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MeSH Review


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Disease relevance of Miosis


Psychiatry related information on Miosis


High impact information on Miosis

  • One or both pupils constricted excessively to 0.0625% pilocarpine eyedrops (3 patients), consistent with ocular parasympathetic deficit [7].
  • INTRODUCTION: Systemic clearance of intravenous (IV) alfentanil (ALF) is an in vivo probe for hepatic cytochrome P450 (CYP) 3A activity, miosis is a surrogate for plasma ALF concentrations, and IV ALF miosis is a noninvasive probe for hepatic CYP3A [8].
  • ALF miosis may be a suitable noninvasive in vivo probe for both hepatic and first-pass CYP3A [8].
  • Pupil diameter was significantly decreased by LAAM after both placebo and ketoconazole pretreatment; ketoconazole increased the tmax for miosis 2.92-fold (2.01-4.25, P <.001) [9].
  • Alfentanil effect (miosis) may be an acceptable surrogate for plasma alfentanil concentrations [10].

Chemical compound and disease context of Miosis

  • Dose-dependent alfentanil disposition was mirrored by commensurate changes in clinical effect, although miosis was variable and not detectable in all subjects at the lowest dose [10].
  • Methadone-induced respiratory depression and miosis lasted more than 48 hr [11].
  • RESULTS: Buspirone (5, 10, and 20 mg) caused a dose-dependent miosis [12].
  • CONCLUSIONS: Whereas morphine clearly produced miosis and respiratory depression, pretreatment with quinidine as an inhibitor of P-glycoprotein did not result in an enhancement of central nervous opioid effects in healthy volunteers [13].
  • The effects of subcutaneous placebo, sumatriptan (8 and 16 mg), and morphine (10 and 20 mg) were assessed on measures of subjective, behavioral, and physiologic responses including signs, symptoms, Addiction Research Center Inventory scales, onset of drug effects and miosis [14].

Biological context of Miosis

  • Alfentanil effect (miosis) is a surrogate for plasma alfentanil concentrations, and alfentanil effect kinetics may be a suitable noninvasive probe for hepatic CYP3A [10].
  • Three measures (pilocarpine-evoked miosis, carbachol-evoked sweating and salivation) reflected the antimuscarinic property of the antidepressants; in two tests (pilocarpine-evoked miosis and salivation) amitriptyline appeared to be more potent than desipramine [15].
  • Surprisingly, however, CYP3A induction (or inhibition) decreased (or increased) mean plasma metabolite AUC from 0 to 96 hours (AUC(96)) [norLAAM + dinorLAAM] (859 +/- 241 versus 107 +/- 48 and 1185 +/- 179 ng . h/mL; p < 0.05) and clinical effects (mean miosis AUC(96) 128 +/- 40 versus 22.5 +/- 14.9 and 178 +/- 81 mm . h; p < 0.05) [16].
  • Despite generalized consensus that pilocarpine-induced miosis results in some degree of visual field constriction, studies describing the predictability of this occurrence, as well as the nature of the field defects that may be seen, have not been undertaken [17].
  • The M1 antagonist pirenzepine was at least 30-fold less potent, with IC50 values of 2.2 microM for outflow facility, 1.4 microM for accommodation and 0.1 microM for miosis [18].

Anatomical context of Miosis


Gene context of Miosis


Analytical, diagnostic and therapeutic context of Miosis

  • The present experiments show that topical application of 10 to 500 micrograms of PGE2 also causes a highly significant IOP reduction in cat eyes lasting up to 48 hr with little or no development of flare or miosis, whereas similar application of PGF2 alpha causes, in addition to an IOP reduction, the development of profound pupillary constriction [28].
  • After the intraventricular injection of bradykinin or GAML-bradykinin, rabbits showed decreased motility, ptosis, miosis and lowered ears; after angiotensin II, animals remained motionless but with wide open eyes, fully raised ears and no miosis [29].
  • CONCLUSIONS: Topical ketorolac was a more effective inhibitor of miosis than topical diclofenac during extracapsular cataract extraction and IOL implantation [30].
  • CONCLUSIONS: Topical ketorolac is an effective inhibitor of miosis during phacoemulsification cataract surgery, and provides a more stable mydriatic effect throughout the surgical procedure [31].
  • CONCLUSION: Systemic diclofenac sodium 50 mg given orally 1 hour before surgery did not significantly inhibit miosis when compared with a control group [32].


