carbachol (Rx)

Brand and Other Names:Miostat
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

intraocular solution

  • 0.01%

topical solution

  • 1.5%
  • 3%
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Glaucoma

1-2 gtt instilled into conjunctival sac three times daily

As a Miotic During Ocular Surgery

0.5 mL instilled into the anterior chamber before or after securing sutures

Administration

Topical solution: to reduce drainage to nose & throat, apply finger pressure to lacrimal sac following administration, remove excess solution from eye & hand

Intraocular Injection: Withdraw appropriate amount into a sterile disposable syringe through a 0.45-micron filter provided by manufacturer using a 21-gauge needle. Prior to administration, remove attached needle & filter from syringe & replace with a suitable atraumatic cannula for intraocular irrigation. Instillation should be gentle & parallel to the iris face & tangential to the pupil border. Discard unused portions.

As in adults

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Interactions

Interaction Checker

and carbachol

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            Adverse Effects

            Frequency Not Defined

            Ocular

            • Corneal clouding
            • Stinging (transient)
            • Ciliary spasm
            • Bullous keratopathy
            • Persistent bullous keratopathy
            • Postoperative iritis following cataract extraction
            • Retinal detachment (rare)
            • Corneal edema, drug effect prolonged miosis, eye inflammation, eye pain, intraocular pressure increased, ocular hyperemia, vision blurred, and visual impairment

            Systemic

            • Abdominal cramps
            • Epigastric distress
            • Flushing
            • Arrhythmia
            • Hypotension
            • Syncope
            • Epigastric stress
            • Salivation
            • Vomiting
            • Asthma
            • Diaphoresis
            • Headache
            • Sweating
            • Tightness in urinary bladder
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            Warnings

            Contraindications

            Hypersensitivity

            Acute iritis

            Acute inflammatory disease of the anterior chamber

            Cautions

            Use caution in asthma, acute heart failure, corneal abrasion, hyperthyroidism, urinary tract obstruction, Parkinson's disease, active peptic ulcer, GI spasm

            Does not penetrate cornea readily, benzalkonium chloride is added in some formulations to enhance corneal penetration (Isopto-Carbachol)

            Topical ophthalmic solution produces transient ocular & frontal headache

            Use with caution in patients undergoing general anesthesia

            The vial stopper contains natural rubber (latex) which may cause severe allergic reactions

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: Excretion in milk unknown; use with caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Stimulates cholinergic receptors in the eye and in turn causes miosis

            Pharmacokinetics

            Duration:4-8 hr (reduction in intraocular pressure with ophthalmic instillation); 24hr (intraocular administration)

            Onset: miosis: 2-3 min ((intraocular inj); ; 10-20 min (ophthalmic instillation)

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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