Source:http://www4.wiwiss.fu-berlin.de/dailymed/resource/drugs/3372
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Phospholine Iodide (Kit)
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DIRECTIONS FOR PREPARING EYEDROPS: 1. Use aseptic technique. 2. Tear off
aluminum seals, and remove and discard rubber plugs from both drug and diluent
containers. 3. Pour diluent into drug container. 4.
Remove dropper assembly from its sterile wrapping. Holding dropper assembly
by the screw cap and, WITHOUT COMPRESSING RUBBER BULB, insert into drug container
and screw down tightly. 5. Shake for several seconds
to ensure mixing. 6. Do not cover nor obliterate instructions
to patient regarding storage of eyedrops.<br/>Glaucoma: Selection of Therapy���The medication prescribed should
be that which will control the intraocular pressure around-the-clock with
the least risk of side effects or adverse reactions.���Tonometric glaucoma���(ocular hypertension without other evidence of the disease) is frequently
not treated with any medication, and echothiophate iodide for ophthalmic solution
is certainly not recommended for this condition. In early chronic simple glaucoma
with field loss or disc changes, pilocarpine is generally used for initial
therapy and can be recommended so long as control is thereby maintained over
the 24 hours of the day. When this is not the case,
echothiophate iodide for ophthalmic solution 0.03% may be effective and probably
has no greater potential for side effects. If this dosage is inadequate, epinephrine
and a carbonic anhydrase inhibitor may be added to the regimen. When still
more effective medication is required, the higher strengths of echothiophate
iodide for ophthalmic solution may be prescribed with the recognition that
the control of the intraocular pressure should have priority regardless of
potential side effects. In secondary glaucoma following cataract surgery,
the higher strengths of the drug are frequently needed and are ordinarily
very well tolerated. The dosage
regimen prescribed should call for the lowest concentration that
will control the intraocular pressure around-the-clock. Where tonometry around-the-clock
is not feasible, it is suggested that appointments for tension-taking be made
at different times of the day so that inadequate control may be more readily
detected. Two doses a day are preferred to one in order to maintain as smooth
a diurnal tension curve as possible, although a single dose per day or every
other day has been used with satisfactory results. Because of the long duration
of action of the drug, it is never necessary or desirable to exceed a schedule
of twice a day. The daily dose or one of the two daily doses should always
be instilled just before retiring to avoid inconvenience due to the miosis. Early Chronic Simple Glaucoma���Echothiophate
iodide for ophthalmic solution 0.03% instilled twice a day, just before retiring
and in the morning, may be prescribed advantageously for cases of early chronic
simple glaucoma that are not controlled around-the-clock with other less potent
agents. Because of prolonged action, control during the night and early morning
hours may then sometimes be obtained. A change in therapy is indicated if,
at any time, the tension fails to remain at an acceptable level on this regimen. Advanced Chronic Simple Glaucoma and Glaucoma Secondary to Cataract Surgery���These
cases may respond satisfactorily to echothiophate iodide for ophthalmic solution
0.03% twice a day as above. When the patient is being transferred to echothiophate
iodide for ophthalmic solution because of unsatisfactory control with pilocarpine,
carbachol, epinephrine, etc., one of the higher strengths, 0.06%, 0.125%,
or 0.25% will usually be needed. In this case, a brief trial with the 0.03%
eyedrops will be advantageous in that the higher strengths will then be more
easily tolerated. Concomitant
Therapy���Echothiophate iodide for ophthalmic solution may
be used concomitantly with epinephrine, a carbonic anhydrase inhibitor, or
both. Technique���Good technique in the administration of echothiophate iodide for
ophthalmic solution requires that finger pressure at the inner canthus should
be exerted for a minute or two following instillation of the eyedrops, to
minimize drainage into the nose and throat. Excess solution around the eye
should be removed with tissue and any medication on the hands should be rinsed
off.<br/>Accommodative Esotropia (Pediatric Use): In Diagnosis���One
drop of 0.125% may be instilled once a day in both eyes on retiring, for a
period of two or three weeks. If the esotropia is accommodative, a favorable
response will usually be noted which may begin within a few hours. In Treatment���Echothiophate iodide for
ophthalmic solution is prescribed at the lowest concentration and frequency
which gives satisfactory results. After the initial period of treatment for
diagnostic purposes, the schedule may be reduced to 0.125% every other day
or 0.06% every day. These dosages can often be gradually lowered as treatment
progresses. The 0.03% strength has proven to be effective in some cases. The
maximum usually recommended dosage is 0.125% once a day, although more intensive
therapy has been used for short periods. Technique���(See���DOSAGE
AND ADMINISTRATION, Glaucoma.���) Duration of Treatment���In diagnosis,
only a short period is required and little time will be lost in instituting
other procedures if the esotropia proves to be unresponsive. In therapy, there
is no definite limit so long as the drug is well tolerated. However, if the
eyedrops, with or without eyeglasses, are gradually withdrawn after about
a year or two and deviation recurs, surgery should beconsidered. As with
other miotics, tolerance may occasionally develop after prolonged use. In
such cases, a rest period will restore the original activity of the drug.
