echothiophate iodide (Rx)

Brand and Other Names:Phospholine Iodide
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

ophthalmic solution

  • 0.125%

Open Angle or Secondary Glaucoma

Initial: 0.03% solution instilled in affected eye(s) twice daily (AM & HS); may use higher dose (>0.06%) if unsatisfactory response

Maintenance: 1 dose every other day

Advanced Chronic Simple Glaucoma/Glaucoma Following Cataract Surgery

Initial 0.03% instilled in affected eye(s) twice daily

Higher strengths usu necessary if transferred after unsatisfactory response with other drugs

Dosage Forms & Strengths

ophthalmic solution

  • 0.125%

Accommodative Esotropia

Initial (Dx): 0.125% solution instilled in both eyes qHS for 2-3 weeks

Maintenance (if Dx+)

  • 0.125% solution qOTHERday
  • May be gradually lowered
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Interactions

Interaction Checker

and echothiophate iodide

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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             activity indicator 

            Contraindicated (0)

              Serious - Use Alternative (1)

              • succinylcholine

                echothiophate iodide increases levels of succinylcholine by decreasing metabolism. Avoid or Use Alternate Drug.

              Monitor Closely (66)

              • aclidinium

                echothiophate iodide increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • amifampridine

                amifampridine and echothiophate iodide both increase cholinergic effects/transmission. Use Caution/Monitor.

              • amitriptyline

                echothiophate iodide increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • amoxapine

                echothiophate iodide increases and amoxapine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • anticholinergic/sedative combos

                echothiophate iodide increases and anticholinergic/sedative combos decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • atracurium

                echothiophate iodide increases and atracurium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • atropine

                echothiophate iodide increases and atropine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • atropine IV/IM

                echothiophate iodide increases and atropine IV/IM decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • belladonna alkaloids

                echothiophate iodide increases and belladonna alkaloids decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • belladonna and opium

                echothiophate iodide increases and belladonna and opium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • benztropine

                echothiophate iodide increases and benztropine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • bethanechol

                bethanechol and echothiophate iodide both increase cholinergic effects/transmission. Use Caution/Monitor.

              • carbachol

                carbachol and echothiophate iodide both increase cholinergic effects/transmission. Use Caution/Monitor.

              • cevimeline

                cevimeline and echothiophate iodide both increase cholinergic effects/transmission. Use Caution/Monitor.

              • cisatracurium

                echothiophate iodide increases and cisatracurium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • clomipramine

                echothiophate iodide increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • cyclizine

                echothiophate iodide increases and cyclizine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • cyclobenzaprine

                echothiophate iodide increases and cyclobenzaprine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • darifenacin

                echothiophate iodide increases and darifenacin decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dicyclomine

                echothiophate iodide increases and dicyclomine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • diphenhydramine

                echothiophate iodide increases and diphenhydramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • donepezil

                donepezil and echothiophate iodide both increase cholinergic effects/transmission. Use Caution/Monitor.

              • dosulepin

                echothiophate iodide increases and dosulepin decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • doxepin

                echothiophate iodide increases and doxepin decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • fesoterodine

                echothiophate iodide increases and fesoterodine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • flavoxate

                echothiophate iodide increases and flavoxate decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • galantamine

                echothiophate iodide and galantamine both increase cholinergic effects/transmission. Use Caution/Monitor.

              • glycopyrrolate

                echothiophate iodide increases and glycopyrrolate decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • glycopyrrolate inhaled

                echothiophate iodide increases and glycopyrrolate inhaled decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • henbane

                echothiophate iodide increases and henbane decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • homatropine

                echothiophate iodide increases and homatropine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • huperzine A

                echothiophate iodide and huperzine A both increase cholinergic effects/transmission. Use Caution/Monitor.

              • hyoscyamine

                echothiophate iodide increases and hyoscyamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • hyoscyamine spray

                echothiophate iodide increases and hyoscyamine spray decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • imipramine

                echothiophate iodide increases and imipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • ipratropium

                echothiophate iodide increases and ipratropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • lofepramine

                echothiophate iodide increases and lofepramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • maprotiline

                echothiophate iodide increases and maprotiline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • meclizine

                echothiophate iodide increases and meclizine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • methscopolamine

                echothiophate iodide increases and methscopolamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • neostigmine

                echothiophate iodide and neostigmine both increase cholinergic effects/transmission. Use Caution/Monitor.

              • nortriptyline

                echothiophate iodide increases and nortriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • onabotulinumtoxinA

                echothiophate iodide increases and onabotulinumtoxinA decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • orphenadrine

                echothiophate iodide increases and orphenadrine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • oxybutynin

                echothiophate iodide increases and oxybutynin decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • oxybutynin topical

                echothiophate iodide increases and oxybutynin topical decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • oxybutynin transdermal

                echothiophate iodide increases and oxybutynin transdermal decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • pancuronium

                echothiophate iodide increases and pancuronium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • physostigmine

                echothiophate iodide and physostigmine both increase cholinergic effects/transmission. Use Caution/Monitor.

