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Cholinergic miotic (intra-ocular)

Acetylcholine chloride

Brand names: Miochol-E

Acetylcholine chloride is a cholinergic agonist used as a sterile intraocular solution to produce rapid, complete miosis during anterior segment ophthalmic surgery, such as cataract extraction.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It directly stimulates muscarinic receptors on the iris sphincter and ciliary muscle, causing prompt pupillary constriction when applied within the eye.

Prescribing in practice

  • It must be reconstituted immediately before use and instilled gently into the anterior chamber, as the prepared solution is unstable and rapidly hydrolysed.
  • Systemic cholinergic effects such as bradycardia, hypotension, flushing, and bronchospasm can occur and may require atropine.
  • Use with caution in patients with asthma, marked bradycardia, or peptic ulcer disease.

Monitoring

Observe intraoperatively for the desired miotic response and for any systemic cholinergic effects on heart rate and blood pressure.

Counselling the patient

  • Explain to the surgical team that this is used intraocularly to constrict the pupil during surgery.
  • Prepare the solution immediately before instillation and discard any unused portion.
  • Have atropine available in case of systemic cholinergic effects.

Evidence & guidelines

A long-established intraocular miotic for anterior segment surgery, consistent with the SPC.

Reference: RCOphth Cataract Surgery Guidelines 2018; SmPC Miochol-E; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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