acetylcholine

Acetylcholine is a medication instilled into the eye during certainocularsurgeries to achieve rapid constriction (miosis) of the pupils for a short period.

Acetylcholine belongs to a class of medications known as direct-acting miotics which act directly on specific eye muscles to cause miosis. The miotic effect occurs immediately and lasts for approximately 10 minutes.

乙酰胆碱是一种天然的化学物质(neurotransmitter) that nerve endings in muscles secrete to stimulate muscle contraction. Acetylcholine used as medication mimics the activity of the natural neurotransmitter. Acetylcholine is instilled into the anterior chamber of the eye which makes the eye’s ciliary muscle and the sphincter muscle encircling theiriscontract, resulting in miosis. Acetylcholine works by stimulating protein molecules known as cholinergic receptors on the eye muscle cells that induce contraction in response to acetylcholine.

Acetylcholine is approved by the FDA for achieving miosis of the iris in seconds after delivery of thelensincataract surgery, in penetrating keratoplasty, iridectomy and other anterior segment surgeries where rapid miosis may be required.

• Do not use acetylcholine in patients with hypersensitivity to any of the components in the acetylcholine formulation.
• Open the pack under aseptic conditions. If package is damaged, discard the drug, do notgassterilize.
• 乙酰胆碱的水溶液不稳定。Prepare solution immediately before use. Do not use the solution if it is not clear and colorless. Discard any solution that has not been used.
• Instill the solution gently, forceful jet may rupture the hyaloid artery, cause vitreous loss, or injure/perforate the iris.
• Rarely, systemic absorption can cause problems for patients withasthma, acuteheart failure, gastrointestinal spasm,peptic ulcerdisease, urinary tract obstruction, acuteheartfailure andhyperthyroidism.

Common side effects of acetylcholine include:

• Ocular effects:
  • Clouding of thecornea
  • Corneal swelling (edema)
  • Corneal decompensation
• Systemic effects (rare):
  • Flushing
  • Low blood pressure(hypotension)
  • Slow heart rate (bradycardia)
  • Shortness of breath(dyspnea)
  • Sweating(diaphoresis)

Call your doctor immediately if you experience any of the following symptoms or serious side effects while using this drug:

• Seriousheart symptomsinclude fast or pounding heartbeats, fluttering in your chest, shortness of breath, and suddendizziness;
• Severeheadache,confusion, slurred speech, severeweakness,vomiting, loss of coordination, feeling unsteady;
• Severe nervous system reaction with very stiff muscles, highfever,sweating, confusion, fast or uneven heartbeats,tremors, and feeling like you might pass out; or
• Serious eye symptoms includeblurred vision,tunnel vision,eye painor swelling, or seeing halos around lights.

This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.

Powder for Injection

• 20 mg

Adult:

Miosis During Ocular Surgery

• 0.5-2 mL of 1% solutionintraocularinstillation 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%pilocarpineor 0.25% physostigmine topically immediately after surgery before application of dressing to maintain miosis
• Forcataractsurgery, instill only after delivery of lens

Pediatric:

• Safety and efficacy not established

Overdose of acetylcholine can result in systemic absorption and may causehypotension, bradycardia,breathingdifficulties, flushing, and sweating. Overdose effects may be reversed with intravenous or intramuscular administration ofatropinesulfate. Epinephrine may be used if there are cardiovascular or bronchoconstrictor effects.

告知你的医生的药物你咕咕叫ently taking, who can advise you on any possibledrug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor’s recommendation.

• Acetylcholine has no known severe, serious, moderate or mild interactions with otherdrugs.

The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.

It is important to always tell your doctor, pharmacist, or health care provider of all prescription andover-the-countermedications you use, as well as the dosage for each, and keep a list of the information. Check with your doctor or health care provider if you have any questions about the medication.

• There are no well-controlled studies on the safety of acetylcholine for ophthalmic surgery inpregnantwomen. Use only if benefits to the mother outweigh possible risks to the mother and fetus.
• It is not known if acetylcholine is present inbreast milk. Although instillation into the eye is unlikely to result in significant systemic absorption, use with caution innursingmothers.