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Medical Disclaimer: This information is for educational purposes only and is not a substitute for professional medical advice.
Acetylcholine Chloride, Histaminum Hydrochloricum, Serotonin (hydrochloride)
Brand Name
Allergy Rescue
Generic Name
Acetylcholine Chloride, Histaminum Hydrochloricum, Serotonin (hydrochloride)
Active Ingredient
AcetylcholineCategory
Vitamin C [EPC]
Salt Form
Chloride
Variants
1
Different strengths and dosage forms
| Strength | Form | Route | NDC |
|---|---|---|---|
| 6 [hp_X]/mL | LIQUID | ORAL | 43742-1249 |
Detailed information about Allergy Rescue
This page is for informational purposes only and does not replace medical advice. Before using any prescription or over-the-counter medication for Allergy Rescue, you must consult a qualified healthcare professional.
Acetylcholine is a primary neurotransmitter and a cholinergic agonist used clinically in ophthalmic surgery to induce miosis. It acts on muscarinic and nicotinic receptors to facilitate parasympathetic nervous system responses.
For ophthalmic use during surgery, the standard dose of Acetylcholine Chloride (Miochol-E) typically ranges from 0.5 mL to 2.0 mL of a 1% solution. The solution is instilled gently into the anterior chamber of the eye. In most cases, a volume of 0.5 mL is sufficient to produce satisfactory miosis. The effect is rapid, usually occurring within seconds, and typically lasts for about 10 to 20 minutes. If the surgical procedure requires a longer duration of miosis, the surgeon may administer additional doses or follow with a longer-acting miotic like carbachol.
Safety and effectiveness of Acetylcholine Chloride in pediatric patients have not been established through formal clinical trials. However, it has been used by ophthalmic surgeons in children when the benefits of miosis during surgery outweigh the potential risks. Dosing in children is usually determined by the surgeon based on the size of the anterior chamber and the specific requirements of the procedure, often using the minimum effective volume.
Because acetylcholine is rapidly hydrolyzed in the plasma and acts locally in the eye, dosage adjustments for patients with renal impairment are generally not required. However, clinicians should monitor for systemic effects in patients with severe renal failure if multiple doses are used.
Patients with severe hepatic impairment may have reduced levels of plasma pseudocholinesterase. While this could theoretically slow the metabolism of any systemically absorbed acetylcholine, the clinical impact is usually negligible given the tiny doses used in eye surgery.
No specific dosage adjustments are recommended for elderly patients. This population frequently undergoes cataract surgery, and acetylcholine is commonly used in this age group without unique age-related complications, provided cardiovascular status is stable.
Acetylcholine is not a medication that patients self-administer. It is used exclusively in a controlled surgical environment.
As this medication is administered by a surgeon during a procedure, missed doses by the patient are not possible. The surgeon will administer the drug as needed based on the real-time requirements of the operation.
Systemic overdose of acetylcholine is extremely rare during ophthalmic use. However, if excessive amounts are absorbed (e.g., through the tear ducts), symptoms of a 'cholinergic crisis' may occur.
> Important: Follow your healthcare provider's dosing instructions. Do not adjust your dose without medical guidance. In the case of acetylcholine, this guidance applies to the clinical team managing your surgical care.
Because acetylcholine is used locally in the eye, most common side effects are ocular. These may include:
Systemic reactions are rare but can occur if the drug enters the systemic circulation through the nasolacrimal duct. These include:
> Warning: Stop taking Acetylcholine and call your doctor immediately if you experience any of these symptoms after your procedure, as they may indicate a systemic reaction or surgical complication.
Acetylcholine is intended for short-term, acute use during surgery. There are no documented long-term side effects associated with a single intraocular administration. However, repeated exposure in experimental settings has been linked to changes in receptor sensitivity (downregulation), though this is not clinically relevant for surgical patients.
There are currently no FDA black box warnings for Acetylcholine Chloride. It is considered safe for its intended ophthalmic use when administered by trained surgical professionals.
Report any unusual symptoms to your healthcare provider. If you notice persistent changes in your vision or heart rate after surgery, ensure your surgical team is informed immediately.
Acetylcholine is a potent biological molecule. Its clinical use is strictly limited to ophthalmic surgery. It should never be self-administered or used for any purpose other than that prescribed by an ophthalmologist. Patients with a history of severe allergies should be monitored closely, as the chloride salt or the diluent may cause reactions in sensitive individuals.
No FDA black box warnings for Acetylcholine.
During surgery, the patient's vital signs—including heart rate, oxygen saturation, and blood pressure—are continuously monitored by the anesthesia team. Post-operatively, the surgeon will monitor:
Patients should not drive or operate machinery immediately following eye surgery. Acetylcholine causes miosis (small pupils), which significantly reduces the amount of light entering the eye and can impair night vision and depth perception. Furthermore, the surgical procedure itself usually requires the eye to be patched or blurred by other medications.
