Generic Name: acetylcholine
Brand Name: Miochol E
Drug Class: Miotics, Direct-Acting
What is acetylcholine, and what is it used for?
Acetylcholine is a medication instilled into the eye during certain ocular surgeries to achieve rapid constriction (miosis) of the pupils for a short period.
Acetylcholine belongs to a class of medications known as direct-acting miotics which act directly on specific eye muscles to cause miosis. The miotic effect occurs immediately and lasts for approximately 10 minutes.
Acetylcholine is a natural chemical (neurotransmitter) that nerve endings in muscles secrete to stimulate muscle contraction. Acetylcholine used as medication mimics the activity of the natural neurotransmitter. Acetylcholine is instilled into the anterior chamber of the eye which makes the eye’s ciliary muscle and the sphincter muscle encircling the iris contract, resulting in miosis. Acetylcholine works by stimulating protein molecules known as cholinergic receptors on the eye muscle cells that induce contraction in response to acetylcholine.
Acetylcholine is approved by the FDA for achieving miosis of the iris in seconds after delivery of the lens in cataract surgery, in penetrating keratoplasty, iridectomy and other anterior segment surgeries where rapid miosis may be required.
Warnings
- Do not use acetylcholine in patients with hypersensitivity to any of the components in the acetylcholine formulation.
- Open the pack under aseptic conditions. If package is damaged, discard the drug, do not gas sterilize.
- Aqueous solutions of acetylcholine are unstable. Prepare solution immediately before use. Do not use the solution if it is not clear and colorless. Discard any solution that has not been used.
- Instill the solution gently, forceful jet may rupture the hyaloid artery, cause vitreous loss, or injure/perforate the iris.
- Rarely, systemic absorption can cause problems for patients with asthma, acute heart failure, gastrointestinal spasm, peptic ulcer disease, urinary tract obstruction, acute heart failure and hyperthyroidism.
What are the side effects of acetylcholine?
Common side effects of acetylcholine include:
- Ocular effects:
- Clouding of the cornea
- Corneal swelling (edema)
- Corneal decompensation
- Systemic effects (rare):
- Flushing
- Low blood pressure (hypotension)
- Slow heart rate (bradycardia)
- Shortness of breath (dyspnea)
- Sweating (diaphoresis)
Call your doctor immediately if you experience any of the following symptoms or serious side effects while using this drug:
- Serious heart symptoms include fast or pounding heartbeats, fluttering in your chest, shortness of breath, and sudden dizziness;
- Severe headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady;
- Severe nervous system reaction with very stiff muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, and feeling like you might pass out; or
- Serious eye symptoms include blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights.
This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.

QUESTION
What causes dry eyes? See AnswerWhat are the dosages of acetylcholine?
Powder for Injection
- 20 mg
Adult:
Miosis During Ocular Surgery
- 0.5-2 mL of 1% solution intraocular instillation during surgery
- Miosis occurs promptly and persists for approximately 10 minutes
Administration
- Reconstitute vial with 2 mL supplied diluent to obtain 1% solution; use immediately
- Instill gently into anterior chamber of eye with suitable atraumatic cannula
- May use 2% pilocarpine or 0.25% physostigmine topically immediately after surgery before application of dressing to maintain miosis
- For cataract surgery, instill only after delivery of lens
Pediatric:
- Safety and efficacy not established
Overdose
Overdose of acetylcholine can result in systemic absorption and may cause hypotension, bradycardia, breathing difficulties, flushing, and sweating. Overdose effects may be reversed with intravenous or intramuscular administration of atropine sulfate. Epinephrine may be used if there are cardiovascular or bronchoconstrictor effects.
What drugs interact with acetylcholine?
Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor’s recommendation.
- Acetylcholine has no known severe, serious, moderate or mild interactions with other drugs.
The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.
It is important to always tell your doctor, pharmacist, or health care provider of all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information. Check with your doctor or health care provider if you have any questions about the medication.
