Carbachol

MIOSTAT

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Carbachol ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Carbachol ballicule

What it isNon-selective cholinergic agonist resistant to cholinesterase; intraoperative miosis and glaucoma.

Why this oneIts resistance to hydrolysis gives a longer effect than acetylcholine in the eye.

What limits itSystemic absorption can cause sweating and abdominal cramps; use cautiously in patients with asthma, acute heart failure, or urinary obstruction.

Carbachol molecular structure (skeletal formula) — Molecular structure: Carbachol

FDA-approved for

miosis (ophthalmic surgery)
glaucoma

Principal riskNicotinic as well as muscarinic activity, so systemic absorption causes broad cholinergic effect

Classes and tags

Clinical profile

Therapeutic safety burden1 / 4

Sedation liability0 / 4

Direct muscarinic antagonism0 / 4

FDA label

Read the full label on DailyMed ↗

NO BOXED WARNINGS

FDA dosing	Population	Start	Target	Max
Miosis during ocular surgery; reduces IOP elevation in first 24 h after cataract surgery	Adults	No more than 0.5 mL gently instilled into anterior chamber, single intraoperative dose	Single dose (miosis maximal within 2-5 min)	0.5 mL

Renal Undefined

Hepatic Undefined

Instructions

Single-dose intraocular use only; discard unused portion
Withdraw into dry sterile syringe; replace needle with atraumatic cannula before instillation
May be instilled before or after securing sutures

Available strengths

sol 0.01 %

Cautions

Use with caution in acute cardiac failure, bronchial asthma, peptic ulcer, hyperthyroidism, GI spasm, urinary tract obstruction, and Parkinson disease
Vial stopper contains natural rubber latex - severe allergic reactions possible

Adverse reactions

Corneal clouding/edema
Persistent bullous keratopathy
Retinal detachment
Postoperative iritis/eye inflammation
Prolonged miosis
Eye pain
Increased IOP
Blurred vision/visual impairment
Systemic (topical/systemic carbachol): flushing, sweating, epigastric distress, abdominal cramps, urinary bladder tightness, headache

Pregnancy No adequate well-controlled studies; use only if potential benefit justifies fetal risk

Lactation Unknown whether excreted in breast milk; exercise caution in nursing women

Cost

Carbachol (MIOSTAT)

Strength		#/mo	generic $/unit	CostPlus
0.01 %	sol	per unit		not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Carbachol is dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

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Self-check

Why does carbachol last longer than acetylcholine in the eye?
Resistance to hydrolysis.
Which respiratory condition warrants caution with carbachol?
Asthma.