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Ophthalmic surgery (miosis): Intraocular: 0.5 mL instilled into anterior chamber before or after securing sutures Dosing: Geriatric Refer to adult dosing. Dosing: Renal Impairment No dosage adjustment provided in manufacturer’s labeling. Dosing: Hepatic Impairment No dosage adjustment provided in manufacturer’s labeling. Dosage Forms: U.S. Excipient information presented when available (limited, particularly for generics); consult specific product labeling. Solution, intraocular: Miostat®: 0.01% (1.5 mL) Solution, ophthalmic: Isopto® Carbachol: 1.5% (15 mL); 3% (15 mL) [contains benzalkonium chloride] Generic Equivalent Available: U.S. No Administration Ophthalmic: Finger pressure should be applied on the lacrimal sac for 1-2 minutes following topical instillation; remove excess around the eye with a tissue. Intraocular: Instillation for miosis prior to eye surgery should be gentle and parallel to the iris face and tangential to the pupil border; discard unused portion. Do not inject >0.5 mL into the anterior chamber. Instillation may occur before or after securing sutures. Sterile technique must be used. Use Lowers intraocular pressure in the treatment of glaucoma; cause miosis during surgery Medication Safety Issues Sound-alike/look-alike issues: Isopto® Carbachol may be confused with Isopto® Carpine Adverse Reactions Significant Frequency not defined. Cardiovascular: Arrhythmia, flushing, hypotension, syncope Central nervous system: Headache Gastrointestinal: Abdominal cramps, diarrhea, epigastric distress, salivation, vomiting Genitourinary: Urinary bladder tightness Ocular: Bullous keratopathy, burning (transient), ciliary spasm, conjunctival injection, corneal clouding, irritation, postoperative iritis (following cataract extraction), retinal detachment, stinging (transient) Respiratory: Asthma Miscellaneous: Diaphoresis Contraindications Hypersensitivity to carbachol or any component of the formulation; acute iritis, acute inflammatory disease of the anterior chamber Warnings/Precautions

Disease-related concerns: • Asthma: Use with caution in patients with asthma. • Corneal abrasion: Use with caution in the presence of corneal abrasion. • Gastrointestinal disease: Use with caution in patients with peptic ulcer disease or gastrointestinal spasm. • Heart failure: Use with caution in patients with acute heart failure. • Hyperthyroidism: Use with caution in patients with hyperthyroidism. • Parkinson's disease: Use with caution in patients with Parkinson's disease. • Urinary tract obstruction: Use with caution in patients with urinary tract obstruction.

Concurrent drug therapy issues: • General anesthesia: Use with caution in patients undergoing general anesthesia. 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 Pregnancy Risk Factor C ( show table ) Pregnancy Implications Reproduction studies have not been conducted. Lactation Excretion in breast milk unknown/use caution Pricing: U.S. (Medi-Span®)

Solution (Miostat Intraocular) 0.01% (1.5 mL): $35.58 International Brand Names Carbachol (PL); Doryl (FI); Isopto Carbachol (AE, AU, BF, BH, BJ, CI, CY, DE, EG, ET, GB, GH, GM, GN, HR, IQ, IR, JO, KE, KW, LB, LR, LU, LY, MA, ML, MR, MU, MW, NE, NG, OM, QA, SA, SC, SD, SL, SN, SY, TN, TZ, UG, YE, ZA, ZM, ZW); Isopto Karbakolin (SE); Isopto-Carbachol (FI, IE); Karbakolin Isopto (DK); Miostat (AR, AU, BE, BR, CH, CZ, FR, HN, IL, KP, LU, MY, NL, NZ, PH, PK, PL, SG, TH, TR, TW); Mioticol (IT) Mechanism of Action Synthetic direct-acting cholinergic agent that causes miosis by stimulating muscarinic receptors in the eye Pharmacodynamics/Kinetics Ophthalmic instillation: Onset of action: Miosis: 10-20 minutes Duration: Reduction in intraocular pressure: 4-8 hours Intraocular administration: Onset of action: Miosis: 2-5 minutes Duration: 24 hours Use of UpToDate is subject to the Subscription and License Agreement . Topic 9197 Version 33.0 © 2013 UpToDate, Inc. All rights reserved. | Subscription and License Agreement | Release: 21.6- C21.56 Licensed to: AsanBook Dig. Med. Lib. | Support Tag: [0502-201.77.166.39-5CA193EFE4-S244013.14]