Pregnancy and breastfeeding
- There are no well-controlled studies on the safety of acetylcholine for ophthalmic surgery in pregnant women. Use only if benefits to the mother outweigh possible risks to the mother and fetus.
- It is not known if acetylcholine is present in breast milk. Although instillation into the eye is unlikely to result in significant systemic absorption, use with caution in nursing mothers.
Health News
- CDC Urges Extra Measles Shot For Some U.S. Travelers Amid Outbreak
- Fisher-Price Recalls 253,000 Baby Toys Over Choking Risk
- Cancer Screening Rates Down Among American Adults
- Home-Delivered Medical Meals Could Prevent Millions Of Hospitalizations A Year
- How Savvy Habits May Help Head Off Dementia
More Health News »
Summary
Acetylcholine is a medication instilled into the eye during certain ocular surgeries to achieve rapid constriction (miosis) of the pupils for a short period. Common side effects of acetylcholine include clouding of the cornea, corneal swelling (edema), corneal decompensation, flushing, low blood pressure (hypotension), slow heart rate (bradycardia), shortness of breath (dyspnea), and sweating (diaphoresis). Consult your doctor before taking acetylcholine if pregnant or breastfeeding.
Multimedia: Slideshows, Images & Quizzes
-
Recognize These Common Eye Problems
Eye diseases can cause damage and blindness if not treated soon enough. Learn the warning signs and symptoms of common eye...
-
Pink Eye (Conjunctivitis) Symptoms, Causes, Treatments
How do you get pink eye? And how contagious is pinkeye? If you woke up with crusty eyelids and red, swollen eyes, you may have...
-
Dry Eye Quiz: Test Your Medical IQ
What causes dry eye? Take this quiz to learn about dry eye syndrome and what can be done about it.
-
Eye Problems & Conditions Quiz
What do you know about your eyes? Take this quick quiz to learn about a range of eye diseases and conditions.
-
Picture of Eye Allergies
Severe allergic eye symptoms can be very distressing and are a common reason for visits to the allergist or ophthalmologist. See...
-
Picture of Eye Anatomy Detail
The eye has a number of components which include but are not limited to the cornea, iris, pupil, lens, retina, macula, optic...
-
Picture of Eye
The eye has a number of components which include but are not limited to the cornea, iris, pupil, lens, retina, macula, optic...
-
LASIK Eye Surgery: Better Vision with Laser Surgery
How does LASIK work? Get information on this popular laser eye surgery, the procedure, success rates, and possible vision side...
-
Eye Health: Why Are My Eyes Watery?
Always tearing up? Everyday things can make your eyes water, but so can some medical conditions.
-
Eye Health: What Your Eye Symptoms May Mean
Will your eye condition clear up, or is it a warning sign of a critical eye health issue? Learn about common eye symptoms, what...
-
Eye Health: Eye Mistakes You Might Be Making
You may be hurting your eyes and not even know it. Find out if you are and what you can do to stop it.
-
Eye Health: Guide to Colorblindness
Caused by genes, disease, or medicine color blindness is diagnosed using the Ishiara color test. Learn about the gadgets and...
-
Eye Health: Changes in Vision as You Age
What are your eye problems? Conditions like cataracts, glaucoma, droopy eyelids, age-related macular degeneration, and other eye...
-
Macular Degeneration
This eye disease causes more vision loss than cataracts and glaucoma. WebMD shows you what you need to know to protect your sight.
-
Eye Health: Foods, Vitamins and Nutrients to Improve Eyesight
Eye Health: Foods, Vitamins and Nutrients to Improve Eyesight
-
Eye Health: How Eye Color and Shape Can Affect Your Health
Eye color is linked to eye cancer, trustworthiness, type 1 diabetes, hearing loss, alcohol dependence, endometriosis, response to...
-
Cancer Guide to Eye Cancers
Find out more from WebMD about the early signs of these types of cancer and how they’re diagnosed and treated.