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dailymed-instance:descripti... |
Chemical name: (2-mercaptoethyl) trimethylammonium iodide
O,O-diethyl phosphorothioate Structural formula Echothiophate iodide for ophthalmic solution occurs as a white,
crystalline, water-soluble, hygroscopic solid having a slight mercaptan-like
odor. When freeze-dried in the presence of potassium acetate, the mixture
appears as a white amorphous deposit on the walls of the bottle. Each
package contains materials for dispensing 5 mL of eyedrops: (1) bottle
containing sterile echothiophate iodide for ophthalmic solution in one of
four potencies [1.5 mg (0.03%), 3 mg (0.06%), 6.25 mg (0.125%),
or 12.5 mg (0.25%)] as indicated on the label, with 40 mg potassium
acetate in each case. Sodium hydroxide or acetic acid may have been incorporated
to adjust pH during manufacturing. (2) a 5 mL bottle of sterile
diluent containing chlorobutanol (chloral derivative), 0.55%; mannitol, 1.2%;
boric acid, 0.06%; and sodium phosphate, 0.026%. (3) sterilized dropper.
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dailymed-instance:clinicalP... |
Echothiophate iodide for ophthalmic solution is a long-acting
cholinesterase inhibitor for topical use which enhances the effect of endogenously
liberated acetylcholine in iris, ciliary muscle, and other parasympathetically
innervated structures of the eye. It thereby causes miosis, increase in facility
of outflow of aqueous humor, fall in intraocular pressure, and potentiation
of accommodation. Echothiophate iodide for ophthalmic
solution will depress both plasma and erythrocyte cholinesterase levels in
most patients after a few weeks of eyedrop therapy.
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dailymed-instance:supply |
Each package contains sterile echothiophate iodide for ophthalmic
solution, sterile diluent, and dropper for dispensing 5 mL eyedrops of
the strength indicated on the label. Four potencies are available: NDC 0046-1062-05
. . . . . . . . . . . . . . . . . 1.5 mg package for 0.03% White
amorphous deposit on bottle walls. Aluminum crimp seal is blue. NDC 0046-1064-05
. . . . . . . . . . . . . . . . . 3 mg package for 0.06% White
amorphous deposit on bottle walls. Aluminum crimp seal is red. NDC 0046-1065-05
. . . . . . . . . . . . . . . . . 6.25 mg package for 0.125% White
amorphous deposit on bottle walls. Aluminum crimp seal is green. NDC 0046-1066-05
. . . . . . . . . . . . . . . . . 12.5 mg package for 0.25% White
amorphous deposit on bottle walls. Aluminum crimp seal is yellow.
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DIRECTIONS FOR PREPARING EYEDROPS: 1. Use aseptic technique. 2. Tear off
aluminum seals, and remove and discard rubber plugs from both drug and diluent
containers. 3. Pour diluent into drug container. 4.
Remove dropper assembly from its sterile wrapping. Holding dropper assembly
by the screw cap and, WITHOUT COMPRESSING RUBBER BULB, insert into drug container
and screw down tightly. 5. Shake for several seconds
to ensure mixing. 6. Do not cover nor obliterate instructions
to patient regarding storage of eyedrops.
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dailymed-instance:precautio... |
General: 1. Gonioscopy is recommended prior to initiation of therapy.
Routine examination to detect lens opacity should accompany clinical use of
echothiophate iodide for ophthalmic solution. 2. Where
there is a quiescent uveitis or a history of this condition, anticholinesterase
therapy should be avoided or used cautiously because of the intense and persistent
miosis and ciliary muscle contraction that may occur. 3.
While systemic effects are infrequent, proper use of the drug requires digital
compression of the nasolacrimal ducts for a minute or two following instillation
to minimize drainage into the nasal chamber with its extensive absorption
area. To prevent possible skin absorption, hands should be washed following
instillation. 4. Temporary or permanent discontinuance
of medication is necessary if cardiac irregularities occur. 5.
