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Adverse Reactions Cardiovascular: Bradycardia, flushing, hypotension Ocular: Clouding, corneal edema, decompensation Respiratory: Dyspnea Miscellaneous: Diaphoresis Contraindications Hypersensitivity to acetylcholine chloride or any component; acute iritis and acute inflammatory disease of the anterior chamber Precautions Systemic effects rarely occur, but can cause problems for patients with acute CHF, bronchial asthma, peptic ulcer, hyperthyroidism, GI spasm, and urinary tract obstruction Warnings Open under aseptic conditions only Metabolism/Transport Effects None known. Drug Interactions (For additional information: Launch Lexi-Interact™ Drug Interactions Program ) Acetylcholinesterase Inhibitors: May enhance the adverse/toxic effect of Cholinergic Agonists. Risk C: Monitor therapy Beta-Blockers: May enhance the adverse/toxic effect of Cholinergic Agonists. Of particular concern are the potential for cardiac conduction abnormalities and bronchoconstriction. Management: Administer these agents in combination with caution, and monitor for conduction disturbances. Avoid methacholine with any beta blocker due to the potential for additive bronchoconstriction. Risk C: Monitor therapy Mechanism of Action Causes contraction of the sphincter muscles of the iris, resulting in miosis and contraction of the ciliary muscle, leading to accommodation Pharmacodynamics Onset of action: Miosis occurs promptly Duration: ∼10-20 minutes Use of UpToDate is subject to the Subscription and License Agreement . Topic 13221 Version 31.0 © 2013 UpToDate, Inc. All rights reserved. | Subscription and License Agreement | Release: 21.6- C21.56 Licensed to: AsanBook Dig. Med. Lib. | Support Tag: [0503-61.234.146.186-DA858D2583-S244013.14]