There is no direct interaction between alcohol and intraocular acetylcholine. However, patients are generally advised to avoid alcohol before and immediately after surgery to ensure proper healing and to avoid interactions with sedative medications used during the procedure.
Acetylcholine is a single-use surgical agent. There is no 'discontinuation' or tapering process for the patient. The effects wear off naturally as the drug is metabolized by the body's enzymes within minutes to an hour.
> Important: Discuss all your medical conditions, especially asthma or heart problems, with your healthcare provider before starting any procedure involving Acetylcholine.
While acetylcholine is used locally, certain drugs can interfere with its action or increase the risk of toxicity:
There are no known food interactions with intraocularly administered acetylcholine. Because the drug is used during surgery, patients are typically under 'NPO' (nothing by mouth) orders, which precludes food interactions during the window of drug activity.
Acetylcholine is not known to interfere with common laboratory blood or urine tests. Its extremely short half-life ensures it is cleared from the system long before most post-operative lab work would be conducted.
For each major interaction, the mechanism involves either competitive binding at the muscarinic receptor (anticholinergics) or interference with the metabolic pathway (cholinesterase inhibitors). The management strategy for surgeons is to ensure a thorough medication reconciliation is performed prior to surgery.
> Important: Tell your doctor about ALL medications, supplements, and herbal products you are taking, especially any eye drops you use for glaucoma.
Acetylcholine Chloride must NEVER be used in the following circumstances:
Conditions requiring a careful risk-benefit analysis include:
Patients who are sensitive to other cholinergic esters (such as methacholine or carbachol) may exhibit cross-sensitivity to acetylcholine. While not a strict contraindication, healthcare providers should proceed with extreme caution in these individuals.
> Important: Your healthcare provider will evaluate your complete medical history, including any history of asthma or heart disease, before prescribing or administering Acetylcholine.
Acetylcholine is classified under FDA Pregnancy Category C. This means that animal reproduction studies have not been conducted, and it is not known whether acetylcholine can cause fetal harm when administered to a pregnant woman. Because acetylcholine is a naturally occurring substance and is rapidly destroyed by plasma esterases, the risk to the fetus from a small intraocular dose is likely very low. However, it should be used during pregnancy only if clearly needed and if the potential benefit outweighs the risk.
It is not known whether acetylcholine chloride is excreted in human milk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or to forgo the drug, taking into account the importance of the drug to the mother. Given its half-life of seconds, the likelihood of it reaching breast milk in active form is extremely remote.
As noted in the dosage section, safety and effectiveness in pediatric patients have not been formally established. While it is used in pediatric ophthalmic surgery, surgeons must exercise caution and use the smallest effective dose to avoid potential systemic effects in smaller children.
No overall differences in safety or effectiveness have been observed between elderly and younger patients. Acetylcholine is used frequently in the geriatric population, as this group undergoes the majority of cataract surgeries. The primary concern in this population is the presence of comorbid cardiovascular disease, which requires careful monitoring for bradycardia during administration.
Specific studies in patients with renal impairment have not been conducted. However, since the drug is metabolized by plasma esterases and not primarily cleared by the kidneys in its active form, renal impairment is not expected to significantly alter the drug's clinical effect or safety profile.
Patients with severe liver disease may have lower levels of pseudocholinesterase, the enzyme responsible for breaking down acetylcholine in the blood. This could theoretically prolong the systemic effects of the drug if absorption occurs. Surgeons should be aware of this possibility in patients with end-stage liver disease.
> Important: Special populations require individualized medical assessment. Always inform your surgical team if you are pregnant, nursing, or have chronic kidney or liver issues.
Acetylcholine is the natural neurotransmitter for cholinergic neurons. In the eye, it acts as a potent miotic by stimulating the muscarinic receptors of the iris sphincter muscle. This stimulation causes the muscle to contract, which pulls the iris inward and constricts the pupil. It also acts on the ciliary muscle, which can lead to a spasm of accommodation. At the molecular level, it is a non-selective agonist, meaning it binds to both muscarinic (M1-M5) and nicotinic (Nm, Nn) receptors, though its surgical use targets the M3 receptors in the ocular tissue.
| Parameter | Value |
|---|---|
| Bioavailability | Negligible (systemic); 100% (local intraocular) |
| Protein Binding | Minimal |
| Half-life | < 1 minute (due to rapid hydrolysis) |
| Tmax | Immediate (seconds) |
| Metabolism | Rapidly hydrolyzed by Acetylcholinesterase and Pseudocholinesterase |
| Excretion | As metabolites (Choline/Acetic Acid) via Renal/Recycling |
Acetylcholine is classified as a Direct-Acting Cholinergic Agonist. Within the therapeutic area of ophthalmology, it is categorized as a Miotic. It is related to other cholinergic agents like Carbachol and Pilocarpine, though it is much shorter-acting than both.