  1. Clinical effects and pharmacokinetics of racemic methadone and its optical isomers. Olsen, G.D., Wendel, H.A., Livermore, J.D., Leger, R.M., Lynn, R.K., Gerber, N. Clin. Pharmacol. Ther. (1977) [Pubmed]
  2. Pupil studies in depressed patients: an investigation of the mechanism of action of desipramine. Shur, E., Checkley, S. The British journal of psychiatry : the journal of mental science. (1982) [Pubmed]
  3. Massive clonidine ingestion with hypertension in a 9-month-old infant. Yagupsky, P., Gorodischer, R. Pediatrics (1983) [Pubmed]
  4. Influence of pupil size, anisocoria, and ambient light on pilocarpine miosis. Implications for supersensitivity testing. Jacobson, D.M., Olson, K.A. Ophthalmology (1993) [Pubmed]
  5. Substance P in the human iris: possible involvement in echothiophate-induced miosis in cluster headache. Fanciullacci, M., Pietrini, U., Geppetti, P., Nicolodi, M., Curradi, C., Sicuteri, F. Cephalalgia : an international journal of headache. (1988) [Pubmed]
  6. A non-invasive method for studying an index of pupil diameter and visual performance in the rhesus monkey. Fairhall, S.J., Dickson, C.A., Scott, L., Pearce, P.C. J. Med. Primatol. (2006) [Pubmed]
  7. Site of autonomic deficit in harlequin syndrome: local autonomic failure affecting the arm and the face. Drummond, P.D., Lance, J.W. Ann. Neurol. (1993) [Pubmed]
  8. Intravenous and oral alfentanil as in vivo probes for hepatic and first-pass cytochrome P450 3A activity: noninvasive assessment by use of pupillary miosis. Kharasch, E.D., Walker, A., Hoffer, C., Sheffels, P. Clin. Pharmacol. Ther. (2004) [Pubmed]
  9. Ketoconazole, a cytochrome P450 3A4 inhibitor, markedly increases concentrations of levo-acetyl-alpha-methadol in opioid-naive individuals. Moody, D.E., Walsh, S.L., Rollins, D.E., Neff, J.A., Huang, W. Clin. Pharmacol. Ther. (2004) [Pubmed]
  10. Disposition and miotic effects of oral alfentanil: a potential noninvasive probe for first-pass cytochrome P4503A activity. Kharasch, E.D., Hoffer, C., Walker, A., Sheffels, P. Clin. Pharmacol. Ther. (2003) [Pubmed]
  11. Respiratory and ventilatory effects of methadone in healthy women. Olsen, G.D., Wilson, J.E., Robertson, G.E. Clin. Pharmacol. Ther. (1981) [Pubmed]
  12. Buspirone, but not sumatriptan, induces miosis in humans: relevance for a serotoninergic pupil control. Fanciullacci, M., Sicuteri, R., Alessandri, M., Geppetti, P. Clin. Pharmacol. Ther. (1995) [Pubmed]
  13. Respiratory and miotic effects of morphine in healthy volunteers when P-glycoprotein is blocked by quinidine. Skarke, C., Jarrar, M., Erb, K., Schmidt, H., Geisslinger, G., Lötsch, J. Clin. Pharmacol. Ther. (2003) [Pubmed]
  14. Psychoactivity and abuse potential of sumatriptan. Sullivan, J.T., Preston, K.L., Testa, M.P., Busch, M., Jasinski, D.R. Clin. Pharmacol. Ther. (1992) [Pubmed]
  15. The peripheral anticholinergic activity of tricyclic antidepressants: comparison of amitriptyline and desipramine in human volunteers. Szabadi, E., Gaszner, P., Bradshaw, C.M. The British journal of psychiatry : the journal of mental science. (1980) [Pubmed]
