the women Carbachol Class: Miotics ATC Class: S01EB02 VA Class: OP102 CAS Number: 51-83-2 Brands: Miostat, Isopto Carbachol Overview Side Effects Dosage Professional Interactions More Pregnancy Warnings Breastfeeding Warnings User Reviews Support Group Q & A Introduction Miotic; direct-acting parasympathomimetic agent. a b c d Slideshow Easy On The Eye - 8 Tips for Maintaining Good Eyesight Uses for Carbachol Open-Angle Glaucoma Reduction of elevated intraocular pressure (IOP) in patients with primary, open-angle (chronic simple, noncongestive) glaucoma. c d Used mainly in patients refractory or hypersensitive to pilocarpine. d May use concomitantly with sympathomimetic agents, β-adrenergic blocking agents, or carbonic anhydrase inhibitors. d Ocular Surgery Production of miosis during surgery on the anterior chamber of the eye (e.g., cataract extraction, keratoplasty, peripheral iridectomy, cyclodialysis). b d Reduction of the intensity of IOP elevation for the first 24 hours after cataract surgery. b Intraocular acetylcholine generally preferred. d Angle-Closure Glaucoma Reduction of IOP in the emergency treatment of acute (congestive) angle-closure glaucoma prior to surgery. d Pilocarpine generally preferred. d Ophthalmologic Examinations Production of miosis to counteract mydriatic effects of sympathomimetic agents (e.g., hydroxyamphetamine, phenylephrine) after ophthalmoscopic examinations in glaucoma patients. d Pilocarpine generally preferred. d Carbachol Dosage and Administration Administration Ophthalmic Administration Administer ophthalmic topical solution to the conjunctival sac; do not inject. a c d Administer intraocular injection by injection into the anterior chamber. a d Topical Solution Remove contact lenses before instilling solution. c d To minimize adverse effects, begin with a low concentration and increase gradually as needed. d Additionally, instill daily dose or one of the daily doses at bedtime. d Following topical instillation, apply finger pressure on the lacrimal sac for 1 2 minutes to minimize drainage into nose and throat and reduce risk of absorption and systemic reactions. a d Remove excess solution around the eye with a tissue and rinse off any medication on hands immediately. a d Intraocular Injection Instill into anterior chamber of the eye before or after securing sutures, following the manufacturer s directions. b Vials are for single-dose use only; discard unused portion. a b Dosage Adjust concentration and frequency of solution instillation according to patient requirements and response, as determined by tonometric readings before and during therapy. a d In patients with heavily pigmented irides, higher solution concentrations may be required. d Adults Open-Angle Glaucoma Ophthalmic Topical 1 2 drops of 1.5 3% topical solution up to 3 times daily. c Ocular Surgery Intraocular Inject 0.5 mL of a 0.01% solution. a b Prescribing Limits Adults Ocular Surgery Intraocular Maximum: 0.5 mL of a 0.01% injection. b Special Populations No special population dosage recommendations at this time. Cautions for Carbachol Contraindications Known hypersensitivity to carbachol or any ingredient in the formulation. a b c d Conditions in which pupillary constriction is undesirable (e.g. acute iritis, pupillary block). c d Warnings/Precautions Warnings Systemic Toxicity Systemic reactions (e.g., salivation, syncope, cardiac arrhythmia, epigastric distress, headache, vomiting, asthma, hypotension, diarrhea, urinary urgency, increased sweating) reported rarely after topical application or intraocular injection; usually occur only with very frequent administration. b c d Use cautiously in patients with acute cardiac failure, bronchial asthma, active peptic ulcer, hyperthyroidism, GI spasm, urinary tract obstruction, Parkinson s disease, recent MI, or systemic hypertension or hypotension. b c d Use topical solution cautiously in presence of corneal abrasion to avoid excessive penetration and systemic toxicity. c d If systemic symptoms occur, discontinue drug, at least temporarily. d Ocular Toxicities Retinal detachment reported rarely; use with extreme caution, if at all, in patients with a history or risk of retinal detachment, especially if young or aphakic. c d Carefully examine retinal periphery at least annually to detect an impending detachment. d Intraocular injection: Corneal clouding, persistent bullous keratopathy, retinal detachment, and postoperative iritis reported following cataract extraction in some patients. a b Sensitivity Reactions Hypersensitivity Allergic conjunctivitis, dermatitis, or keratitis reported occasionally with miotics; usually alleviated by changing to another miotic. d In some instances, allergic reactions may be caused by preservatives in the preparations. d Discontinue the drug if sensitivity develops or if original irritation persists or increases. d General Precautions Ocular Effects (Topical Solution) Possible spasm of accommodation and poor vision in dim light, particularly in geriatric patients and patients with lens opacities. c d (See Advice to Patients.) Adverse effects often subside after first few days of therapy or if drug is temporarily discontinued. d (See Administration under Dosage and Administration.) Possible transient increase in IOP even when the angle is open. d In some patients with angle-closure glaucoma receiving miotics, may increase IOP and precipitate acute attacks. d Possible lens opacities and cataracts; lens opacities may regress if therapy discontinued early in development; however, cataracts are often progressive. d Regular slit-lamp examinations recommended; discontinue therapy, at least temporarily, if iris cysts, iritis, synechiae, or lens opacities occur. d Specific Populations Pregnancy Category C. b c Lactation Not known whether carbachol is distributed into milk. b c d Use with caution. b c Pediatric Use Safety and efficacy not established. b c d Geriatric Use Reduced visual acuity in dim light is common in geriatric patients. c d (See Ocular Effects [Topical Solution] under Cautions.) Common Adverse