Carbachol (4 brand names, 2 dosage forms, 2 routes)
Available dosage forms: SOLUTION/DROPS, SOLUTION.
Routes of administration: OPHTHALMIC, INTRAOCULAR.
Brand Names
- CARBACHOL
- CARBASTAT
- MIOSTAT
- YUVEZZI
Indications and Usage
YUVEZZI™ is indicated for the treatment of presbyopia in adults.
Contraindications
YUVEZZI is contraindicated in patients with known hypersensitivity to the active ingredients or to any of the excipients.
Adverse Reactions
The following clinically significant adverse reactions are described elsewhere in labeling: Hypersensitivity [see Contraindications (4)]
Mechanism of Action
The proposed mechanism of action of this fixed-dose combination of carbachol and brimonidine in presbyopia is pupillary constriction and the creation of a pinhole effect that improves near visual acuity and depth of focus. Carbachol is a cholinergic agent which produces constriction of the iris sphincter and ciliary body. Brimonidine tartrate, an alpha-adrenergic agonist, blocks contraction of the iris dilator muscle and relaxes tonic contraction of the ciliary muscle, enhancing selectivity for the pupil and increasing bioavailability of carbachol in the aqueous humor.
Overdosage
Systemic toxicity following topical ocular administration of carbachol is rare, but patients who are sensitive may occasionally develop sweating and gastrointestinal overactivity. Accidental ingestion can produce sweating, salivation, nausea, and a decrease in blood pressure. In moderate overdosage, spontaneous recovery is to be expected and is aided by intravenous fluids to compensate for dehydration. For patients demonstrating severe poisoning, use atropine, the pharmacologic antagonist to carbachol. Very limited information exists on accidental ingestion of brimonidine in adults; the only adverse reaction reported to date has been hypotension. Treatment of an oral overdose includes supportive and symptomatic therapy; a patent airway should be maintained.