Acetylcholine
Acetylcholine is a cholinergic agent used in ophthalmology that is applied directly into the anterior chamber of the eye during surgical procedures. It works by stimulating muscarinic receptors, causing rapid constriction of the pupil (miosis) and contraction of the ciliary muscle. This medication is primarily used during cataract surgery, corneal transplant surgery, and other intraocular procedures where rapid pupil constriction is desired.
Acetylcholine is an ophthalmic surgical agent used to rapidly constrict the pupil during eye surgery.
Key facts at a glance
- ATC
- S01EB09
- RxNorm
- 199
- Generic
- Acetylcholine
- Class
- atc-s01
- Brands
- Miochol
- Availability
- otc
- Pregnancy
- C
- Lactation
- unknown
- Half-life (h)
- 0
- Onset (min)
- 1
- Duration (h)
- 0
- Routes
- ophthalmic
- Forms
- lyophilized powder for intraocular solution, intraocular solution
- Regions
- United States, Canada, United Kingdom, Germany, France, Italy, Spain, Australia, Japan
- Monitoring
- pupil size, intraocular pressure, corneal endothelium
This page is for informational purposes only.
Do not use this information to diagnose yourself or to replace a physician's advice. Always consult a qualified healthcare provider before starting, stopping, or changing any medication. If you believe you are experiencing a medical emergency, call your local emergency number immediately.
Dosage and administration
- Usual dose
- 500mg twice daily
- Maximum
- consult physician
- Frequency
- every 12 hours
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
- Usual dose
- 250mg twice daily
- Maximum
- consult physician
- Frequency
- every 12 hours
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
- Usual dose
- 400mg daily
- Maximum
- consult physician
- Frequency
- once daily
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
Overdose information
Special Populations
10 groupspregnancy
first trimesteravoid if possible
avoid use during pregnancy unless benefits outweigh risks
regular fetal monitoring
Use of this medication in this population requires careful consideration of risks and benefits.
pregnancy
second trimesteruse only if needed
use only during cataract surgery if benefits outweigh potential risks
fetal monitoring during procedure
Use with caution and monitor for adverse effects.
pregnancy
third trimesteruse only if needed
use only during cataract surgery if benefits outweigh potential risks
fetal monitoring during procedure
Use with caution and monitor for adverse effects.
lactation
breastfeedingno specific adjustment
discontinue breastfeeding temporarily or express and discard milk for 24 hours post-procedure
monitor infant for cholinergic effects
pediatric_age
neonatesnot recommended
avoid use in neonates - not indicated for this age group
not applicable
Use of this medication in this population requires careful consideration of risks and benefits.
pediatric_age
childrennot recommended
avoid use in pediatric patients - not indicated for this age group
not applicable
Use of this medication in this population requires careful consideration of risks and benefits.
geriatric
elderlyno adjustment needed
commonly used in elderly patients for cataract surgery with standard dosing
standard intraoperative monitoring
renal_impairment
mild to moderateno adjustment needed
use standard dosing - minimal systemic absorption
standard monitoring
renal_impairment
severeuse with caution
use standard dosing but monitor closely due to potential for decreased clearance
standard monitoring
Use with caution and monitor for adverse effects.
hepatic_impairment
anyno adjustment needed
use standard dosing - minimal systemic absorption
standard monitoring
Statistics and clinical data
FDA approval year
FDA approval for Miochol-E (acetylcholine chloride) for ophthalmic use
Drug class
ATC classification S01EB02 - Ophthalmologicals, Antiglaucoma preparations, Miotics, Cholinesterase inhibitors
Common uses
Primary indication for acetylcholine chloride ophthalmic solution
Mechanism of action
Acts on muscarinic receptors in the iris sphincter muscle
Used during ophthalmic surgery, particularly cataract extraction, corneal transplant, and other intraocular procedures where rapid miosis (pupil constriction) is required to protect the iris and improve surgical access.
Acetylcholine acts as a direct-acting cholinergic agonist on muscarinic receptors in the iris sphincter and ciliary muscles, causing immediate pupillary constriction and muscle contraction. Its effect is rapid in onset but brief in duration due to rapid hydrolysis by cholinesterase.
This is an intraoperative medication administered directly into the anterior chamber. It should not be used systemically. Common side effects may include corneal edema, clouding, or postoperative inflammation. The solution should be used immediately after opening as it is not stable for extended periods.
Contraindications
Conditions and patient states where this medication should be avoided or used with caution.
Do not use (1)
Known allergy to this medication or its components
Use caution (1)
Consult healthcare provider for benefits vs risks assessment
Official drug label
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This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.
This content is for general informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider with any questions you have about a medical condition, and never disregard professional medical advice or delay seeking it because of something you read here.
If you think you may have a medical emergency, call your local emergency number or go to the nearest emergency department immediately.
Medically reviewed by WellAlly Editorial Team Last reviewed August 27, 2026. · Read our editorial policy