Acetylcholine

Pronunciation (a se teel KOE leen)

• Glaucoma Drug Therapy

U.S. Brand Names Miochol-E®

Synonyms Acetylcholine Chloride

Generic Available No

Canadian Brand Names Miochol®-E

Pharmacologic Category Cholinergic Agonist; Ophthalmic Agent, Miotic

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

Pregnancy Risk Factor C

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

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

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 Reconstitute immediately before use.

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

Nursing Implications Discard any solution that is not used; open under aseptic conditions only

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 Ophthalmic use of acetylcholine has no effect on dental treatment

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 suspension, as chloride: 1:100 [10 mg/mL] (2 mL)

International Brand Names Acetilcolina Colirio® (AR); Acetilcolina Cusi® (ES); Acetylcholin. ophthalmologic.® (CH); Acetylcholinum Opht. Ampul® (TR); Covochol (ZA); Miochol (AU, BE, CA, FI, GB, LU, NL, NZ, ZA, SE, CH); Miochol-3 (ZA); Miochol®-E (CA); Miochole (FR); Miochol-E® (DE, IT); Miovisin (IT)