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Acetylcholine is a parasympathomimetic drug that is used for ophthalmological applications. Parasympathomimetic drugs are also called cholinomimetic drugs, and these activate the parasympathetic nervous system (PSNS).
The sympathetic nervous system is a part of the brain that is involved in the "fight or flight" response, and the PSNS is the "rest and digest" side.
The PSNS uses acetylcholine, a neurotransmitter (chemical messenger) that helps in brain-body coordination. Cholinomimetic drugs delay the breakdown or promote the release of acetylcholine.
Acetylcholine in drug form is available as eye drops. It is used to create rapid miosis (shrinking of the pupil) during cataract surgery after the lens is placed or during general eye surgery.
This drug has no value when intravenously administered as it is quickly deactivated by a group of enzymes in the Central Nervous System called cholinesterase. The eye drop form, however, helps quicken recovery after eye surgery.
When administered inside the eyes, Acetylcholine controls nerve impulse transmission and causes rapid shrinking of the pupil.
A nerve impulse is the way nerve cells (neurons) communicate with one another. Nerve impulses are mostly electrical signals.
About 0.5-2 ml of the 1% solution is introduced into the eyes, and miosis occurs (pupil shrinks to less than 2mm). Miosis lasts for about 10 minutes
Some common side effects of acetylcholine are:
Rarer side effects of acetylcholine are:
Acetylcholine can interact with certain drugs and lower the efficiency of the drug or cause extreme side effects. Therefore, make sure to notify your doctor if you are on any of the following drugs.
The ACE gene (angiotensin-converting gene) helps produce the ACE enzyme.
The ACE enzyme regulates blood pressure and fluid balance in the body by constricting the blood vessels.
In a study, researchers introduced enalaprilat, an ACE inhibitor drug, to 56 patients with atherosclerosis (a condition caused by the build-up of fat and cholesterol).
ACE inhibitor drugs interfere with the ACE enzyme activity and relax the blood vessels.
Image: Action of ACE Inhibitors
These patients were then administered acetylcholine. Changes in the coronary blood flow, vascular resistance, and epicardial diameter were then measured.
People with the DD and ID types of the ACE gene had a better blood flow and relaxation of blood vessels than those with the II type.
| Genotype | Implications |
| DD | Increased coronary blood flow |
| ID | Increased coronary blood flow |
| II | Lowered coronary blood flow |
As a topical eye solution, acetylcholine is very unstable. Therefore, the solution has to be prepared and used immediately.
Acetylcholine overdose can lead to cardiovascular complications or constriction of the airways. Drugs that can counteract this constriction effect have to be kept ready while administering acetylcholine.
Rarely, some people can have an allergic response to acetylcholine and develop the below symptoms.
If you experience any of the above-mentioned symptoms when treated with acetylcholine, notify your doctor immediately.
Genetic testing can help understand how your body responds to acetylcholine. This can enable your doctor to administer the drug at correct dosages with proper precautions.
Analyze Your Genetic Response to Acetylcholine
