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Carbachol
Systematic (IUPAC) name
2-carbamoyloxyethyl-trimethyl-azanium
Identifiers
CAS number	51-83-2
ATC code	N07AB01
PubChem	2551
DrugBank	APRD00845
Chemical data
Formula	C6H15N2O2+
Mol. mass	147.196
Pharmacokinetic data
Bioavailability	?
Metabolism	?
Half life	?
Excretion	?
Therapeutic considerations
Pregnancy cat.	C (US)
Legal status	?
Routes	Tablet, liquid

Carbachol (Kar-ba-kol key), also known as carbamylcholine (marketed under the brand names Carbastat®, Carboptic®, Isopto Carbachol®, Miostat®), is classified as a cholinergic. Thus, it acts as an AChR 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. eyedrop).

Contents 1 Chemistry and pharmacology 2 Indications 3 Contraindications 4 Overdose 5 External links 6 References

Carbachol is a choline ester 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 two 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 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.

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 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 occular 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.

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.

The effects of a systemic overdose on a cholinergic will probably be similar to the effects of a nerve agent, but weaker.^{[citation needed]} However, when administered ocularly there is probably little risk of such effects.^{[citation needed]}

• RxList.com - Carbachol

• Links to external chemical sources

• Brenner, G. M. (2000). Pharmacology. Philadelphia, PA: W.B. Saunders Company. ISBN 0-7216-7757-6
• Canadian Pharmacists Association (2000). Compendium of pharmaceuticals and specialties (25th ed.). Toronto, ON: Webcom. ISBN 0-919115-76-4
• Carbachol (1998). MedlinePlus. Retrieved June 27, 2004, from http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202110.html
• Carbachol (2003). RxList. Retrieved June 27, 2004, from http://www.rxlist.com/cgi/generic2/carbachol.htm
• National Institute for Occupational Safety and Health. (2002). Choline, chloride, carbamate. In The registry of toxic effects of chemical substances. Retrieved June 27, 2004, from http://www.cdc.gov/niosh/rtecs/gad59f8.html
• Carbachol Chloride (2004). Hazardous Substances Data Bank. Retrieved July 16, 2004, from http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?hsdbb.htm (search carbachol).

v • d • e Antiglaucoma preparations and miotics (S01E)
Sympathomimetics	Apraclonidine, Brimonidine, Clonidine, Dipivefrine, Epinephrine
Parasympathomimetics	Aceclidine, Acetylcholine, Carbachol, Demecarium, Echothiophate, Fluostigmine, Neostigmine, Paraoxon, Physostigmine, Pilocarpine
Carbonic anhydrase inhibitors	Acetazolamide, Brinzolamide, Diclofenamide, Dorzolamide, Methazolamide
Beta blocking agents	Befunolol, Betaxolol, Carteolol, Levobunolol, Metipranolol, Timolol
Prostaglandin analogues	Bimatoprost, Latanoprost, Travoprost, Unoprostone
Other agents	Dapiprazole, Guanethidine