Dosing & Uses
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
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.
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
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
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.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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Formulary
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