy with ophthalmic cholinergic agents, particularly the long-acting cholinesterase inhibitors (e.g., demecarium and echothiophate), should be administered cautiously in patients with corneal abrasion (which may increase drug penetration), bronchospastic diseases, spastic gastrointestinal disturbances, urinary tract obstruction, peptic ulcer, pronounced bradycardia and hypotension, vascular hypertension, acute cardiac failure, recent myocardial infarction, epilepsy, parkinsonism, and other conditions that may respond adversely to vagotonic effects. The usual precautions should be followed to minimize the risk of systemic toxicity, including digital compression of the nasolacrimal ducts (1 to 2 minutes) following instillation to limit drainage into the nasal chamber, where extensive absorption may occur, and washing hands after use to prevent skin absorption. Excessive cholinergic effects may be reversed with parenterally administered atropine.


  1. Ellis PP "Systemic reactions to topical therapy." Int Ophthalmol Clin 11 (1971): 1-11
  2. Babinski M, Smith B, Wickerham EP "Hypotension and bradycardia following intraocular acetylcholine injection. Report of a case." Arch Ophthalmol 94 (1976): 675-6
  3. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
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Miochol-E (acetylcholine ophthalmic) drug Interactions

There are 370 drug interactions with Miochol-E (acetylcholine ophthalmic)

Miochol-E (acetylcholine ophthalmic) alcohol/food Interactions

There is 1 alcohol/food interaction with Miochol-E (acetylcholine ophthalmic)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No information available.

Do not stop taking any medications without consulting your healthcare provider.

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