Intraocular Parasympathomimetic

Aka: Intraocular Parasympathomimetic, Intraocular Cholinergic, Ocular Parasympathomimetic Agent, Miotic, Carbachol, Echothiophate, Phospholine Iodide, Isopto Carbachol

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II. Indication

  1. Open Angle Glaucoma second line agent (adjunctive)
  2. Presbyopia (Pilocarpine or Vuity)

III. Contraindications

  1. Ocular inflammation

IV. Mechanism

  1. Reduces resistance to aqueous outflow (decreases IOP 20 to 30%)

V. 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)

VI. 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

VII. Drug Interactions

  1. Dicylomine

VIII. References

  1. Harris (2023) Am Fam Physician 107(3): 238-46 [PubMed]

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