Elevated intraocular pressure: Ophthalmic:
Initial: Instill 1 drop in affected eye(s) twice daily (prior to bedtime and in the morning).
Maintenance: Twice-daily dosing is preferred, but some patients have been treated with once-daily or every-other-day dosing (with 1 dose just prior to bedtime).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
(For additional information see "Echothiophate: Pediatric drug information")
Esotropia, accommodative: Children and Adolescents: Ophthalmic:
Diagnosis: Instill 1 drop once daily into both eyes at bedtime for 2 to 3 weeks
Treatment: Instill 1 drop every other day in both eyes; gradually lower dose as treatment progresses. Maximum daily dose: 1 drop once daily in both eyes. Note: Use lowest frequency which gives satisfactory response; if necessary, more aggressive therapy may be used for short periods of time.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution Reconstituted, Ophthalmic:
Phospholine Iodide: 0.125% (5 mL [DSC])
Phospholine Iodide: 0.125% (5 mL) [contains chlorobutanol (chlorobutol)]
No
Ophthalmic: Proper administration technique is required for maximal benefit. The nasolacrimal duct(s) should be compressed for 1 to 2 minutes after instillation of the drops. Excess fluid around the eye should be blotted with tissue; wash hands after instillation.
For ophthalmic use only. Proper administration technique is required for maximal benefit. Wash hands prior to use; to avoid contamination, do not allow dispenser tip to touch the eye or any surface; apply gentle pressure to the nasolacrimal duct(s) for 1 to 2 minutes after instillation of the drops to minimize drainage into nose and throat. Excess fluid around the eye should be blotted with tissue; wash hands after instillation.
Accommodative esotropia: Concomitant esotropias with a significant accommodative component
Elevated intraocular pressure: Reduction of elevated intraocular pressure
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Frequency not defined.
Cardiovascular: Bradycardia, cardiac abnormality, flushing, hypotension
Central nervous system: Brow ache, myasthenia
Dermatologic: Diaphoresis
Gastrointestinal: Diarrhea, nausea, vomiting
Ophthalmic: Blepharospasm, blurred vision, burning sensation of eyes, cataract, conjunctival abnormalities (thickening), conjunctival erythema, eye redness, increased intraocular pressure (paradoxical), iris cyst, iritis (latent), lacrimal duct obstruction (nasolacrimal canal), lacrimation, miosis, myopia, retinal detachment, stinging of eyes, uveitis (activation)
Respiratory: Dyspnea
Hypersensitivity to echothiophate or any component of the formulation; most cases of angle-closure glaucoma without iridectomy (due to possibility of increasing angle block); active uveal inflammation
Concerns related to adverse effects:
• Cardiac irregularities: Temporarily or permanently discontinue if cardiac irregularities occur.
• Cholinergic effects: Discontinue if symptoms of excess cholinergic activity (eg, salivation, sweating, urinary incontinence); overdosage may result in cholinergic crisis, which must be distinguished from myasthenic crisis.
Disease-related concerns:
• Asthma: Not generally recommended for use in patients with asthma.
• Cardiovascular disease: Not generally recommended for use in patients with bradycardia, hypotension or recent MI. In a scientific statement from the American Heart Association, ophthalmic cholinergic agents have been determined to be agents that may exacerbate underlying myocardial dysfunction (magnitude: minor) (AHA [Page 2016]).
• Gastrointestinal disease: Not generally recommended for use in patients with spastic gastrointestinal disturbances or peptic ulcer disease.
• Parkinsonism: Not generally recommended for use in patients with Parkinsonism.
• Seizure disorder: Not generally recommended for use in patients with a history of seizure disorder.
• Vagotonia: Not generally recommended for use in patients with vagotonia.
Other warnings/precautions:
• Appropriate use: Do not use for tonometric glaucoma, or in patients with active or history of uveitis, or history of retinal detachment. Use cautiously prior to ophthalmic surgery due to risk of blood in the anterior chamber. Digital compression of the nasolacrimal ducts for 1 to 2 minutes following instillation to minimize drainage into the nasal chamber is recommended. Wash hands following instillation.
• Exposure to pesticides and insecticides: Use with caution in patients exposed to carbamate- or organophosphate-type insecticides and pesticides; absorption of the pesticide through skin or respiratory tract may result in additive systemic effects; respiratory masks and frequent clothing changes may be necessary during exposure to pesticides in patients receiving echothiophate iodide.
• Tolerance: Patients may develop tolerance after prolonged use; a rest period restores response to the drug.
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Cyclopentolate: May diminish the therapeutic effect of Echothiophate Iodide. Risk C: Monitor therapy
Mivacurium: Echothiophate Iodide may increase the serum concentration of Mivacurium. Risk C: Monitor therapy
Succinylcholine: Echothiophate Iodide may increase the serum concentration of Succinylcholine. Management: For patients receiving echothiophate iodide eye drops, consider using a neuromuscular-blocking agents other than succinylcholine. If succinylcholine is used, consider a reduced dose, and monitor for enhanced/prolonged effects. Risk D: Consider therapy modification
Animal reproduction studies have not been conducted.
It is not known if echothiophate is excreted in breast milk. Due to the potential for serious adverse reactions in the breastfed infant, a decision should be made whether to discontinue breastfeeding or to discontinue the drug, taking into account the importance of treatment to the mother.
Baseline measurement of anterior chamber angle; routine lens examinations (for opacities and during treatment of accommodative esotropia); IOP (at different times of the day)
Long-acting inhibition of cholinesterase enhances activity of endogenous acetylcholine. Reduced degradation of acetylcholine leads to continuous stimulation of the ciliary muscle producing miosis; other effects include potentiation of accommodation and facilitation of aqueous humor outflow, with attendant reduction in intraocular pressure.
Onset of action: Miosis: ≤60 minutes
Peak effect: Intraocular pressure decrease: After 24 hours
Duration: Miosis: 1 to 4 weeks; Intraocular pressure: Days to weeks.
Solution (reconstituted) (Phospholine Iodide Ophthalmic)
0.125% (per mL): $611.60
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