Puneet Varma (Editor)

Carbachol

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Covid-19
Trade names  Miostat
Molar mass  182.696 g/mol
AHFS/Drugs.com  Monograph
CAS ID  51-83-2
Carbachol USP Monographs Carbachol
Pregnancy category  US: C (Risk not ruled out)
Routes of administration  By mouth (tablets) Solution for injection Topical (ophthalmic solution)
ATC code  N07AB01 (WHO) S01EB02 (WHO) QA03AB92 (WHO)
Legal status  In general: ℞ (Prescription only)

Glaucoma drugs cholinomimetics pilocarpine carbachol physostigmine echothiophate


Carbachol (Carbastat, Carboptic, Isopto Carbachol, Miostat), also known as carbamylcholine, is a cholinomimetic drug that binds and activates the acetylcholine receptor. Thus it is classified as a cholinergic agonist. It is primarily used for various ophthalmic purposes, such as for treating glaucoma, or for use during ophthalmic surgery. It is generally administered as an ophthalmic solution (i.e. eye drops).

Contents

Carbachol Carbachol as miotic agent in intraocular lens implant surgery

Carbachol produces effects comparable to those of V-series nerve agents if a massive overdose is administered (as may occur following industrial and shipping accidents) and therefore constitutes a risk to human health. It is classified as an extremely hazardous substance in the United States as defined in Section 302 of the U.S. Emergency Planning and Community Right-to-Know Act (42 U.S.C. 11002), and is subject to strict reporting requirements by facilities which produce, store, or use it in significant quantities.

Carbachol FileCarbacholsvg Wikimedia Commons

Cholinomimetic drugs direct agonists bethanechol carbachol pilocarpine methacholine


Chemistry and pharmacology

Carbachol AddexBio Product Detail Carbachol

Carbachol is a choline carbamate and a positively charged quaternary ammonium compound. It is not well absorbed in the gastro-intestinal tract and does not cross the blood–brain barrier. It is usually administered topical ocular or through intraocular injection. Carbachol is not easily metabolized by cholinesterase, it has a 2 to 5 minute onset of action and its duration of action is 4 to 8 hours with topical administration and 24 hours for intraocular administration. Since carbachol is poorly absorbed through topical administration, benzalkonium chloride is mixed in to promote absorption.

Carbachol Carbachol Therapeutic uses Dosage amp Side Effects DoctorAlerts

Carbachol is a parasympathomimetic that stimulates both muscarinic and nicotinic receptors. In topical ocular and intraocular administration its principal effects are miosis and increased aqueous humour outflow.

Carbachol carbachol ophthalmic Uses Side Effects Interactions Pictures

In the cat and rat, carbachol is well known for its ability to induce rapid eye movement (REM) sleep when microinjected into the pontine reticular formation. Carbachol elicits this REM sleep-like state via activation of postsynaptic muscarinic cholinergic receptors (mAChRs).

Carbachol Carbachol United States Pharmacopeia USP Reference Standard

A recent review indicates that carbachol is a strong promoter of ICC activity, which is mediated through the calcium-activated chloride channel, anoctamin 1.

Indications

Carbachol Karbakol Wikipdia

Carbachol is primarily used in the treatment of glaucoma, but it is also used during ophthalmic surgery. Carbachol eyedrops are used to decrease the pressure in the eye for people with glaucoma. It is sometimes used to constrict the pupils during cataract surgery.

Topical ocular administration is used to decrease intraocular pressure in people with primary open-angle glaucoma. Intraocular administration is used to produce miosis after lens implantation during cataract surgery. Carbachol can also be used to stimulate bladder emptying if the normal emptying mechanism is not working properly.

In most countries carbachol is only available by prescription. Outside the United States, it is also indicated for urinary retention as an oral (2 mg) tablet.

Contraindications

Use of carbachol, as well as all other muscarinic receptor agonists, is contraindicated in patients with asthma, coronary insufficiency, gastroduodenal ulcers, and incontinence. The parasympathomimetic action of this drug will exacerbate the symptoms of these disorders.

Overdose

The effects of a systemic overdose will probably be similar to the effects of a nerve agent (they both act on the cholinergic system, increasing cholinergic transmission), but its toxicity is much weaker and it is easier to antagonize in overdose. When administered ocularly there is little risk of such effects, since the doses are much smaller (see topical versus systemic administration).

References

Carbachol Wikipedia


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