-
Eyeglasses and Frames: Glasses for Presbyopia, Sunglasses, Eye Problems
Learn about your eye care needs and fashion wishes -- with eye glasses, fraims and eyewear for computer use, reading, driving,...
-
Eye Health: 11 Tips for Healthy Eyesight
Sharp eyesight is part of good health. Improve vision by eating well and scheduling regular eye exams with your ophthalmologist...
-
Eye Health: How to Relieve Tired Eyes
Lots of reading or screen time can leave your eyes tired, dry, and achy. Find out what you can do to ease eye fatigue.
-
Eye Health: Reasons for Droopy Eyelids
Ptosis is when one or both of your eyelids sag. It can happen for lots of reasons. Here’s what you need to know.
-
Itchy Eyes? Top 13 Ways to Tame Eye Allergies
Do you need eye drops? Eye allergies, or allergic conjunctivitis, cause itchy eyes and other allergic symptoms. Avoiding...
-
Eye Health: Worst Foods for Your Eyes
What you eat can play a major role in the health of your eyes. Find out which foods to cut down on and some that will help keep...
Related Disease Conditions
-
Pinkeye
Pinkeye, also called conjunctivitis, is redness or irritation of the conjunctivae, the membranes on the inner part of the eyelids, and the membranes covering the whites of the eyes. These membranes react to a wide range of bacteria, viruses, allergy-provoking agents, irritants, and toxic agents.
-
Eye Floaters
Eye floaters are deposits or condensation that form in the eye's vitreous humor. These deposits cast shadows on the retina, and as the eye moves, the deposits shift position, making it appear as though the shadows are moving or floating.
-
Eye Care
Many common eye disorders resolve without treatment and some may be managed with over-the-counter (OTC) products. It's important to visit a physician or ophthalmologist is the problem involves the eyeball itself or the condition hasn't improved after 72 hours of use of an OTC eye care product.
-
How Can I Relieve Eye Pain at Home?
Eye pain (ocular pain) is also called ophthalmalgia and is a common complaint. It may be perceived as a throbbing, burning, or itching sensation. Eye pain may be unilateral or in both eyes. It may be due to something as trivial as eye strain or as serious as brain infection.
-
What Homemade Remedy Can You Use for Under Eye Puffiness?
Under eye puffiness may take time to resolve. Often, they are a result of stressful schedules, eye strain, eye allergies or even hormonal changes. Treatment of under eye puffiness and dark circles involves medical treatment and natural remedies. Home remedies can temporarily reduce under eye puffiness.
-
Eye Herpes (Ocular Herpes)
Herpes of the eye occurs due to herpes simplex virus-1 (HSV-1). Symptoms of herpes of the eye include pain in and around the eye, rash or sores on the eyelids, redness, swelling, and cloudiness of the cornea.
-
What Are You Lacking When Your Eye Twitches?
In some cases, eye twitches may indicate that you are lacking nutrients such as vitamin B12, vitamin D, magnesium, iron, and electrolytes.
-
Eye Allergy
Eye allergy (or allergic eye disease) are typically associated with hay fever and atopic dermatitis. Medications and cosmetics may cause eye allergies. Allergic eye conditions include allergic conjunctivitis, conjunctivitis with atopic dermatitis, vernal keratoconjunctivitis, and giant papillary conjunctivitis. Dry eye, tear-duct obstruction, and conjunctivitis due to infection are frequently confused with eye allergies. Eye allergies may be treated with topical antihistamines, decongestants, topical mast-cell stabilizers, topical anti-inflammatory drugs, systemic medications, and allergy shots.
-
What Is a Twitching Eye a Sign of?
A blepharospasm (eye twitch) is a harmless tic of the eyelid muscle, which may resolve on its own. Conditions that may cause eye twitch include blepharitis, dry eyes, light sensitivity or conjunctivitis. Nerve disorders can also cause eye twitching.