Anticholinesterase drugs should be used with extreme caution, if at all, in
patients with marked vagotonia, bronchial asthma, spastic gastrointestinal
disturbances, peptic ulcer, pronounced bradycardia and hypotension, recent
myocardial infarction, epilepsy, parkinsonism, and other disorders that may
respond adversely to vagotonic effects. 6. Anticholinesterase
drugs should be employed prior to ophthalmic surgery only as a considered
risk because of the possible occurrence of hyphema. 7.
Echothiophate iodide for ophthalmic solution should be used with great caution,
if at all, where there is a prior history of retinal detachment. 8.
Temporary discontinuance of medication is necessary if salivation, urinary
incontinence, diarrhea, profuse sweating, muscle weakness, or respiratory
difficulties occur. 9. Patients receiving echothiophate
iodide for ophthalmic solution who are exposed to carbamate- or organophosphate-type
insecticides and pesticides (professional gardeners, farmers, workers in plants
manufacturing or formulating such products, etc.) should be warned of the
additive systemic effects possible from absorption of the pesticide through
the respiratory tract or skin. During periods of exposure to such pesticides,
the wearing of respiratory masks, and frequent washing and clothing changes
may be advisable.<br/>Drug Interactions: Echothiophate iodide for ophthalmic solution potentiates
other cholinesterase inhibitors such as succinylcholine or organophosphate
and carbamate insecticides. Patients undergoing systemic anticholinesterase
treatment should be warned of the possible additive effects of echothiophate
iodide for ophthalmic solution.<br/>Carcinogenesis, Mutagenesis, Impairment of Fertility: No data is available regarding carcinogenesis, mutagenesis,
and impairment of fertility.<br/>Pregnancy:<br/>Teratogenic Effects���Pregnancy Category C: Animal reproduction studies have not been conducted with
echothiophate iodide for ophthalmic solution. It is also not known whether
echothiophate iodide for ophthalmic solution can cause fetal harm when administered
to a pregnant woman or can affect reproduction capacity. Echothiophate iodide
for ophthalmic solution should be given to a pregnant woman only if clearly
needed.<br/>Nursing Mothers: Because of the potential for serious adverse reactions in
nursing infants from echothiophate iodide for ophthalmic solution, a decision
should be made whether to discontinue nursing or to discontinue the drug,
taking into account the importance of the drug to the mother.<br/>Pediatric Use: Safety and effectiveness in pediatric patients have been
established.<br/>Geriatric Use: No overall differences in safety or effectiveness have been
observed between elderly and younger patients.
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dailymed-instance:genericMe... |
Echothiophate Iodide
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dailymed-instance:fullName |
Phospholine Iodide (Kit)
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dailymed-instance:adverseRe... |
1. Although the relationship, if any, of retinal detachment
to the administration of echothiophate iodide for ophthalmic solution has
not been established, retinal detachment has been reported in a few cases
during the use of echothiophate iodide for ophthalmic solution in adult patients
without a previous history of this disorder. 2. Stinging,
burning, lacrimation, lid muscle twitching, conjunctival and ciliary redness,
browache, induced myopia with visual blurring may occur. 3.
Activation of latent iritis or uveitis may occur. 4.
Iris cysts may form, and if treatment is continued, may enlarge and obscure
vision. This occurrence is more frequent in children. The cysts usually shrink
upon discontinuance of the medication, reduction in strength of the drops
or frequency of instillation. Rarely, they may rupture or break free into
the aqueous. Regular examinations are advisable when the drug is being prescribed
for the treatment of accommodative esotropia. 5. Prolonged
use may cause conjunctival thickening, obstruction of nasolacrimal canals. 6.
Lens opacities occurring in patients under treatment for glaucoma with echothiophate
iodide for ophthalmic solution have been reported and similar changes have
been produced experimentally in normal monkeys. Routine examinations should
accompany clinical use of the drug. 7. Paradoxical increase
in intraocular pressure may follow anticholinesterase instillation. This may
be alleviated by prescribing a sympathomimetic mydriatic such as phenylephrine. 8.
Cardiac irregularities.
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1. Succinylcholine should be administered only with great
caution, if at all, prior to or during general anesthesia to patients receiving
anticholinesterase medication because of possible respiratory or cardiovascular
collapse. 2. Caution should be observed in treating
glaucoma with echothiophate iodide for ophthalmic solution in patients who
are at the same time undergoing treatment with systemic anticholinesterase
medications for myasthenia gravis, because of possible adverse additive effects.
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Glaucoma: Chronic open-angle glaucoma. Subacute or chronic angle-closure
glaucoma after iridectomy or where surgery is refused or contraindicated.
Certain non-uveitic secondary types of glaucoma, especially glaucoma following
cataract surgery.<br/>Accommodative Esotropia: Concomitant esotropias with a significant accommodative component.
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Phospholine Iodide
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