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Carbachol: Drug information

Carbachol: Drug information
(For additional information see "Carbachol: Patient drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: US
  • Miostat
Brand Names: Canada
  • Miostat
Pharmacologic Category
  • Cholinergic Agonist;
  • Ophthalmic Agent, Miotic
Dosing: Adult
Ophthalmic surgery

Ophthalmic surgery (miosis): Intraocular: 0.5 mL instilled into anterior chamber before or after securing sutures

Dosing: Kidney Impairment: Adult

No dosage adjustment provided in manufacturer's labeling.

Dosing: Hepatic Impairment: Adult

No dosage adjustment provided in manufacturer's labeling.

Dosing: Older Adult

Refer to adult dosing.

Adverse Reactions

The following adverse drug reactions are derived from product labeling unless otherwise specified.

Postmarketing:

Cardiovascular: Flushing

Dermatologic: Diaphoresis

Gastrointestinal: Abdominal cramps, epigastric discomfort, vomiting

Genitourinary: Bladder spasm

Nervous system: Headache

Ophthalmic: Blurred vision, corneal edema, corneal opacity, epithelial keratopathy (bullous), eye pain, increased intraocular pressure, iritis (postoperative), ocular hyperemia, ophthalmic inflammation, retinal detachment, visual impairment

Contraindications

Hypersensitivity to carbachol or any component of the formulation.

Warnings/Precautions

Disease-related concerns:

• Asthma: Use with caution in patients with asthma.

• 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. 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]).

• Hyperthyroidism: Use with caution in patients with hyperthyroidism.

• Parkinson disease: Use with caution in patients with Parkinson's disease.

• Urinary tract obstruction: Use with caution in patients with urinary tract obstruction.

Dosage form specific issues:

• Latex: Injection packaging may contain natural latex rubber.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Intraocular [preservative free]:

Miostat: 0.01% (1.5 mL)

Generic Equivalent Available: US

No

Pricing: US

Solution (Miostat Intraocular)

0.01% (per mL): $33.72

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Intraocular:

Miostat: 0.01% (1.5 mL)

Administration: Adult

Intraocular: Do not inject >0.5 mL into the anterior chamber. Instillation may occur before or after securing sutures. Sterile technique must be used.

Use: Labeled Indications

Ophthalmic surgery: To obtain miosis during cataract surgery and reduce intraocular pressure following cataract surgery.

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Cyclopentolate: May diminish the therapeutic effect of Carbachol. Risk C: Monitor therapy

Tropicamide: May diminish the therapeutic effect of Carbachol. Risk C: Monitor therapy

Pregnancy Considerations

Reproduction studies have not been conducted.

Breastfeeding Considerations

It is not known if carbachol is excreted in breast milk. The manufacturer recommends that caution be exercised when administering carbachol to nursing women.

Mechanism of Action

Synthetic direct-acting cholinergic agent that causes miosis by stimulating muscarinic receptors in the eye

Pharmacokinetics (Adult Data Unless Noted)

Onset of action: Miosis: 2 to 5 minutes.

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Miostat;
  • (AR) Argentina: Miostat;
  • (AU) Australia: Miostat;
  • (BE) Belgium: Miostat;
  • (CO) Colombia: Miostat;
  • (CZ) Czech Republic: Miostat;
  • (EE) Estonia: Miostat;
  • (FI) Finland: Miostat;
  • (HU) Hungary: Miostat;
  • (ID) Indonesia: Miostat;
  • (KR) Korea, Republic of: Miostat;
  • (LB) Lebanon: Miostat;
  • (LT) Lithuania: Miostat;
  • (MX) Mexico: Miostat;
  • (MY) Malaysia: Miostat;
  • (NL) Netherlands: Miostat;
  • (NO) Norway: Miostat;
  • (PH) Philippines: Miostat;
  • (PK) Pakistan: Miostat;
  • (PL) Poland: Miostat;
  • (PR) Puerto Rico: Miostat;
  • (PY) Paraguay: Miostat;
  • (SG) Singapore: Miostat;
  • (SI) Slovenia: Miostat;
  • (TH) Thailand: Miostat;
  • (TR) Turkey: Miostat
  1. Miostat (carbachol) [prescribing information]. Forth Worth, TX: Alcon Laboratories Inc; June 2021.
  2. Page RL 2nd, O'Bryant CL, Cheng D, et al; American Heart Association Clinical Pharmacology and Heart Failure and Transplantation Committees of the Council on Clinical Cardiology; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular and Stroke Nursing; and Council on Quality of Care and Outcomes Research. Drugs That May Cause or Exacerbate Heart Failure: A Scientific Statement From the American Heart Association. Circulation. 2016;134(6):e32-e69. doi:10.1161/CIR.0000000000000426 [PubMed 27400984]
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