Name: Acetylcholine


Causes contraction of the sphincter muscles of the iris, resulting in miosis and contraction of the ciliary muscle, leading to accommodation spasm

Use Labeled Indications

Ophthalmic surgery: To obtain miosis of the iris in seconds after delivery of the lens in cataract surgery, in penetrating keratoplasty, iridectomy, and other anterior segment surgery where rapid miosis may be required


Disease-related concerns:

• Diseases affected by systemic effects: Systemic effects rarely occur but can cause problems for patients with asthma, GI spasm, acute heart failure, hyperthyroidism, Parkinson's disease, peptic ulcer disease, and or urinary tract obstruction. In a scientific statement from the American Heart Association, ophthalmic cholinergic agents have been determined to be agents that may exacerbate underlying myocardial dysfunction (magnitude: minor) (AHA [Page 2016]).

Other warnings/precautions:

• Aseptic conditions: Open under aseptic conditions only; do not gas sterilize.

• Cataract surgery: During cataract surgery, use only after lens is in place.

Acetylcholine Brand Names

Acetylcholine may be found in some form under the following brand names:

  • Miochol

Acetylcholine ophthalmic Pregnancy Warnings

Animal reproduction studies have not been conducted. There are no adequate and well-controlled studies in pregnant women. AU TGA pregnancy category B2: Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. Studies in animals are inadequate or may be lacking, but available data show no evidence of an increased occurrence of fetal damage. US FDA pregnancy category Not Assigned: The US FDA has amended the pregnancy labeling rule for prescription drug products to require labeling that includes a summary of risk, a discussion of the data supporting that summary, and relevant information to help health care providers make prescribing decisions and counsel women about the use of drugs during pregnancy. Pregnancy categories A, B, C, D and X are being phased out.

Use is not recommended. AU TGA pregnancy category: B2 US FDA pregnancy category: Not assigned Comments: -It is unknown whether this drug can cause fetal harm when administered to a pregnant woman or can affect reproductive capacity. -Briggs, et al., state that acetylcholine, as a quaternary ammonium compound, is ionized at physiologic pH, and transplacental passage in significant amounts would not be expected.

Acetylcholine Identification

Substance Name


CAS Registry Number


Drug Class


Muscarinic Agonists,