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Miochol-E (Acetylcholine Chloride Electrolytes)
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Pharmacology
Acetylcholine is a naturally occurring neurohormone which mediates nerve impulse transmission at all cholinergic sites involving somatic and autonomic nerves. After release from the nerve ending, acetylcholine is rapidly inactivated by the enzyme acetylcholinesterase by hydrolysis to acetic acid and choline.
Direct application of acetylcholine to the iris will cause rapid miosis of short duration. Topical ocular instillation of acetylcholine to the intact eye causes no discernible response as cholinesterase destroys the molecule more rapidly than it can penetrate the cornea.
Acetylcholine is a naturally occurring neurohormone which mediates nerve impulse transmission at all cholinergic sites involving somatic and autonomic nerves. After release from the nerve ending, acetylcholine is rapidly inactivated by the enzyme acetylcholinesterase by hydrolysis to acetic acid and choline.
Direct application of acetylcholine to the iris will cause rapid miosis of short duration. Topical ocular instillation of acetylcholine to the intact eye causes no discernible response as cholinesterase destroys the molecule more rapidly than it can penetrate the cornea.
Indications
Acetylcholine Is A Naturally Occurring Neurohormone Which Mediates Nerve Impulse Transmission At All Cholinergic Sites Involving Somatic And Autonomic Nerves. After Release From The Nerve Ending, Acetylcholine Is Rapidly Inactivated By The Enzyme Acetylcholinesterase By Hydrolysis To Acetic Acid And Choline.
Direct Application Of Acetylcholine To The Iris Will Cause Rapid Miosis Of Short Duration. Topical Ocular Instillation Of Acetylcholine To The Intact Eye Causes No Discernible Response As Cholinesterase Destroys The Molecule More Rapidly Than It Can Penetrate The Cornea.
Acetylcholine Is A Naturally Occurring Neurohormone Which Mediates Nerve Impulse Transmission At All Cholinergic Sites Involving Somatic And Autonomic Nerves. After Release From The Nerve Ending, Acetylcholine Is Rapidly Inactivated By The Enzyme Acetylcholinesterase By Hydrolysis To Acetic Acid And Choline.
Direct Application Of Acetylcholine To The Iris Will Cause Rapid Miosis Of Short Duration. Topical Ocular Instillation Of Acetylcholine To The Intact Eye Causes No Discernible Response As Cholinesterase Destroys The Molecule More Rapidly Than It Can Penetrate The Cornea.
Contraindications
Information not available
Information not available
Safety Information / Warning
Do not gas sterilize. If blister or peelable backing is damaged or broken, sterility of the enclosed bottle cannot be assured. Open under aseptic conditions only.
Do not gas sterilize. If blister or peelable backing is damaged or broken, sterility of the enclosed bottle cannot be assured. Open under aseptic conditions only.
Precautions
General: In the reconstitution of the solution, as described under Directions for Using Univial, if the centre rubber plug seal in the univial does not go down or is down, do not use the vial.
If miosis is to be obtained quickly with Miochol-E, anatomical hindrances to miosis, such as anterior or posterior synechiae, must be released prior to administration. During cataract surgery, use Miochol-E only after delivery of the lens.
Aqueous solutions of acetylcholine are unstable. Prepare solution immediately before use. Do not use solution which is not clear and colorless. Discard any solution that has not been used.
Drug Interactions : Although clinical studies with acetylcholine and animal studies with acetylcholine or carbachol revealed no interference, and there is no known pharmacological basis for an interaction, there have been reports that acetylcholine and carbachol have been ineffective when used in patients treated with topical nonsteroidal anti-inflammatory agents.
Children: Safety and effectiveness in children have not been established.
General: In the reconstitution of the solution, as described under Directions for Using Univial, if the centre rubber plug seal in the univial does not go down or is down, do not use the vial.
If miosis is to be obtained quickly with Miochol-E, anatomical hindrances to miosis, such as anterior or posterior synechiae, must be released prior to administration. During cataract surgery, use Miochol-E only after delivery of the lens.
Aqueous solutions of acetylcholine are unstable. Prepare solution immediately before use. Do not use solution which is not clear and colorless. Discard any solution that has not been used.
Drug Interactions : Although clinical studies with acetylcholine and animal studies with acetylcholine or carbachol revealed no interference, and there is no known pharmacological basis for an interaction, there have been reports that acetylcholine and carbachol have been ineffective when used in patients treated with topical nonsteroidal anti-inflammatory agents.
Children: Safety and effectiveness in children have not been established.
Side Effects / Adverse Effects
Infrequent cases of corneal edema, corneal clouding and corneal decompensation have been reported with the use of intraocular acetylcholine.
