Pronunciation(a se teel KOE leen)
U.S. Brand NamesMiochol-E®
SynonymsAcetylcholine Chloride
Generic AvailableNo
Canadian Brand NamesMiochol-E®
UseProduces complete miosis in cataract surgery, keratoplasty, iridectomy and other anterior segment surgery where rapid miosis is required
Pregnancy Risk FactorC
Pregnancy ImplicationsAcetylcholine 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
ContraindicationsHypersensitivity to acetylcholine chloride or any component of the formulation; acute iritis and acute inflammatory disease of the anterior chamber
Warnings/PrecautionsSystemic 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 ReactionsFrequency 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/ToxicologyTreatment includes flushing eyes with water or normal saline and supportive measures; if accidentally ingested, induce emesis or perform gastric lavage
Drug InteractionsDecreased effect possible with flurbiprofen and suprofen, ophthalmic Increased effect may be prolonged or enhanced in patients receiving tacrine
StabilityPrepare solution immediately before use and discard unused portion; acetylcholine solutions are unstable; reconstitute immediately before use
Mechanism of ActionCauses contraction of the sphincter muscles of the iris, resulting in miosis and contraction of the ciliary muscle, leading to accommodation spasm
Pharmacodynamics/KineticsOnset of action: Rapid Duration: ~10 minutes
DosageAdults: Intraocular: 0.5-2 mL of 1% injection (5-20 mg) instilled into anterior chamber before or after securing one or more sutures
AdministrationOpen under aseptic conditions only.
Patient EducationMay 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 ConsiderationsSystemic effects are rare after intraocular administration, but can occur. Caution should be used in patients with cardiovascular disease.
Cardiovascular ConsiderationsSystemic effects are rare after intraocular administration, but can occur. Caution should be used in patients with cardiovascular disease.
Dental Health: Effects on Dental TreatmentNo significant effects or complications reported
Dental Health: Vasoconstrictor/Local Anesthetic PrecautionsNo information available to require special precautions
Mental Health: Effects on Mental StatusNone reported
Mental Health: Effects on Psychiatric TreatmentIntraocular product; should not impact psychiatric drug treatment
Dosage FormsPowder for intraocular solution, as chloride: 1:100 [10 mg/mL] (2 mL)
International Brand NamesAcetil 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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