Acetylcholine:

Acetylcholine: Drug information
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(For additional information see “Acetylcholine: Patient drug information” and see “Acetylcholine: Pediatric drug information”)

Brand Names: U.S. Miochol®-E
Brand Names: Canada Miochol®-E
Pharmacologic Category Cholinergic Agonist; Ophthalmic Agent, Miotic
Dosing: Adult To produce miosis: Intraocular: 0.5-2 mL of 1% injection (5-20 mg) instilled into anterior chamber before or after securing one or more sutures
Dosing: Geriatric Refer to adult dosing.
Dosage Forms: U.S. Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Powder for solution, intraocular, as chloride:

Miochol®-E: 20 mg (2 mL) [supplied with diluent; reconstitution results in 1:100 solution]

Generic Equivalent Available: U.S. No
Administration 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.
Use Produces complete miosis in cataract surgery, keratoplasty, iridectomy, and other anterior segment surgery where rapid miosis is required
Medication Safety Issues
Sound-alike/look-alike issues:
Acetylcholine may be confused with acetylcysteine

Adverse Reactions Significant Frequency not defined.
Cardiovascular: Bradycardia, flushing, hypotension

Ocular: Clouding, corneal edema, decompensation

Respiratory: Dyspnea

Miscellaneous: Diaphoresis

Contraindications Hypersensitivity to acetylcholine chloride or any component of the formulation
Warnings/Precautions
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.

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.

Drug Interactions
(For additional information: Launch Lexi-Interact™ Drug Interactions Program )
Acetylcholinesterase Inhibitors: May enhance the adverse/toxic effect of Cholinergic Agonists. Risk C: Monitor therapy

International Brand Names Acetilcolina Colirio (AR); Acetilcolina Cusi (ES); Miochol (FI, LU, NL, PT); Miochol-E (AU, BE, CH, CN, DE, DK, FI, GB, GR, HK, ID, IE, IL, IT, KP, NL, NO, NZ, SE, TR, ZA); Miochole (FR); OQ-Miot (CO)
Mechanism of Action Causes contraction of the sphincter muscles of the iris, resulting in miosis and contraction of the ciliary muscle, leading to accommodation spasm
Pharmacodynamics/Kinetics
Onset of action: Rapid

Duration: ~6 hours

REFERENCES
Roszkowska AM, Ferreri G, Squeri CA, et al, “Effect of Intraocular Acetylcholine and Carbachol on the Corneal Endothelium. In vivo Comparative Study,” Ophthalmologica, 1998, 212(6):407-9. [PubMed 9787232]