Antiglaucoma Agent, Cholinergic, Long-Acting

Antiglaucoma agent is used to treat certain forms of glaucoma and other eye conditions. It can also be used to diagnose some eye diseases, such as accommodative esotropia.

Overview

Antiglaucoma agent, cholinergic medications, in the groups, demecarium, echothiophate, and isoflurophate are used to treat certain forms of glaucoma and other eye diseases, including accommodative esotropia. These medications may also be used to diagnose certain eye conditions, including accommodative esotropia.

In the US, these medications are available under the following brand names:

  • Zioptan
  • Xalatan
  • Trusopt Ocumeter
  • Travatan
  • Timoptic-XE Ocumeter Plus
  • Timoptic Ocudose
  • Simbrinza
  • Rescula
  • Propine
  • Phospholine Iodide
  • Optipranolol
  • Ocusert Pilo
  • Latisse
  • Istalol
  • Isopto Carpine
  • Isopto Carbachol
  • Iopidine
  • Eserine
  • Cosopt
  • Combigan
  • Betoptic S
  • Betimol
  • Betagan
  • Azopt
  • Alphagan P

Canadian-branded forms of this medication include:

  • Brimonidine Tartrate
  • Brimonidine Ophthalmic
  • Betoptic
  • Betagan 05
  • Betagan 025
  • Azopt 1
  • Apo-Timop
  • Apo-Levobunolol
  • Apo-Dipivefrin
  • Alti-Timolol Maleate
  • Akarpine

All these antiglaucoma agent, cholinergic medications are only available on prescription from your doctor or ophthalmologist.

Conditions treated

  • glaucoma
  • accommodative esotropia

Type of medicine

  • cholinergic medication (demecarium, echothiophate, isoflurophate)

Side-effects

As well as the many benefits that treatment with antiglaucoma agent medication can bring, some people may suffer a few side-effects. Most of these side-effects may not affect you, but if you do experience any unusual or unpleasant effects, you should speak to your doctor or ophthalmologist, as you may require medical attention.

Thankfully, these effects in people using antiglaucoma agent medications are rare, but you should still be aware of them in case you are affected. You may experience eye pain, or find that a blurring of your vision occurs, as though a curtain or veil was affecting part of your field of vision. Some people complain of feeling a burning, stinging sensation in their eye after using the medication, together with redness or other irritation.

If too much of the medication has been absorbed by the body, you might experience other symptoms, such as increased sweating, even during cool weather. You could find that you have a loss of full bladder control. You might feel nauseous, or suffer spells of vomiting, diarrhea, and pain or cramps in your stomach. Some patients taking this medication report shortness of breath, wheezing or tightness in the chest, together with a slow or irregular heartbeat. You may feel unusually tired or weak, and your mouth may water continually.

If you experience any of the aforementioned effects, you should consult your doctor immediately.

This list of side-effects is not all-inclusive. If you experience any other unusual effects that are not mentioned above, you should report them to your doctor or eye specialist straight away.

In the unlikely event that you do experience any non-serious but unpleasant effects when using this medication, your doctor may be able to suggest ways of preventing or reducing them.

Dosage

Antiglaucoma agent is available in a number of different dosage forms:

  • powder for suspension
  • solution
  • ointment
  • gel forming solution
  • device
  • gel/jelly

The dosage of this medication will vary between patients. Always follow your doctor’s instructions or refer to the dosage instructions on the product prescription label. The information that follows only includes the average mean dose of these medicines. If you have been prescribed a different dose, do not alter it unless your doctor or ophthalmologist instructs you to do so.

The dose of medication that you are prescribed will depend on the form of the product, as will the number of doses you should administer each day. The duration of your course of treatment may also vary, depending on the eye disease that you are receiving treatment for.

Do not share or pass on your medication to anyone else.

If you find that your condition does not improve or actually becomes worse when you begin using this medication, you should consult your doctor or ophthalmologist straight away.

Demecarium

Ophthalmic solution (eye drops) dosage form:

For the treatment of glaucoma:

  • Adults and older children: Place one drop in the eye once or twice a day.
  • Young children and infants: The use and dose of this medication must be determined by a doctor.

For the treatment of accommodative esotropia:

  • Adults and older children: Place one drop in the eye once a day for two to three weeks, and then one drop in the eye once every two days for three to four weeks. Subsequent use to be determined by your doctor.
  • Young children and infants: The use and dose of this medication must be determined by a doctor.

For the diagnosis of accommodative esotropia:

  • Adults and older children: Place one drop in the eye once a day for two weeks, and then one drop in the eye once every two days for three to four weeks.
    Young children and infants: The use and dose of this medication must be determined by a doctor.

Echothiophate

Ophthalmic solution (eye drops) dosage form:

For the treatment of glaucoma:

  • Adults and older children: Place one drop in the eye once or twice a day.
  • Young children and infants: The use and dose of this medication must be determined by a doctor.

