Acetylcholine chloride

Name: Acetylcholine chloride

Clinical 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.

Warnings

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 center 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 of MIOCHOL -E. During cataract surgery, use MIOCHOL -E only after delivery of the lens.

Aqueous solutions of acetylcholine chloride 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.

Overdosage

Atropine sulfate (0.5 to 1 mg) should be given intramuscularly or intravenously and should be readily available to counteract possible overdosage. Epinephrine (0.1 to 1 mg subcutaneously) is also of value in overcoming severe cardiovascular or bronchoconstrictor responses.

Dosage and Administration

With a new needle of sturdy gauge, 18-20, 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, 0.5 to 2 mL produces satisfactory miosis.

In cataract surgery, use MIOCHOL -E only after delivery of the lens.

Aqueous solutions of acetylcholine chloride 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 during preparation of solution.
  4. Immediately before use, give plunger-stopper a quarter turn and press to force diluent and center plug into lower chamber.
  5. Shake gently to dissolve drug.
  6. Discard univial and any unused solution.
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