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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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