Effects Topical solution: Ocular irritation (burning or discomfort), lacrimation, temporal or periorbital headache, painful ciliary or accommodative spasm, blurred vision or myopia, conjunctival vascular congestion, poor vision in dim light. c d Interactions for Carbachol Specific Drugs Drug Interaction Comments Miotics, anticholinesterase Possible antagonism d Concomitant use of miotics not recommended; unresponsiveness to both drugs may develop d Increased risk of allergic reactions and toxicity d Ocular hypotensive agents (e.g., carbonic anhydrase inhibitors, topical epinephrine, topical timolol) Additive IOP lowering effects d Used to therapeutic advantage d Carbachol Pharmacokinetics Absorption Bioavailability Topical carbachol penetrates intact corneal epithelium very poorly; penetration greatly improved in combination with wetting agent (e.g., benzalkonium chloride 0.003%). d May be absorbed through intact skin. d Onset Topical solution: Miosis occurs within 10 20 minutes; maximal reduction in IOP occurs within 4 hours. a Intraocular injection: Maximal miosis occurs within 2 5 minutes. a b Duration Topical solution: Miosis persists for 4 8 hours; reduced IOP persists for approximately 8 hours (3% solution has a slightly longer duration of action than lower concentrations). a Intraocular injection: Miosis persists for about 24 hours. a Stability Storage Ophthalmic Topical Solution 8 27 C. c Intraocular Injection 15 30 C; protect from freezing and excessive heat. a b Stable for 18 months after the date of manufacture. a Actions Choline ester; structurally related to acetylcholine. a Directly stimulates cholinergic receptors, resulting in muscarinic and nicotinic effects. c d Indirectly inhibits cholinesterase activity. c Resistant to hydrolysis by cholinesterases. c May increase release of acetylcholine following nerve stimulation. d Contracts the iris sphincter and the ciliary muscle, which produces constriction of the pupil (miosis) and spasm of accommodation, respectively. b d Reduces IOP in normal and glaucomatous eyes. d Exact mechanism for lowering IOP is not precisely known. b d Facilitates aqueous humor outflow by contracting the ciliary muscle and widening the trabecular meshwork. d Decreases activity of extraocular muscles of convergence and causes vasodilation of blood vessels of the conjunctiva, iris, and ciliary body and increased permeability of the blood-aqueous barrier, which may lead to vascular congestion and ocular inflammation. d Systemically absorbed carbachol produces parasympathomimetic effects on various body systems. d (See Systemic Toxicity under Cautions.) Advice to Patients Importance of removing contact lenses prior to administering topical solution. c d Importance of not touching dropper tip to any surface in order to avoid contamination. c Advise patient to immediately contact clinician if signs or symptoms of an ocular infection occur. d Importance of using caution in night driving or other hazardous tasks in poor light. c d Importance of instilling daily dose or one of daily doses at bedtime to minimize adverse ocular effects. d Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs. d Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed. d Importance of informing patients of other important precautionary information. (See Cautions.) Preparations Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details. Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations. * available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name Carbachol Routes Dosage Forms Strengths Brand Names Manufacturer Bulk Powder Ophthalmic Injection, for intraocular use only 100 mcg/mL (0.01%) Miostat Intraocular Alcon Solution* 1.5% Isopto Carbachol (with benzalkonium chloride; viscous) Alcon 3%* Isopto Carbachol (with benzalkonium chloride; viscous) Alcon AHFS DI Essentials. Copyright 2017, Selected Revisions May 1, 2008. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814. Use is not currently included in the labeling approved by the US Food and Drug Administration. References a. AHFS Drug Information 2008. McEvoy GK, ed. Carbachol. Bethesda, MD: American Society of Health-System Pharmacists; 2008:2944-5. b. Alcon Laboratories, Inc. Miostat (carbachol intraocular solution, USP) prescribing information. Fort Worth, TX; 2003 Dec. From website . Accessed 2007 Sept 20. c. Alcon Laboratories, Inc. Isopto carbachol (carbachol ophthalmic solution) prescribing information. Fort Worth, TX; 2003 Sept. d. AHFS Drug Information 2008. McEvoy GK, ed. Miotics general statement. Bethesda, MD: American Society of Health-System Pharmacists; 2008:2940-3. Next Interactions Print this page Add to My Med List More about carbachol ophthalmic Side Effects During Pregnancy or Breastfeeding Dosage Information Drug Interactions Support Group En Español 0 Reviews Add your own review/rating Drug class: ophthalmic glaucoma agents Consumer resources Carbachol ophthalmic Carbachol Eye Drops Carbachol Ocular Injection Professional resources Other brands: Miostat , Carbastat Related treatment guides Glaucoma Intraocular Hypertension Production of Miosis} FEATURED: CAR-T Cell Therapy Overview Mechanism of Action KTE-C19 Studies KTE-C19 Cancer Targets Adverse Events Manufacturing Drug Status Rx Availability Prescription only C Pregnancy Category Risk cannot be ruled out N/A CSA Schedule Not a controlled drug Approval History Drug history at FDA Drug Class Ophthalmic glaucoma agents Related Drugs Production of Miosis pilocarpine ophthalmic , acetylcholine ophthalmic , Isopto Carpine , Miostat , Isopto Carbachol , Pilopine HS , More... Glaucoma Combigan , nadolol , pilocarpine ophthalmic , acetazolamide , Diamox , mitomycin ophthalmic , Corgard , methazolamide , More... Intraocular Hypertension timolol ophthalmic , Lumigan , latanoprost ophthalmic , Travatan , brimonidine ophthalmic , Xalatan , Combigan , Alphagan , More... Carbachol ophthalmic Rating No Reviews - Be the first! No Reviews - Be the first! Not Rated - Be the first!} } reputable
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