Common questions about Allergy Rescue
Acetylcholine is primarily used as a medical intervention during ophthalmic (eye) surgeries, such as cataract removal or iridectomy. When applied directly into the eye during these procedures, it causes the pupil to constrict rapidly and completely. This constriction, known as miosis, helps the surgeon protect the eye's lens and better visualize the surgical field. It is not used as a daily medication but rather as a one-time surgical aid. Its role as a natural neurotransmitter in the body is also vital for muscle movement and memory, but its clinical drug form is specialized for the eye.
The most common side effects of acetylcholine are localized to the eye and include temporary clouding of vision, redness (hyperemia), and swelling of the cornea. Some patients may also experience a 'brow ache' or a headache just above the eye due to the sudden contraction of the eye muscles. Because the drug is broken down so quickly by the body, these effects are usually very short-lived. Systemic side effects like sweating or a slow heart rate are extremely rare. If you notice persistent pain or vision loss after surgery, you should contact your ophthalmologist immediately.
While there is no known direct chemical interaction between alcohol and the acetylcholine used in eye surgery, you should generally avoid alcohol before and after any surgical procedure. Alcohol can interfere with the anesthesia used during your surgery and may slow the healing process. It can also increase the risk of dehydration and affect your coordination while your vision is still recovering. Always follow the specific pre-operative and post-operative instructions provided by your surgical team regarding food and drink. If you have questions about when it is safe to resume alcohol consumption, consult your doctor.
Acetylcholine is classified as FDA Pregnancy Category C, meaning there is limited data on its safety in pregnant women. Because it is a naturally occurring substance in the human body and is used in very small, localized doses during eye surgery, many experts believe the risk to a developing fetus is minimal. However, it should only be used if the surgical procedure is absolutely necessary and the benefits outweigh any potential risks. If you are pregnant or planning to become pregnant, ensure your eye surgeon is aware of your status. They will weigh the necessity of the drug against your individual health needs.
Acetylcholine works incredibly fast when applied directly to the eye during surgery. It typically produces complete pupil constriction (miosis) within seconds of instillation. This rapid onset is one of the primary reasons surgeons use it, as it allows them to proceed with the next steps of the surgery without delay. The effect is also relatively short-lived, usually lasting between 10 and 20 minutes. This allows the eye to begin returning to its normal state shortly after the procedure is completed, although other medications used during surgery may keep the eye blurry for longer.
Acetylcholine is not a medication that you take on a regular schedule, so there is no concern about 'stopping' it suddenly. It is administered as a single dose by a healthcare professional during a surgical procedure. Once the surgery is over, the drug is naturally and rapidly broken down by enzymes in your body. There are no withdrawal symptoms or 'rebound' effects associated with its use. If you have concerns about how your eyes are reacting in the days following your surgery, these are likely related to the surgical process itself rather than the discontinuation of acetylcholine.
It is not possible for a patient to miss a dose of acetylcholine because it is not self-administered. It is a tool used by surgeons in the operating room. The surgeon determines the exact timing and amount of the drug needed based on the progress of your eye surgery. You do not need to worry about a dosing schedule or remembering to take this medication. Your only responsibility is to follow your surgeon's post-operative care instructions, which will focus on protecting your eye while it heals from the procedure.
No, acetylcholine does not cause weight gain. It is used as a one-time localized treatment during eye surgery and is cleared from the body within minutes. Weight gain is typically a side effect associated with medications taken over a long period, such as certain hormones or psychiatric drugs. Because acetylcholine is a naturally occurring neurotransmitter that is processed almost instantly by the body's enzymes, it has no impact on metabolism, appetite, or fat storage. Any weight changes you experience would be unrelated to the use of this specific medication.
Acetylcholine can interact with other medications, particularly those that affect the nervous system or the heart. If you are taking beta-blockers for high blood pressure or heart issues, or if you use other eye drops for glaucoma, your surgeon needs to know. Some medications can make the effects of acetylcholine stronger or weaker. For example, certain glaucoma drops (cholinesterase inhibitors) can make acetylcholine last much longer than intended. Always provide your surgical team with a complete list of all prescription drugs, over-the-counter medicines, and herbal supplements you are currently using.
Acetylcholine chloride is available as a generic intraocular solution, though it is most commonly recognized by the brand name Miochol-E. Because it is a specialized surgical product rather than a retail prescription, you will not find it at a standard community pharmacy. The hospital or surgical center provides the medication as part of your procedure. Generic versions must meet the same strict FDA standards for safety, purity, and effectiveness as the brand-name version. Your surgeon will choose the specific brand or generic version used during your operation based on the facility's protocols.
Other drugs with the same active ingredient (Acetylcholine)