Quaternary choline esters do not cross the blood—brain barrier. Therapeutic Uses
Acetylcholine (miochol-e) is available as an ophthalmic surgical aid for rapid production of miosis. Bethanechol chloride ( urecholine, others) is available in tablets and as an injection for use as a stimulant of GI smooth muscle, especially the urinary bladder. Pilocarpine hydrochloride (salagen) is available as 5- or 7.5-mg oral doses for treatment of xerostomia or as ophthalmic solutions (pilocar, others) of varying strength. Methacholine chloride (provocholine) may be administered for diagnosis of bronchial hyperreactivity. The unpredictability of absorption and intensity of response has precluded its use as a vasodilator or cardiac vagomimetic agent. Cevimeline (evoxac) is a newer muscarinic agonist available orally for use in treatment of xerostomia.
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