Dosing and uses of Miochol E (acetylcholine)
Adult dosage forms and strengths
powder for injection
- 20mg
Miosis During Ocular Surgery
0.5-2 mL of 1% solution intraocular instillation during surgery
Miosis occurs promptly and persists for approximately 10 minutes
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
Pediatric dosage forms and strengths
Safety & efficacy not established
Miochol E (acetylcholine) adverse (side) effects
Frequency not defined
Ocular
- Corneal edema
- Corneal clouding
- Corneal decompensation
Systemic (Rare)
- Bradycardia
- Flushing
- Hypotension
- Breathing difficulty
- Sweating
Warnings
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, GI spasm, peptic ulcer disease, urinary tract obstruction, acute heart failure, and hyperthyroidism
Pregnancy and lactation
Pregnancy category: C
Lactation: Excretion in milk unknown; use with caution
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Miochol E (acetylcholine)
Mechanism of action
Direct-acting parasympathomimetic neurotransmitter; causes contraction of sphincter muscles of the iris, which results in miosis and contraction of ciliary muscle and leads to accomodation spasm
Pharmacokinetics
Onset of action: Rapid
Duration: 6 hr