Adverse reactions have been reported rarely which are indicative of systemic absorption. These include bradycardia, hypotension, flushing, breathing difficulties and sweating.
Infrequent cases of corneal edema, corneal clouding and corneal decompensation have been reported with the use of intraocular acetylcholine.
Adverse reactions have been reported rarely which are indicative of systemic absorption. These include bradycardia, hypotension, flushing, breathing difficulties and sweating.
Overdose
Symptoms and Treatment: Atropine sulfate (0.5to 1mg) should be given i.m. or i.v. and should be readily available to counteract possible overdosage. Epinephrine (0.1to 1mg s.c.) is also of value in overcoming severe cardiovascular or bronchoconstrictor responses.
Symptoms and Treatment: Atropine sulfate (0.5to 1mg) should be given i.m. or i.v. and should be readily available to counteract possible overdosage. Epinephrine (0.1to 1mg s.c.) is also of value in overcoming severe cardiovascular or bronchoconstrictor responses.
Recommended Dosage
With a new needle of sturdy gauge, 18 to 20, draw all the solution into a dry, sterile syringe. Replace needle with a suitable atraumatic cannulae for intraocular irrigation.
The Miochol-E solution is instilled into the anterior chamber before or after securing one or more sutures. Instillation should be gentle and parallel to the iris face and tangential to pupil border.
If there are no mechanical hindrances, the pupil starts to constrict in seconds and the peripheral iris is drawn away from the angle of the anterior chamber. Any anatomical hindrance to miosis must be released to permit the desired effect of the drug. In most cases, 0.5to 2mL produces satisfactory miosis.
In cataract surgery, use Miochol-E only after delivery of the lens.
Aqueous solutions of acetylcholine are unstable. Prepare solution immediately before use. Do not use solution which is not clear and colorless. Discard any solution that has not been used.
Directions for using the univial: Sterile unless package open or broken.
1.Inspect univial while inside unopened blister. Diluent must be in upper chamber.
2.Peel open blister.
3.Aseptically transfer univial to sterile field. Maintain sterility of outer container duing preparation of solution.
4.Immediately before use, give plunger-stopper a quarter turn and press to force diluent and centre plug into lower chamber.
5.Shake gently to dissolve drug.
6.Discard univial and any unused solution.
With a new needle of sturdy gauge, 18 to 20, draw all the solution into a dry, sterile syringe. Replace needle with a suitable atraumatic cannulae for intraocular irrigation.
The Miochol-E solution is instilled into the anterior chamber before or after securing one or more sutures. Instillation should be gentle and parallel to the iris face and tangential to pupil border.
If there are no mechanical hindrances, the pupil starts to constrict in seconds and the peripheral iris is drawn away from the angle of the anterior chamber. Any anatomical hindrance to miosis must be released to permit the desired effect of the drug. In most cases, 0.5to 2mL produces satisfactory miosis.
In cataract surgery, use Miochol-E only after delivery of the lens.
Aqueous solutions of acetylcholine are unstable. Prepare solution immediately before use. Do not use solution which is not clear and colorless. Discard any solution that has not been used.
Directions for using the univial: Sterile unless package open or broken.
1.Inspect univial while inside unopened blister. Diluent must be in upper chamber.
2.Peel open blister.
3.Aseptically transfer univial to sterile field. Maintain sterility of outer container duing preparation of solution.
4.Immediately before use, give plunger-stopper a quarter turn and press to force diluent and centre plug into lower chamber.
5.Shake gently to dissolve drug.
6.Discard univial and any unused solution.
Supplied / Packaging
Each univial (two chamber vial) contains: acetylcholine chloride 20mg and mannitol 56mg (lower chamber) and electrolyte diluent 2mL (upper chamber). The reconstituted solution provides acetylcholine chloride 10mg/mL. Nonmedicinal ingredients: calcium chloride dihydrate, magnesium chloride hexahydrate, mannitol, potassium chloride, sodium acetate trihydrate and sterile water for injection. Store at 4to 25°C. Keep from freezing.
Each univial (two chamber vial) contains: acetylcholine chloride 20mg and mannitol 56mg (lower chamber) and electrolyte diluent 2mL (upper chamber). The reconstituted solution provides acetylcholine chloride 10mg/mL. Nonmedicinal ingredients: calcium chloride dihydrate, magnesium chloride hexahydrate, mannitol, potassium chloride, sodium acetate trihydrate and sterile water for injection. Store at 4to 25°C. Keep from freezing.
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Brand Name
Miochol-E
Miochol-E
Generic Name
Acetylcholine Chloride Electrolytes
Acetylcholine Chloride Electrolytes
General Indications
Miotic
Miotic