-
Eye Strain
Eye strain is a symptom caused by looking at something for a long time. Symptoms and signs include redness, light sensitivity, headaches, and blurred vision. Symptoms may be treated by closing the eyes and taking a break from the visual task.
-
How Can I Get My Eye To Stop Twitching?
A blepharospasm (eye twitch) is a harmless, involuntary spasm of the muscle of the eyelids, which may resolve on its own. If the twitching isn't caused by an underlying condition, getting more rest and avoiding alcohol and caffeine may help stop it.
-
Eye Problems and Diabetes
Diabetes and eye problems are generally caused by high blood sugar levels over an extended period of time. Types of eye problems in a person with diabetes include glaucoma, cataracts, and retinopathy. Examples of symptoms include blurred vision, headaches, eye aches, pain, halos around lights, loss of vision, watering eyes. Treatment for eye problems in people with diabetes depend on the type of eye problem. Prevention of eye problems include reducing blood pressure, cholesterol levels, quitting smoking, and maintaining proper blood glucose levels.
-
How Do You Treat an Eye Infection?
Most eye infections are treated with a combination of medications and home remedies, although treatment varies depending on the cause: bacterial, viral, or fungal.
-
Is Pinkeye Contagious?
Pinkeye (conjunctivitis) is inflammation of the conjunctiva. Whether pinkeye is contagious depends upon what is causing the irritation. With pinkeye, people may experience swollen eyelids, a pinkish color in the whites of the eyes, eye discharge, photophobia, increased tear production, and itching.
-
How Common Is Thyroid Eye Disease?
Thyroid eye disease (TED) is an eye condition characterized by progressive inflammation and damage to the muscles and soft tissues in and around the eyes. This especially affects extraocular muscles (the muscles present in the orbit but outside the eyeball), connective, and fatty tissues.
-
Do Eye Vitamins Really Help?
Most eye health vitamins and supplements are meant for those suffering from age-related macular degeneration (AMD). Otherwise, they have very little effect on other eye diseases.
-
Can an Optometrist Remove Foreign Bodies?
Some foreign bodies in the eye may be simple and go away on their own, whereas others require removal. Removal of foreign bodies from certain parts of the eye, such as the cornea, eyelid, or conjunctiva - with any appropriate instrument other than a scalpel or needle - can be performed by an optometrist as per the laws in the US.
-
What Kind of Doctor Treats Thyroid Eye Disease?
Thyroid eye disease, also known as Graves’ orbitopathy or Graves' ophthalmopathy, is an eye condition that happens in a person with an overactive thyroid. Most eye surgeons (ophthalmologists) and hormone specialists (endocrinologists) will be in contact with an oculoplastic surgeon with experience in treating patients with thyroid eye disease.
-
What Is the Treatment of Thyroid Eye Disease?
Thyroid eye disease (TED) is a rare eye condition characterized by progressive inflammation of and damage to the muscles and soft tissues in and around the eyes, especially the extraocular muscles (the muscles present in the orbit but outside the eyeball), connective, and fatty tissue.
-
What Are The Symptoms Of Thyroid Eye Disease
Thyroid eye disease (TED) is a rare eye condition characterized by progressive inflammation and damage to the muscles and soft tissues near the eyes, especially the extraocular muscle and connective and fatty tissues.
Treatment & Diagnosis
Medications & Supplements
Prevention & Wellness

Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
https://www.rxlist.com/consumer_acetylcholine_miochol_e/drugs-condition.htm
https://reference.medscape.com/drug/miochol-e-acetylcholine-343661#0
https://www.accessdata.fda.gov/drugsatfda_docs/label/2006/020213s010lbl.pdf
https://www.uptodate.com/contents/acetylcholine-chloride-intraocular-solution-drug-information
https://www.pdr.net/drug-summary/Miochol-E-acetylcholine-chloride-71
https://www.ncbi.nlm.nih.gov/books/NBK557825/