Acetylcholine

Acetylcholine is a prescription drug used as a parasympathomimetic preparation for intraocular use.

Acetylcholine is available under the following different brand names: Miochol E.

Powder for injection

• 20 mg

Safety and efficacy not established for pediatric use.

Dosing considerations:

• Miosis during Ocular Surgery
  • 0.5-2 ml of 1% solution intraocular instillation during surgery
• Administration
  • Reconstitute vial with 2 ml supplied diluent to obtain 1% solution; use immediately
  • Instill gently into anterior chamber of eye with suitable atraumatic cannula
  • May use 2% pilocarpine or 0.25% physostigmine topically immediately after surgery before application of dressing to maintain miosis
  • For cataract surgery, instill only after delivery of lens
• Gel
  • Children over 12 years: 30 mg every 6-8 hours, not to exceed 120 mg per day
• Lozenges
  • Children 6-12 years: 5-10 mg every 1-4 hours, not to exceed 60 mg per day
  • Children over 12 years: 5-15 mg orally every 1-4 hours, not to exceed 120 mg per day
• Strips
  • Children 6-12 years: 15 mg orally every 6-8 hours, not to exceed 60 mg per day
  • Children over 12 years: 30 mg orally every 6-8 hours, not to exceed 120 mg per day
• Dosing Considerations
  • Potential toxic doses children under 6 years: 10 mg/kg
  • About 15-30 mg acetylcholine is equal to 8-15 mg codeine as an antitussive

Common (ocular) side effects of Acetylcholine include:

• corneal swelling
• corneal clouding
• corneal decompensation

Rare (systemic) side effects of Acetylcholine include:

• slow heartrate
• flushing
• low blood pressure (hypotension)
• breathing difficulty
• sweating

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

• Acetylcholine has no known severe interactions with other drugs.
• Acetylcholine has no known serious interactions with other drugs.
• Acetylcholine has no known moderate interactions with other drugs.
• Acetylcholine has no known mild interactions with other drugs.

This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns or for more information about this medicine.

Warnings

• Avoid simultaneous use with nonselective monoamine oxidase inhibitors (MAO inhibitors) – serotonin syndrome
• Contains aspartame, use caution in patients with phenylketonuria
• May cause hallucinations, confusion, agitation, overactive reflexes, shivering, twitching of muscles and rapid heart rate
• Not for use in children under 4 years old and use caution when using in children younger than 6 years old
• Use caution in patients who are sedated, debilitated or confined to a supine position
• This medication contains acetylcholine
• Do not take Balminil DM, Benylin DM, Bronchophan, Buckleys D, Calylin #1, Delsym, Koffex DM, Novahistex DM, Robitussin Lingering Cold Long-Acting Cough, Robitussin lingering Cold Long-Acting CoughGels, Children's Robitussin Cough Long-Acting, and Sucrets 8 Hour Cough Relief DM Cough Formula if you are allergic to acetylcholine or any ingredients contained in this drug
• Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately

Contraindications

• None.

Effects of Drug Abuse

• No information provided

Short-Term Effects

• See "What Are Side Effects Associated with Using Acetylcholine?"

Long-Term Effects

• See "What Are Side Effects Associated with Using Acetylcholine?"

Cautions

• Use reconstituted solution immediately; aqueous solution unstable
• Instill gently; forceful jet may rupture the hyaloid, cause vitreous loss, or traumatize/perforate iris
• Systemic effects (rare) can cause problems for patients with asthma, acute heart failure, gastrointestinal spasm, peptic ulcer disease, urinary tract obstruction, acute heart failure, and hyperthyroidism

Pregnancy and Lactation

• Use acetylcholine during pregnancy with caution if benefits outweigh risks. Animal studies show risk and human studies are not available, or neither animal nor human studies were done
• It is not known if acetylcholine is excreted in breast milk, use caution if breastfeeding