(a se teel KOE leen)
Produces complete miosis in cataract surgery, keratoplasty, iridectomy, and other anterior segment surgery where rapid miosis is required
Hypersensitivity to acetylcholine chloride or any component of the formulation
To produce miosis: Intraocular: 0.5-2 mL of 1% injection (5-20 mg) instilled into anterior chamber before or after securing one or more sutures
Refer to adult dosing.
No dosage adjustment provided in manufacturers labeling.
No dosage adjustment provided in manufacturers labeling.
Reconstitute in an aseptic environment immediately before use.
Ophthalmic: Open under aseptic conditions only. Attach filter before irrigating eye. Instill into anterior chamber before or after securing one or more sutures; instillation should be gentle and parallel to the iris face and tangential to the pupil border; in cataract surgery, acetylcholine should be used only after delivery of the lens.
Store unopened vial at 4 ‚ °C to 25 ‚ °C (39 ‚ °F to 77 ‚ °F); prevent from freezing. Prepare solution immediately before use and discard unused portion. Acetylcholine solutions are unstable. Only use if solution is clear and colorless.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution Reconstituted, Intraocular, as chloride:
Miochol-E: 20 mg (1 ea) [contains mannitol]
Acetylcholinesterase Inhibitors: May enhance the adverse/toxic effect of Cholinergic Agonists. Monitor therapy
Beta-Blockers: May enhance the adverse/toxic effect of Cholinergic Agonists. Of particular concern are the potential for cardiac conduction abnormalities and bronchoconstriction. Management: Administer these agents in combination with caution, and monitor for conduction disturbances. Avoid methacholine with any beta blocker due to the potential for additive bronchoconstriction. Monitor therapy
Frequency not defined.
Cardiovascular: Bradycardia, flushing, hypotension
Dermatologic: Diaphoresis
Ophthalmic: Cloudy vision, corneal decompensation, corneal edema
Respiratory: Dyspnea
Disease-related concerns:
- Diseases affected by systemic effects: Systemic effects rarely occur but can cause problems for patients with asthma, GI spasm, acute heart failure, hyperthyroidism, Parkinsons disease, peptic ulcer disease, and or urinary tract obstruction.
Other warnings/precautions:
- Aseptic conditions: Open under aseptic conditions only; do not gas sterilize.
- Cataract surgery: During cataract surgery, use only after lens is in place.
Causes contraction of the sphincter muscles of the iris, resulting in miosis and contraction of the ciliary muscle, leading to accommodation spasm
Rapid
~20 minutes (Kanski 1968); duration as long as 6 hours has been reported (Roszkowska 1998)
- Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
- Have patient report immediately to prescriber sudden vision changes, severe eye irritation, or eye pain (HCAHPS).
- Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.