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Medically reviewed by Last updated on Jul 13, 2021.


(a se teel KOE leen)

Index Terms

  • Acetylcholine Chloride

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution Reconstituted, Intraocular, as chloride:

Miochol-E: 20 mg (1 ea) [contains mannitol]

Brand Names: U.S.

  • Miochol-E

Pharmacologic Category

  • Cholinergic Agonist
  • Ophthalmic Agent, Miotic


Causes contraction of the sphincter muscles of the iris, resulting in miosis and contraction of the ciliary muscle, leading to accommodation spasm

Onset of Action


Duration of Action

~20 minutes (Kanski 1968); duration as long as 6 hours has been reported (Roszkowska 1998)

Use: Labeled Indications

Ophthalmic surgery: 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


Hypersensitivity to acetylcholine chloride or any component of the formulation

Dosing: Adult

Ophthalmic surgery: Intraocular: Usual dosage: 0.5 to 2 mL

Dosing: Geriatric

Refer to adult dosing.


Reconstitute in an aseptic environment immediately before use.


Ophthalmic: Open under aseptic conditions only. Attach filter before irrigating eye. 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.


Store unopened vial at 4°C to 25°C (39°F to 77°F); prevent from freezing. Prepare solution immediately before use and discard unused portion. Acetylcholine solutions are unstable. Only use if solution is clear and colorless.

Drug Interactions

Acetylcholinesterase Inhibitors: May enhance the adverse/toxic effect of Cholinergic Agonists. Specifically, cholinergic effects may be enhanced or increased. Monitor therapy

Beta-Blockers: May enhance the adverse/toxic effect of Cholinergic Agonists. Of particular concern are the potential for cardiac conduction abnormalities and bronchoconstriction. Monitor therapy

Sincalide: Drugs that Affect Gallbladder Function may diminish the therapeutic effect of Sincalide. Management: Consider discontinuing drugs that may affect gallbladder motility prior to the use of sincalide to stimulate gallbladder contraction. Consider therapy modification

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Frequency not defined.

Cardiovascular: Bradycardia, flushing, hypotension

Dermatologic: Diaphoresis

Ophthalmic: Cloudy vision, corneal decompensation, corneal edema

Respiratory: Dyspnea


Disease-related concerns:

• Diseases affected by systemic effects: Systemic effects rarely occur but can cause problems for patients with asthma, GI spasm, acute heart failure, hyperthyroidism, Parkinson's disease, peptic ulcer disease, and or urinary tract obstruction. In a scientific statement from the American Heart Association, ophthalmic cholinergic agents have been determined to be agents that may exacerbate underlying myocardial dysfunction (magnitude: minor) (AHA [Page 2016]).

Other warnings/precautions:

• Aseptic conditions: Open under aseptic conditions only; do not gas sterilize.

• Cataract surgery: During cataract surgery, use only after lens is in place.

Patient Education

What is this drug used for?

• It is used during eye surgery.

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Sudden vision changes

• Severe eye irritation

• Eye pain

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a limited summary of general information about the medicine's uses from the patient education leaflet and is not intended to be comprehensive. This limited summary does NOT include all information available about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not intended to provide medical advice, diagnosis or treatment and does not replace information you receive from the healthcare provider. For a more detailed summary of information about the risks and benefits of using this medicine, please speak with your healthcare provider and review the entire patient education leaflet.

Further information

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