Pharm

Intraocular Parasympathomimetic

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Intraocular Parasympathomimetic, Intraocular Cholinergic, Ocular Parasympathomimetic Agent, Miotic, Intraocular Pilocarpine, Isoptocarpine, Pilopine gel, Ocusert, Carbachol, Echothiophate, Phospholine Iodide, Isopto Carbachol, Pilocar

  • Indication
  1. Open Angle Glaucoma second line agent (adjunctive)
  • Contraindications
  1. Ocular inflammation
  • Mechanism
  1. Reduces resistance to aqueous outflow (decreases IOP 20 to 30%)
  • Medications (Green Cap)
  1. Cholinergic Agonists
    1. Pilocarpine (Isoptocarpine, Pilopine gel, Ocusert, Pilocar)
      1. Dosing: 1 drop three to four times daily
      2. Most common Cholinergic Agent used in Open Angle Glaucoma
    2. Carbachol (Isopto Carbachol)
  2. Anticholinesterases
    1. Echothiophate (Phospholine Iodide)
    2. Demacarium (Humorsol)
  • Adverse Effects
  1. Generally well tolerated
  2. Burning or stinging
  3. Cataract formation
  4. Pupil Constriction or Miosis (primary expected effect)
  5. Headache
  6. Systemic effects (if absorbed)
    1. Nausea or Vomiting
    2. Diarrhea
    3. Sweating
    4. Tremor
    5. Hypotension
    6. Sinus Bradycardia
    7. Atrioventricular Block
  • Drug Interactions
  1. Dicylomine
  • References
  1. Harris (2023) Am Fam Physician 107(3): 238-46 [PubMed]