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SENSORY ORGANS › OPHTHALMOLOGICALS › ANTIGLAUCOMA PREPARATIONS AND MIOTICS › Parasympathomimetics
carbachol
S01EB02
Forms & Strengths
- Intraocular solution: 0.01% (Miochol-E)
- Topical ophthalmic solution: 0.75%
- Topical ophthalmic solution: 3%
Adult Dosing
- Intraocular: 0.5 mL of 0.01% solution injected into the anterior chamber for miosis during surgery
- Topical: 1 to 2 drops instilled into the eye up to 3 times daily for open-angle or narrow-angle glaucoma
Pediatric Dosing
- Safety and efficacy in pediatric patients have not been established
- Intraocular use off-label in pediatric cataract surgery: 0.1 to 0.5 mL of 0.01% solution
Indications
- Induction of miosis during intraocular surgery
- Reduction of intraocular pressure in the treatment of open-angle or narrow-angle glaucoma
Mechanism of Action
- Direct-acting cholinergic agonist stimulating muscarinic receptors
- Causes contraction of the iris sphincter (miosis) and ciliary muscle
- Contraction of ciliary muscle opens the trabecular meshwork spaces, decreasing aqueous humor outflow resistance and lowering intraocular pressure
Contraindications
- Hypersensitivity to carbachol or any component of the formulation
- Acute inflammatory disease of the anterior chamber
- Conditions where miosis is undesirable (e.g., acute iritis)
Adverse Reactions
- Transient corneal clouding
- Persistent miosis
- ocular hyperemia, burning, and stinging upon instillation
- Retinal detachment (rare, associated with intraocular use)
- Systemic cholinergic effects (rare: sweating, salivation, flushing, hypotension)
Drug Interactions
- Concurrent topical anticholinergics (e.g., atropine) antagonize the therapeutic effects of carbachol
- Additive bradycardia or systemic toxicity when used with systemic cholinesterase inhibitors or beta-blockers
Curated Content: Needs Vetting Before Put to Clinical Use