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]
Pharmacology
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
Pharmacokinetics/Pharmacodynamics
Onset of Action
Rapid
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
Contraindications
Hypersensitivity to acetylcholine chloride or any component of the formulation
Dosage and Administration
Dosing: Adult
Ophthalmic surgery: Intraocular: Usual dosage: 0.5 to 2 mL
Dosing: Geriatric
Refer to adult dosing.
Reconstitution
Reconstitute in an aseptic environment immediately before use.
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.
Storage
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. 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
Frequency not defined.
Cardiovascular: Bradycardia, flushing, hypotension
Dermatologic: Diaphoresis
Ophthalmic: Cloudy vision, corneal decompensation, corneal edema
Respiratory: Dyspnea
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. 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
- Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
- Have patient report immediately to prescriber sudden vision changes, severe eye irritation, or eye pain (HCAHPS).
- Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.