  16. Paradoxical role of cytochrome P450 3A in the bioactivation and clinical effects of levo-alpha-acetylmethadol: importance of clinical investigations to validate in vitro drug metabolism studies. Kharasch, E.D., Whittington, D., Hoffer, C., Krudys, K., Craig, K., Vicini, P., Sheffels, P., Lalovic, B. Clinical pharmacokinetics. (2005) [Pubmed]
  17. The effect of pilocarpine on the visual field in normals. McCluskey, D.J., Douglas, J.P., O'Connor, P.S., Story, K., Ivy, L.M., Harvey, J.S. Ophthalmology (1986) [Pubmed]
  18. Inhibition of outflow facility and accommodative and miotic responses to pilocarpine in rhesus monkeys by muscarinic receptor subtype antagonists. Gabelt, B.T., Kaufman, P.L. J. Pharmacol. Exp. Ther. (1992) [Pubmed]
  19. Administration of recombinant enkephalinase (neutral endopeptidase) prevents capsaicin-induced miosis in the rabbit eye in vivo. Malfroy, B., Liggitt, D., McCabe, J., Baughman, R., Kado-Fong, H., Mulholland, K., Bridenbaugh, R., Anderson, J. J. Pharmacol. Exp. Ther. (1990) [Pubmed]
  20. Drug ingestions associated with miosis in comatose children. Mitchell, A.A., Lovejoy, F.H., Goldman, P. J. Pediatr. (1976) [Pubmed]
  21. Bradykinin contracts the pupillary sphincter and evokes ocular inflammation through release of neuronal substance P. Bynke, G., Håkanson, R., Hörig, J., Leander, S. Eur. J. Pharmacol. (1983) [Pubmed]
  22. Intraocular miotics and postoperative inflammation. Roberts, C.W. Journal of cataract and refractive surgery. (1993) [Pubmed]
  23. Assessment of muscarinic transmission in the superior cervical and ciliary ganglion of the cat. Koss, M.C., Rieger, J.A. Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics. (1997) [Pubmed]
  24. The 1990 Endre Balazs Lecture. Effects of some neuropeptides on the uvea. Anders, B. Exp. Eye Res. (1991) [Pubmed]
  25. C-terminal calcitonin gene-related peptide fragments and vasopressin but not somatostatin-28 induce miosis in monkeys. Almegård, B., Bill, A. Eur. J. Pharmacol. (1993) [Pubmed]
  26. A pilot evaluation of alfentanil-induced miosis as a noninvasive probe for hepatic cytochrome P450 3A4 (CYP3A4) activity in humans. Phimmasone, S., Kharasch, E.D. Clin. Pharmacol. Ther. (2001) [Pubmed]
  27. Outflow facility in the monkey eye: effects of calcitonin gene-related peptide, cholecystokinin, galanin, substance P and capsaicin. Almegård, B., Andersson, S.E. Exp. Eye Res. (1990) [Pubmed]
  28. Comparison of the hypotensive and other ocular effects of prostaglandins E2 and F2 alpha on cat and rhesus monkey eyes. Stern, F.A., Bito, L.Z. Invest. Ophthalmol. Vis. Sci. (1982) [Pubmed]
  29. Effect of intracerebroventricular bradykinin and related peptides on rabbit operant behavior. Melo, J.C., Graeff, F.G. J. Pharmacol. Exp. Ther. (1975) [Pubmed]
  30. Topical ketorolac tromethamine 0.5% versus diclofenac sodium 0.1% to inhibit miosis during cataract surgery. Srinivasan, R., Madhavaranga, n.u.l.l. Journal of cataract and refractive surgery. (2002) [Pubmed]
  31. Topical 0.5% ketorolac vs 0.03% flurbiprofen for inhibition of miosis during cataract surgery. Solomon, K.D., Turkalj, J.W., Whiteside, S.B., Stewart, J.A., Apple, D.J. Arch. Ophthalmol. (1997) [Pubmed]
  32. Systemic diclofenac sodium to maintain mydriasis during phacoemulsification. Sidiki, S.S., Wykes, W.N. Journal of cataract and refractive surgery. (1998) [Pubmed]
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