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
Long-acting, topical ophthalmic cholinesterase inhibitor that enhances effect of endogenously liberated acetylcholine in iris, ciliary muscle, and other parasympathetically innervated structures of the eye
Thus, it causes miosis, increase in facility of outflow of aqueous humor, fall in intraocular pressure (IOP), and potentiation of accommodation
Echothiophate iodide ophthalmic solution will depress both plasma and erythrocyte cholinesterase levels in most patients after a few weeks of eye drop therapyUse for topical use
This long-acting cholinesterase inhibitor enhances the effect of endogenously liberated acetylcholine in iris, ciliary muscle, and other parasympathetically innervated structures of the eye
Thus, it causes miosis, increase in facility of outflow of aqueous humor, fall in intraocular pressure (IOP), 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
Pharmacokinetics
Onset of action: 10-30 min (miosis); 4-8hr (IOP); 24 hr (peak effects IOP)
Duration: 1-4 weeks (miosis)
Images
Patient Handout
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 often 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 this drug, 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 clear vision until you can do it safely.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 often. 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 unknown 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.Lab and/or medical tests (such as eye exams) should be done while you are using this medication. Keep all medical and lab appointments. 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 July 2023. Copyright(c) 2023 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.
Formulary
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