Acetylcholine

Pronunciation

(a se teel KOE leen)

U.S. Brand Names

Miochol-E®

Synonyms

Acetylcholine Chloride

Generic Available

Canadian Brand Names

Miochol-E®

Use

Produces complete miosis in cataract surgery, keratoplasty, iridectomy and other anterior segment surgery where rapid miosis is required

Pregnancy Risk Factor

Pregnancy Implications

Acetylcholine is used primarily in the eye and there are no reports of its use in pregnancy; because it is ionized at physiologic pH, transplacental passage would not be expected

Contraindications

Hypersensitivity to acetylcholine chloride or any component of the formulation; acute iritis and acute inflammatory disease of the anterior chamber

Warnings/Precautions

Systemic effects rarely occur but can cause problems for patients with acute cardiac failure, bronchial asthma, peptic ulcer, hyperthyroidism, GI spasm, urinary tract obstruction, and Parkinson's disease; open under aseptic conditions only

Adverse Reactions

Frequency not defined.

Cardiovascular: Bradycardia, hypotension, flushing

Central nervous system: Headache

Ocular: Altered distance vision, decreased night vision, transient lenticular opacities

Respiratory: Dyspnea

Miscellaneous: Diaphoresis

Overdosage/Toxicology

Treatment includes flushing eyes with water or normal saline and supportive measures; if accidentally ingested, induce emesis or perform gastric lavage

Drug Interactions

Decreased effect possible with flurbiprofen and suprofen, ophthalmic

Increased effect may be prolonged or enhanced in patients receiving tacrine

Stability

Prepare solution immediately before use and discard unused portion; acetylcholine solutions are unstable; reconstitute immediately before use

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: ~10 minutes

Dosage

Adults: Intraocular: 0.5-2 mL of 1% injection (5-20 mg) instilled into anterior chamber before or after securing one or more sutures

Administration

Open under aseptic conditions only.

Patient Education

May sting on instillation; use caution while driving at night or performing hazardous tasks; do not touch dropper to eye

Anesthesia and Critical Care Concerns/Other Considerations

Systemic effects are rare after intraocular administration, but can occur. Caution should be used in patients with cardiovascular disease.

Cardiovascular Considerations

Systemic effects are rare after intraocular administration, but can occur. Caution should be used in patients with cardiovascular disease.

Dental Health: Effects on Dental Treatment

No significant effects or complications reported

Dental Health: Vasoconstrictor/Local Anesthetic Precautions

No information available to require special precautions

Mental Health: Effects on Mental Status

None reported

Mental Health: Effects on Psychiatric Treatment

Intraocular product; should not impact psychiatric drug treatment

Dosage Forms

Powder for intraocular solution, as chloride: 1:100 [10 mg/mL] (2 mL)

International Brand Names

Acetil colina® (CO); Acetilcolina Colirio® (AR); Acetilcolina Cusi® (ES); Acetil colina intraocular® (CO); Miochol® (AU, BE, DE, IL, LU, NL, NZ); Miochol-E® (CA); Miochol E® (CH); Miochol-E® (CL, DE, FI); Miochole® (FR); Miochol-E® (GB, ID, IL, SG, ZA); Miovisin® (IT)

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