Antiglaucoma agent, cholinergic, long-acting (ophthalmic route)

Brand Name

US Brand Name

Alphagan P

Azopt

Betagan

Betimol

Betoptic S

Combigan

Cosopt

Eserine

Iopidine

Isopto Carbachol

Isopto Carpine

Istalol

Latisse

Ocusert Pilo

Omlonti

Optipranolol

Phospholine Iodide

Propine

Qlosi

Rescula

Rhopressa

Rocklatan

Simbrinza

Timoptic Ocudose

Timoptic-XE Ocumeter Plus

Travatan

Trusopt Ocumeter

Vyzulta

Xalatan

Zioptan

Canadian Brand Name

Akarpine

Alti-Timolol Maleate

Apo-Levobunolol

Apo-Timop

Azopt 1%

Betagan 0.25%

Betagan 0.5%

Betoptic

Brimonidine Ophthalmic

Brimonidine Tartrate

Crown-Tim

Description

Demecarium, echothiophate, and isoflurophate are used in the eye to treat certain types of glaucoma and other eye conditions, such as accommodative esotropia. They may also be used in the diagnosis of certain eye conditions, such as accommodative esotropia.

These medicines are available only with your doctor's prescription.

This product is available in the following dosage forms:

Solution
Suspension
Emulsion
Gel Forming Solution
Implant

Before Using

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to medicines in this group or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Demecarium, echothiophate, or isoflurophate can cause serious side effects in any patient. When this medicine is used for a long time, eye cysts may occur. These eye cysts occur more often in children than in adults. Therefore, it is especially important that you discuss with the child's doctor the good that this medicine may do as well as the risks of using it.

Geriatric

Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing use of these medicines in the elderly with use in other age groups. However, demecarium, echothiophate, or isoflurophate can cause serious side effects in any patient.

Pregnancy

Because of the toxicity of these medicines in general, demecarium, echothiophate, and isoflurophate are not recommended during pregnancy.

Breastfeeding

Demecarium, echothiophate, and isoflurophate may be absorbed into the body. These medicines are not recommended during breast-feeding, because they may cause unwanted effects in nursing babies. It may be necessary for you to use another medicine or to stop breast-feeding during treatment. Be sure you have discussed the risks and benefits of the medicine with your doctor.

Drug Interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking any of these medicines, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using medicines in this class with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Albuterol
Bimatoprost
Ceritinib
Clonidine
Cobicistat
Crizotinib
Darunavir
Desvenlafaxine
Diltiazem
Dronedarone
Duloxetine
Epinephrine
Escitalopram
Fenoldopam
Fingolimod
Fluoxetine
Formoterol
Indacaterol
Iohexol
Lacosamide
Latanoprost
Levalbuterol
Olodaterol
Oxymetazoline
Paroxetine
Ponesimod
Rivastigmine
Salmeterol
Sertraline
Tafluprost
Tegafur
Terbutaline
Thimerosal
Travoprost
Unoprostone
Verapamil
Vilanterol

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Proper Use

To use the ophthalmic solution (eye drops) form of this medicine:

First, wash your hands. Tilt the head back and, pressing your finger gently on the skin just beneath the lower eyelid, pull the lower eyelid away from the eye to make a space. Drop the medicine into this space. Let go of the eyelid and gently close the eyes. Do not blink. Keep the eyes closed and apply pressure to the inner corner of the eye with your finger for 1 or 2 minutes to allow the medicine to be absorbed by the eye.
Remove any excess solution around the eye with a clean tissue, being careful not to touch the eye.
Immediately after using the eye drops, wash your hands to remove any medicine that may be on them.
To keep the medicine as germ-free as possible, do not touch the applicator tip to any surface (including the eye). Also, keep the container tightly closed.
The preservative in the eye drops containing the medicine, demecarium, may be absorbed by soft contact lenses. If you wear soft contact lenses, and your doctor has informed you that you can wear them while taking this medication, you should wait at least 15 minutes after applying the eye drops before inserting your lenses.

To use the ophthalmic ointment (eye ointment) form of this medicine:

First, wash your hands. Tilt the head back and, pressing your finger gently on the skin just beneath the lower eyelid, pull the lower eyelid away from the eye to make a space. Squeeze a thin strip of ointment into this space. A ½-cm (approximately ¼-inch) strip of ointment is usually enough, unless you have been told by your doctor to use a different amount. Let go of the eyelid and gently close the eyes. Keep the eyes closed for 1 to 2 minutes to allow the medicine to be absorbed by the eye.
Immediately after using the eye ointment, wash your hands to remove any medicine that may be on them.
Since isoflurophate loses its effectiveness when exposed to moisture, do not wash the tip of the ointment tube or allow it to touch any moist surface (including the eye).
To keep the medicine as germ-free as possible, do not touch the applicator tip to any surface (including the eye). After using this eye ointment, wipe the tip of the ointment tube with a clean tissue and keep the tube tightly closed.

It is very important that you use this medicine only as directed. Do not use more of it and do not use it more often than your doctor ordered. To do so may increase the chance of too much medicine being absorbed into the body and the chance of side effects.

If the applicator tip touches any surface (including the eye), it may become contaminated with bacteria, which may increase the chance of developing an eye infection. If you think the applicator has become contaminated, notify your doctor immediately.

