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Miochol Plus (acetylcholine ophthalmic) Disease Interactions

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


Miotics (applies to Miochol Plus) systemic vagotonic effects

Moderate Potential Hazard, Low plausibility. Applicable conditions: Asthma, Chronic Obstructive Pulmonary Disease, Dyspepsia, 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, Arrhythmias

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):
  4. Zimmerman TJ, Wheeler TM "Miotics: side effects and ways to avoid them." Ophthalmology 89 (1982): 76-80
  5. Brinkley JR Jr, Henrick A "Vascular hypotension and bradycardia following intraocular injection of acetylcholine during cataract surgery." Am J Ophthalmol 97 (1984): 40-2
  6. "Product Information. Isopto Carpine (pilocarpine ophthalmic)" Alcon Laboratories Inc, Fort Worth, TX.
  7. Rasch D, Holt J, Wilson M, Smith RB "Bronchospasm following intraocular injection of acetylcholine in a patient taking metoprolol." Anesthesiology 59 (1983): 583-5
  8. Benjamin KW "Toxicity of ocular medications." Int Ophthalmol Clin 19 (1979): 199-255
  9. Sekiya M, Okayama H, Suzuki M, Kobayashi T, Matsuoka H, Sumimoto T, Hamada M, Hiwada K "Acetylcholine-induced myocardial ischemia without epicardial coronary artery spasm: a possible vasospasm of small coronary arteries--a case report." Angiology 44 (1993): 811-5
  10. "Product Information. Isopto Carbachol (carbachol ophthalmic)" Alcon Laboratories Inc, Ft Worth, TX.
  11. "Product Information. Eserine (physostigmine ophthalmic)." Ciba Vision Ophthalmics, Duluth, GA.
  12. "Product Information. Humorsol Ophthalmic Solution (demecarium bromide ophthalmic)." Merck & Co, Inc, West Point, PA.
  13. "Product Information. Phospholine iodide (echothiophate iodide)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  14. Gombos GM "Systemic reactions following intraocular acetylcholine instillation." Ann Ophthalmol 14 (1982): 529-30
  15. Taytard A, Vergeret J, Auzerie J, Freour P "Acetylcholine-induced bronchospasm in asthma patients: dose/response curves." Eur J Respir Dis Suppl 128(Pt 2) (1983): 513-4
  16. Rongey KA, Weisman H "Hypotension following intraocular acetylcholine." Anesthesiology 36 (1972): 412
  17. Gombos DS "Acetylcholine in ophthalmology: a revisit." Ann Ophthalmol 20 (1988): 455,462
  18. Marmion VJ "Vascular hypotension and bradycardia following intraocular injection of acetylcholine during cataract surgery." Am J Ophthalmol 97 (1984): 799-80
  19. Treasure CB, Vita JA, Cox DA, Fish RD, Selwyn AP, Alexander RW, Ganz P "Acute myocardial infarction with normal coronary arteries associated with acetylcholine-induced vasoconstriction in the absence of a positive ergonovine test." Am J Cardiol 65 (1990): 255-7
  20. "Product Information. Miochol (acetylcholine chloride, intraocular)." Ciba Vision Ophthalmics, Duluth, GA.
View all 20 references

Miochol Plus (acetylcholine ophthalmic) drug interactions

There are 101 drug interactions with Miochol Plus (acetylcholine ophthalmic)

Miochol Plus (acetylcholine ophthalmic) alcohol/food interactions

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

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
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 interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.