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

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    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

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            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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              Images

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              Patient Handout

              Patient Education
              echothiophate iodide ophthalmic (eye)

              ECHOTHIOPHATE SOLUTION - OPHTHALMIC

              (eck-oh-THIGH-oh-fate)

              COMMON BRAND NAME(S): Phospholine Iodide

              USES: This medication is used to treat high pressure inside the eye (due to conditions such as certain types of glaucoma) and other eye problems (such as accommodative esotropia). It works by causing the pupil to shrink, decreasing the amount of fluid within the eye, and affecting certain eye muscles.

              HOW TO USE: Follow all directions supplied by the manufacturer for mixing the eye drops. Discard the mixed solution if it changes color, becomes cloudy, or develops particles.To apply eye drops, wash your hands first. To avoid contamination, be careful not to touch the dropper to any surface or let it touch your eye.If you are wearing contact lenses, remove them before using eye drops. Wait at least 15 minutes before replacing your contact lenses.Tilt your head back, look upward, and pull down the lower eyelid to make a pouch. Hold the dropper directly over your eye and place one drop into the pouch. Let go of the eyelid and gently close your eyes. Place one finger at the corner of your eye (near the nose) and apply gentle pressure for 1 to 2 minutes. This will prevent the medication from draining out. Try not to blink and do not rub your eye. Repeat these steps for your other eye if so directed or if your dose is for more than 1 drop.Remove extra solution around the eye with a tissue, and wash your hands to remove any medicine that may be on them. Do not rinse the dropper. Replace the dropper cap after each use.If you are using another kind of eye medication (such as drops or ointments), wait at least 5 minutes before using the other medication. Use eye drops before ointments to allow the eye drops to enter the eye.The dosage is based on your medical condition and response to therapy. Do not increase your dose or use more frequently than directed by your doctor. Doing so may increase the risk for serious side effects.

              SIDE EFFECTS: Temporary irritation/burning/stinging of the eye, temporary blurred vision, eyelid muscle twitching, poor vision in dim light, headache, or brow ache may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: eye pain, flushing, diarrhea, nausea, irregular heartbeat, stomach/abdominal pain or cramps, increased saliva, increased urination, unusual sweating, vision changes.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before using echothiophate, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: asthma, epilepsy, other eye problems (such as iritis, uveitis, detached retina), heart disease (such as heart failure, recent heart attack), low or high blood pressure, myasthenia gravis, overactive thyroid (hyperthyroidism), Parkinsonism, stomach/intestinal problems (such as ulcers, spasms), certain urinary problems (such as blockage).After you apply echothiophate, your vision may become temporarily blurred or unstable. Vision in dim light may be affected. Do not drive (especially at night), use machinery, or do any activity that requires alertness or clear vision until you are sure you can perform such activities safely. Limit alcoholic beverages.Avoid exposure to insecticides. Some types of insecticides may increase the risk of certain side effects. If you have contact with insecticides, wear a mask and/or gloves and wash or change clothing frequently. Consult your doctor or pharmacist for more information.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is not known if this drug passes into breast milk. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

              OVERDOSE: This medicine may be harmful if swallowed. If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: increased saliva, irregular/slow heartbeat, nausea, diarrhea, increased sweating.

              NOTES: Do not share this medication with others.Laboratory and/or medical tests (such as eye exams) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

              MISSED DOSE: If you are prescribed this medication on a once- or twice-daily schedule and miss a dose, apply it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Use your next dose at the regular time. Do not double the dose to catch up.Ask your doctor ahead of time what you should do if you miss a dose while using this medication on another schedule besides a daily one.

              STORAGE: Store the unmixed product in the refrigerator away from light and moisture. Do not freeze. The mixed solution may be stored at room temperature for up to 4 weeks. Do not refrigerate the mixed solution. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              Information last revised June 2022. Copyright(c) 2022 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

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              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              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.
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              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.
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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.