Eye ointment usually causes blurred vision for a short time after you use it, and eye drops containing these medicines may affect your vision for several hours after you use them. Therefore, ask your doctor if the dose (or one of the doses if you use more than 1 dose a day) can be used at bedtime.

Dosing

The dose medicines in this class will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For demecarium

For ophthalmic solution (eye drops) dosage form:
- For glaucoma:
  - Adults and older children—Use one drop in the eye one or two times a day.
  - Infants and young children—Use and dose must be determined by your doctor.
- For treatment of accommodative esotropia:
  - Adults and older children—Use one drop in the eye once a day for two to three weeks, then one drop in the eye once every two days for three to four weeks, then use as determined by the doctor.
  - Infants and young children—Use and dose must be determined by your doctor.
- For diagnosis of accommodative esotropia:
  - Adults and older children—Use one drop in the eye once a day for two weeks, then one drop in the eye once every two days for two to three weeks.
  - Infants and young children—Use and dose must be determined by your doctor.

For echothiophate

For ophthalmic solution (eye drops) dosage form:
- For glaucoma:
  - Adults and older children—Use one drop in the eye one or two times a day.
  - Infants and younger children—Use and dose must be determined by your doctor.
- For treatment of accommodative esotropia:
  - Adults and older children—Use one drop in the eye once a day or one drop in the eye once every two days.
  - Infants and young children—Use and dose must be determined by your doctor.
- For diagnosis of accommodative esotropia:
  - Adults and older children—Use one drop in the eye once a day at bedtime for two to three weeks.
  - Infants and young children—Use and dose must be determined by your doctor.

For isoflurophate

For ophthalmic ointment dosage form:
- For glaucoma:
  - Adults and older children—Use the ointment in the eyes once every three days or as often as three times a day as directed by the doctor.
  - Infants and young children—Use and dose must be determined by your doctor.
- For treatment of accommodative esotropia:
  - Adults and older children—Use the ointment in the eyes once a day at bedtime for two weeks, then once a week or as often as once every two days as directed by the doctor.
  - Infants and young children—Use and dose must be determined by your doctor.
- For diagnosis of accommodative esotropia:
  - Adults and older children—Use the ointment in the eyes once a day at bedtime for two weeks.
  - Infants and young children—Use and dose must be determined by your doctor.

Missed Dose

Call your doctor or pharmacist for instructions.

If you miss a dose of this medicine and your dosing schedule is:

One dose every other day—Use the missed dose as soon as possible if you remember it on the day it should be used. However, if you do not remember the missed dose until the next day, use it at that time. Then skip a day and start your dosing schedule again. Do not double doses.
One dose a day—Use the missed dose as soon as possible. However, if you do not remember the missed dose until the next day, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
More than one dose a day—Use the missed dose as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Keep out of the reach of children.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Do not keep outdated medicine or medicine no longer needed.

Precautions

If you are using this medicine for glaucoma, your doctor should check your eye pressure at regular visits to make sure the medicine is working.

If you will be using this medicine for a long time, your doctor should examine your eyes at regular visits to make sure this medicine does not cause unwanted effects.

Before you have any kind of surgery (including eye surgery), dental treatment, or emergency treatment, tell the medical doctor or dentist in charge and the anesthesiologist or anesthetist (the person who puts you to sleep) that you are using this medicine or have used it within the past month.

These medicines should not be used if an eye infection is present, or if the eye is wounded or injured. If redness, pain, or discharge develops, or if a foreign object becomes lodged in one or both eyes, or if you suffer a blow to the eye or eye area, notify your doctor immediately.

Avoid breathing in even small amounts of carbamate- or organophosphate-type insecticides or pesticides (for example, carbaryl [Sevin], demeton [Systox], diazinon, malathion, parathion, ronnel [Trolene], or TEPP). They may add to the effects of this medicine. Farmers, gardeners, residents of communities undergoing insecticide or pesticide spraying or dusting, workers in plants manufacturing such products, or other persons exposed to such poisons should protect themselves by wearing a mask over the nose and mouth, changing clothes frequently, and washing hands often.

Make sure your vision is clear before you drive, use machines, or do anything else that could be dangerous if you are not able to see well. This is because:

After you apply this medicine to your eyes, your pupils may become unusually small. This may cause you to see less well at night or in dim light.
After you begin using this medicine, your vision may be blurred or there may be a change in your near or distance vision.
The eye ointment form of this medicine usually causes blurred vision for a short time after you apply it.

Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Rare

Burning, redness, stinging, or other eye irritation
eye pain
veil or curtain appearing across part of vision

Symptoms of too much medicine being absorbed into the body

The most common of these symptoms, especially in children, are nausea, vomiting, diarrhea, and stomach cramps or pain. Your doctor may tell you to stop taking the medicine if any of these side effects occur.

Too much medicine being absorbed is rare with the eye ointment form of this medicine.

Increased sweating
loss of bladder control
muscle weakness
nausea, vomiting, diarrhea, or stomach cramps or pain
shortness of breath, tightness in chest, or wheezing
slow or irregular heartbeat
unusual tiredness or weakness
watering of mouth

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Blurred vision or change in near or distance vision
difficulty in seeing at night or in dim light
headache or browache
twitching of eyelids
watering of eyes

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

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