For the treatment of accommodative esotropia:

  • Adults and older children: Place one drop in the eye once a day or one drop in the eye once every two days.
  • Young children and infants: The use and dose of this medication must be determined by a doctor.

For the diagnosis of accommodative esotropia:

  • Adults and older children: Place one drop in the eye once a day at bedtime for two to three weeks.
  • Young children and infants: The use and dose of this medication must be determined by a doctor.

Isoflurophate

Ophthalmic ointment dosage form:

For the treatment of glaucoma:

  • Adults and older children: Use the ointment in your eyes once every three days or up to three times a day, as instructed by your doctor.
  • Young children and infants: The use and dose of this medication must be determined by a doctor.

For the treatment of accommodative esotropia:

  • Adults and older children: Use the ointment in your eyes once daily at bedtime, initially for two weeks, and then once weekly or as frequently as once every two days or as directed by your doctor.
  • Young children and infants: The use and dose of this medication must be determined by a doctor.

For the diagnosis of accommodative esotropia:

  • Adults and older children: Use the ointment in your eyes once daily at bedtime, for two weeks.
  • Young children and infants: The use and dose of this medication must be determined by a doctor.

If you miss your scheduled dose of your prescribed medication and you are supposed to use one dose every other day, use the omitted dose as soon as possible on the day you are scheduled to use it. If you miss your scheduled dosage day, use it the following day at the usual time, and then skip the next day and resume your dosing schedule again. Do not double the dose.

If you should be using the medication once a day, use the missed dose as soon as you remember. If you forget the dose until the next day, skip the one that you have missed and revert to your usual dosage schedule. Do not double the dose.

If you should use more than one dose per day, use the missed dose as soon as possible. However, if it is close to your next dosage time, omit the dose that you have missed and revert to your usual dosage schedule. Do not double the dose.

Correct use of the ophthalmic solution form of this medication (eye drops)

  • Before using your eye drops, wash your hands thoroughly.
  • Tilt your head back and press your finger carefully on the skin beneath your lower eyelid. Gently pull the eyelid away from your eye so that a space is created. Drop the medication into the space.
  • Let go of your eyelid so that you can close your eyes. Try not to blink.
  • Keep your eyes closed and apply a small amount of pressure to the inner corner of your eye with your finger for a few minutes to allow the eye to absorb the medication.
  • Blot away any excess solution from around your eye with a clean tissue, avoiding touching your eye.
  • Wash your hands immediately. Do not touch the medication container applicator to any surface (including your eye), and keep the container tightly closed.
  • If you wear soft contact lenses, the demecarium preservative contained in the medication may be absorbed by the lenses. To avoid this happening, wait at least 15 minutes after you have applied the eye drops before inserting the lenses.

Correct use of the ophthalmic ointment form of this medication

  • Before using the eye ointment, wash your hands thoroughly.
  • Tilt your head back and press your finger carefully on the skin beneath your lower eyelid. Gently pull the eyelid away from your eye so that a space is created. Squeeze a thin line of ointment (approximately ¼-inch) into this space.
  • Let go of your eyelid so that you can close your eyes.
  • Keep your eyes closed for a couple of minutes to allow the eye to absorb the medication.
  • Wash your hands immediately. Do not touch the medication container applicator to any surface (including your eye), and keep the container tightly closed. Do not wash the tip of the applicator tube or allow it to touch a moist surface; moisture causes isoflurophate to lose its efficacy.
  • To prevent germs from entering the medication tube, avoid touching the applicator tip with any surface, including your fingers and your eye. After each use, carefully wipe away excess ointment from the tip of the tube and close it tightly.

Do not use more of this medication or apply it more frequently than directed by your doctor or eye specialist. Overuse may increase the chance of unpleasant side-effects or overdose.

Major drug interactions

Some medication should not be used concurrently, as interactions may occur that could affect the way in which your medications work, and could increase the risk of you experiencing side-effects. In some cases, several different medicines can be used together safely, even though there may be an interaction between them. If this applies in your case, your treating physician may decide to change the dose, frequency or strength of one of your medications. Alternatively, there may be some precautions that you can take to negate the effect of such interactions, and your doctor or pharmacist will give you advice on this.

Before using antiglaucoma agents, make a list of any medication that you are currently using, including prescription and over-the-counter drugs, herbal remedies, and vitamin supplements and give this list to your physician. Do not alter the frequency of dose of any of these medications, unless advised to do so by your doctor.

The following medications are known to have interactions with antiglaucoma agents:

  • clonidine
  • diltiazem
  • epinephrine
  • fingolimod
  • verapamil

If you are taking any of these drugs, notify your doctor before using antiglaucoma agents.

Warnings

Keep the applicator tip away from surfaces (including your eye) where it could become contaminated with bacteria, which could cause an eye infection. If you think that the applicator has become contaminated, ask your doctor for a fresh prescription and safely dispose of the damaged medication.

Immediately after use and for a short time following application, eye drops and ointment usually cause blurred vision. It is therefore advisable to ask your doctor if you can use your dose, or one of the doses if you use more than one dose per day, at bedtime. Do not drive or operate machinery if you find that your eyesight has been temporarily affected by your medication.