              • pilocarpine

                echothiophate iodide and pilocarpine both increase cholinergic effects/transmission. Use Caution/Monitor.

              • pralidoxime

                echothiophate iodide increases and pralidoxime decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • propantheline

                echothiophate iodide increases and propantheline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • protriptyline

                echothiophate iodide increases and protriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • pyridostigmine

                echothiophate iodide and pyridostigmine both increase cholinergic effects/transmission. Use Caution/Monitor.

              • rapacuronium

                echothiophate iodide increases and rapacuronium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • rivastigmine

                echothiophate iodide and rivastigmine both increase cholinergic effects/transmission. Use Caution/Monitor.

              • rocuronium

                echothiophate iodide increases and rocuronium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • scopolamine

                echothiophate iodide increases and scopolamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • solifenacin

                echothiophate iodide increases and solifenacin decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • succinylcholine

                echothiophate iodide and succinylcholine both increase cholinergic effects/transmission. Use Caution/Monitor.

              • tiotropium

                echothiophate iodide increases and tiotropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • tolterodine

                echothiophate iodide increases and tolterodine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • trimipramine

                echothiophate iodide increases and trimipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • trospium chloride

                echothiophate iodide increases and trospium chloride decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • umeclidinium bromide

                echothiophate iodide increases and umeclidinium bromide decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor. Monitor when umeclidinium bromide is coadministered with cholinergic agents.

              • vecuronium

                echothiophate iodide increases and vecuronium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              Minor (6)

              • desipramine

                echothiophate iodide increases and desipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

              • donepezil

                donepezil increases effects of echothiophate iodide by pharmacodynamic synergism. Minor/Significance Unknown.

              • galantamine

                galantamine increases effects of echothiophate iodide by pharmacodynamic synergism. Minor/Significance Unknown.

              • pantothenic acid

                pantothenic acid, echothiophate iodide. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown.

              • procainamide

                procainamide decreases effects of echothiophate iodide by pharmacodynamic antagonism. Minor/Significance Unknown.

              • trazodone

                echothiophate iodide increases and trazodone decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

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              Adverse Effects

              Frequency Not Defined

              Burning

              Bradycardia

              Flushing

              Hypotension

              Stinging

              Lacrimation

              Iris cyst formation

              Diarrhea

              Nausea

              Vomiting

              Blurred vision

              Ciliary redness

              Increased intraocular pressure

              Miosis

              Myopia

              Uveitis activation

              Lens opacities

              Retinal detachment

              Lid muscle twitching

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              Warnings

              Contraindications

              Hypersensitivity

              Active uveitis

              Angle-closure glaucoma without iridectomy

              Relative: history of retinal detachment; quiescent/history of uveitis

              Cautions

              Use with 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

              Concomitant cholinergic drugs (succinylcholine, systemic myasthenia gravis drugs)

              Potential for conjunctival thickening, retinal detachment, lens opacity; use with caution, where there is prior history of retinal detachment

              Temporary discontinuance of medication necessary if cholinergic side-effects, including hyperhidrosis, sialorrhea, urinary incontinence, diarrhea, muscle weakness, cardiac irregularities, or respiratory difficulties occur

              Do not use more frequently than q12hr

              Few weeks of therapy may depress plasma and erythrocyte cholinesterase levels

              Perform baseline measurement of anterior chamber angle and perform routine lenss examination; do not use for tonometric glaucoma, or with active history of uveitis

              Because of possible adverse effects, observe caution in treating elevated IOP with echothiophate iodide for ophthalmic solution in patients who are at same time undergoing treatment with systemic anticholinesterase medications

              Digital compression of nasolacrimal ducts for a minute or two following instillation to minimize drainage into nasal chamber recommended; to prevent possible skin absorption, hands should be washed following instillation

              Patients receiving echothiophate iodide for ophthalmic solution exposed to carbamate- or organophosphate-type insecticides and pesticides should be warned of additive systemic effects possible from absorption of pesticide through 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

              Administer succinylcholine 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

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              Pregnancy & Lactation

              Pregnancy Category: C

              Lactation: Discontinue drug or do not nurse

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Cholinesterase inhibitor; enhances activity of endogenous acetylcholine, which leads to continuous stimulation of the ciliary muscle producing miosis and fascilitation of humor outflow that may reduce intraocular pressure

              Pharmacokinetics

              Onset of action: 10-30 min (miosis); 4-8hr (IOP); 24 hr (peak effects IOP)

              Duration: 1-4 weeks (miosis)

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              Patient Handout

              A Patient Handout is not currently available for this monograph.
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              Formulary

              FormularyPatient Discounts

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              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.