Drugs List

Therapeutic Indications

Uses

Complete miosis in ocular anterior segment surgery

Contraindications

None known

Precautions and Warnings

Children under 18 years
Asthma
Breastfeeding
Cardiac failure
Gastrointestinal disorder
Hyperthyroidism
Parkinsonism
Peptic ulcer
Pregnancy
Urinary obstruction

During cataract surgery: use only after delivery of the lens
Aqueous solutions are unstable - prepare immediately before use
Discard any unused portion
Use only if the solution is clear and colourless
Driving or operating machinery not advisable following treatment

Pregnancy and Lactation

Pregnancy

Use acetylcholine chloride with caution in pregnancy.

No reports of the use of acetylcholine irrigation in pregnancy have been located. It is a quaternary ammonium compound, and is ionised at physiologic pH. Transplacental passage in significant amounts is not anticipated.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use acetylcholine chloride with caution in breastfeeding.

No reports describing the use of acetylcholine during human lactation have been located. The risk to a nursing infant is probably nil and breastfeeding should be compatible.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Bradycardia
Corneal clouding
Corneal decompensation
Corneal oedema
Flushing
Hypotension
Respiratory difficulties
Sweating

Presentation

Powder for reconstitution containing acetylcholine chloride

Drugs List

Therapeutic Indications

Uses

Complete miosis in ocular anterior segment surgery

Dosage

Adults

Children

Additional Dosage Information

Contraindications

None known

Precautions and Warnings

Children under 18 years
Asthma
Breastfeeding
Cardiac failure
Gastrointestinal disorder
Hyperthyroidism
Parkinsonism
Peptic ulcer
Pregnancy
Urinary obstruction

During cataract surgery: use only after delivery of the lens
Aqueous solutions are unstable - prepare immediately before use
Discard any unused portion
Use only if the solution is clear and colourless
Driving or operating machinery not advisable following treatment

Pregnancy and Lactation

Pregnancy

Use acetylcholine chloride with caution in pregnancy.

No reports of the use of acetylcholine irrigation in pregnancy have been located. It is a quaternary ammonium compound, and is ionised at physiologic pH. Transplacental passage in significant amounts is not anticipated.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use acetylcholine chloride with caution in breastfeeding.

No reports describing the use of acetylcholine during human lactation have been located. The risk to a nursing infant is probably nil and breastfeeding should be compatible.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Bradycardia
Corneal clouding
Corneal decompensation
Corneal oedema
Flushing
Hypotension
Respiratory difficulties
Sweating

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: May 2015.

Reference Sources

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

Summary of Product Characteristics: Miochol-E 20mg Powder and Solvent for Solution for Intraocular Irrigation. Bausch & Lomb U.K. Ltd. Revised May 2011.

Summary of Product Characteristics: Miphtel 20mg powder and Solvent for Solution for Intraocular Irrigation. Farmigea S.p.A. for Alan Pharmaceuticals. Revised January 2010.

NICE - Evidence Services
Available at: www.nice.org.uk
Last accessed: 19 June 2017