If this medication has been prescribed for you in order to treat glaucoma and you will be using it for the long term, you should attend your doctor regularly for check-ups. This to make sure that the medication is working and to allow your doctor to check your eye pressure and to discuss any side-effects that you may be experiencing.

If you are due to have any kind of eye surgery, dental treatment, or other surgical procedures, always tell the surgeon, dentist in charge, or anesthetist before your procedure that you are using this medication or have used it in the last month.

Do not use this medication if you have an existing eye infection or if your eye has been damaged or injured. If a foreign object becomes lodged in one or both of your eyes, if you experience pain, redness of the eye, or if a discharge develops, you should notify your doctor immediately. If you suffer trauma to the eye or to the area surrounding the eye, tell your doctor straight away, but do not stop using your medication unless instructed to do so.

You should avoid inhaling even very small quantities of organophosphate-type or carbamate-type insecticides or pesticides, including carbaryl, demeton, diazinon, malathion, ronnel, parathion, or TEPP. These chemicals can exacerbate the side-effects of antiglaucoma agent medication. If you work or live in an area where insecticide or pesticide spraying or dusting is taking place, or if you work in a plant where such products are manufactured or processed, you must wear suitable protective clothing, including a face mask. Change your clothes frequently and wash your hands often.

Eye drops and ointments often cause blurring of vision or other visual disturbances. Always ensure that your vision is completely clear before driving, using machinery, or undertaking any activity that could be dangerous if you are unable to see properly. Note that, following application of this medication your pupils may contract to an unusually small size, meaning that your vision is not as good in dim light or at night as it usually is.

After you start using this medication, you may find that your vision is blurry or your close or distance vision may change.

Demecarium, echothiophate, and isoflurophate can cause eye cysts in long-term users of the medication, especially in children. It is therefore important that you discuss with your child’s treating physician the benefits of this medication, as well as the risks of using it.

Demecarium, echothiophate, and isoflurophate are highly toxic and should not be used during pregnancy as they may present a risk to the fetus as they are metabolised by the mother’s body. Because demecarium, echothiophate, and isoflurophate are all readily absorbed by the body, you should not use them if you are breastfeeding. You may have to stop breastfeeding during your treatment or ask your doctor if there is an alternative medication that you could use.

Certain other medical conditions can affect the use of medications in this class. Be sure to tell your doctor if you or your child suffer from any of the following medical problems:

  • asthma
  • epilepsy
  • cardiac disease
  • severe low or high blood pressure (hypertension, hypotension)
  • myasthenia gravis
  • overactive thyroid
  • Parkinson’s disease
  • stomach ulcers
  • digestive problems
  • urinary tract blockage (this medication can make this condition worse)
  • Down's syndrome (mongolism) (this medication can cause hyperactivity)
  • any other form of eye disease (these medicines can make existing conditions worse)

Storage

You should always keep your supply of eye medicine in its original container and keep it tightly sealed. Store the medication at room temperature. Do not freeze it or place it in your refrigerator. Be sure to keep the medication dry. Keep the medication away from direct sunlight or extreme heat sources.

Always keep your eye medication away from children or pets. If a pet does consume your eye drops or ointment, you should seek veterinary advice without delay.

Do not keep any unused eye medication. Do not use any medicine that has passed its use-by date. Never flush unused medication down the toilet or drain. Do not discard unused medication with your garbage.

Seek the advice of your doctor or pharmacist if you need to dispose of any unused or unwanted medication.

Summary

Antiglaucoma agent, cholinergic medications in the groups, demecarium, echothiophate, and isoflurophate are used to treat some forms of glaucoma, as well as some other eye diseases, including accommodative esotropia. These drugs are also used diagnostically.

This medication can have a number of side-effects, including eye pain, blurred vision, a burning, stinging sensation in the eye after using the medication, together with redness or other irritation. The medication is safe for use in adults and children, under your doctor’s supervision. However, demecarium, echothiophate, and isoflurophate are toxic and should not be used by pregnant women or mothers who are breastfeeding.

There are a number of drugs that can interact adversely with this medication, so be sure to tell your doctor if you are already taking clonidine, diltiazem, epinephrine, fingolimod, or verapamil. Some common pre-existing medication conditions can be made worse by taking antiglaucoma drugs, including among others asthma, epilepsy, and existing eye conditions.

Antiglaucoma cholinergic agents are extremely effective in controlling and managing the symptoms of certain types of glaucoma and accommodative esotropia. In order to enjoy the benefits of this drug, you will need to work closely with your doctor or ophthalmologist in order to establish the most suitable dose and dosage schedule for the medication. This will mean that you must attend your treating physician for regular reviews and eye pressure tests. These tests and discussions are important in order to make sure that the medication is working effectively, and that there are no unwanted side-effects.

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Last Reviewed:
December 23, 2017
Last Updated:
December 22, 2017