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Pronunciation:

(KAR ba kole)

U.S. Brand Names:

Carbastat® [DSC]; Isopto® Carbachol; Miostat®

Synonyms:

Carbacholine; Carbamylcholine Chloride

Generic Available:

Canadian Brand Names:

Carbastat®; Isopto® Carbachol; Miostat®

Use:

Lowers intraocular pressure in the treatment of glaucoma; cause miosis during surgery

Pregnancy Risk Factor:

Pregnancy Implications:

Reproduction studies have not been conducted.

Lactation:

Excretion in breast milk unknown/use caution

Contraindications:

Hypersensitivity to carbachol or any component of the formulation; acute iritis, acute inflammatory disease of the anterior chamber

Warnings/Precautions:

Use with caution in patients undergoing general anesthesia and in presence of corneal abrasion. Use caution with acute cardiac failure, asthma, peptic ulcer, hyperthyroidism, gastrointestinal spasm, urinary tract obstruction, and Parkinson's disease.

Adverse Reactions:

Frequency not defined.

Cardiovascular: Arrhythmia, flushing, hypotension, syncope

Central nervous system: Headache

Gastrointestinal: Abdominal cramps, diarrhea, epigastric distress, salivation, vomiting

Genitourinary: Urinary bladder tightness

Ocular: Bullous keratopathy, burning (transient), ciliary spasm, conjunctival injection, corneal clouding, irritation, postoperative iritis (following cataract extraction), retinal detachment, stinging (transient)

Respiratory: Asthma

Miscellaneous: Diaphoresis

Overdosage/Toxicology:

Symptoms of overdose include miosis, flushing, vomiting, bradycardia, bronchospasm, involuntary urination Atropine is the treatment of choice for intoxications manifesting with significant muscarinic symptoms. Atropine I.V. 1-2 mg every 5-60 minutes (or 0.04-0.08 mg/kg I.V. every 5-60 minutes if needed for children) should be repeated to control symptoms and then continued as needed for 1-2 days following the acute ingestion. Epinephrine 0.1-1 mg SubQ may be useful in reversing severe cardiovascular or pulmonary sequelae.

Drug Interactions:

Decreased effect of carbachol possible with topical NSAIDs

Stability:

Intraocular: Store at room temperature of 15°C to 30°C (59°F to 86°F)

Topical: Store at 8°C to 27°C (46°F to 80°F)

Mechanism of Action:

Synthetic direct-acting cholinergic agent that causes miosis by stimulating muscarinic receptors in the eye

Pharmacodynamics/Kinetics:

Ophthalmic instillation:

Onset of action: Miosis: 10-20 minutes

Duration: Reduction in intraocular pressure: 4-8 hours

Intraocular administration:

Onset of action: Miosis: 2-5 minutes

Duration: 24 hours

Dosage:

Adults:

Ophthalmic: Instill 1-2 drops up to 3 times/day

Intraocular: 0.5 mL instilled into anterior chamber before or after securing sutures

Administration:

Ophthalmic: Finger pressure should be applied on the lacrimal sac for 1-2 minutes following topical instillation; remove excess around the eye with a tissue.

Intraocular: Instillation for miosis prior to eye surgery should be gentle and parallel to the iris face and tangential to the pupil border; discard unused portion. Not >0.5 mL should be injected into the anterior chamber. Instillation may occur before or after securing sutures. Sterile technique must be used.

Patient Education:

May sting on instillation. May cause headache, altered distance vision, and decreased night vision. Pregnancy precaution: Inform prescriber if you are or intend to become pregnant. Consult prescriber if breast-feeding.

Dental Health: Effects on Dental Treatment:

Key adverse event(s) related to dental treatment: Increased salivation.

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:

None reported

Dosage Forms:

[DSC] = Discontinued product

Solution, intraocular (Carbastat® [DSC], Miostat®): 0.01% (1.5 mL)

Solution, ophthalmic (Isopto® Carbachol): 1.5% (15 mL); 3% (30 mL) [contains benzalkonium chloride]

International Brand Names:

Carbachol® (GB, PL); Carbacolo Alfa INTES® (IT); Carbamann® (DE); Carbastat® (CA); Doryl® (DE); Isopto Carbachol® (AU, BE); Isopto® Carbachol (CA); Isopto Carbachol® (CZ, DE, FI, GB, HR, IE, IL, LU, NL, NO, NZ, PL, SI, ZA); Isopto-Karbakolin® (SE); Jestryl® (CZ, DE); Miostat® (AU, BE, BR, CA, CH, CZ, IL, LU, NL, NZ, PL, RO, SG, SI, TH, TR); Mioticol® (IT)

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