Medically reviewed on Oct 31, 2018
Commonly used brand name(s)
In the U.S.
- Isopto Eserine
Pharmacologic Class: Cholinesterase Inhibitor
Uses For physostigmine
Physostigmine is used to treat certain types of glaucoma.
Physostigmine is available only with your doctor's prescription.
Before Using physostigmine
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For physostigmine, the following should be considered:
Tell your doctor if you have ever had any unusual or allergic reaction to physostigmine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Although there is no specific information comparing use of physostigmine in children with use in other age groups, it is not expected to cause different side effects or problems in children than it does in adults.
Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. Although there is no specific information comparing use of physostigmine in the elderly with use in other age groups, it is not expected to cause different side effects or problems in older people than it does in younger adults.
There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Interactions with Medicines
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking physostigmine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using physostigmine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Using physostigmine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Interactions with Food/Tobacco/Alcohol
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.
Other Medical Problems
The presence of other medical problems may affect the use of physostigmine. Make sure you tell your doctor if you have any other medical problems, especially:
- Eye disease or problems (other)—Physostigmine may make the condition worse
Proper Use of physostigmine
To use the ophthalmic solution (eye drops) form of physostigmine:
- Do not use if the solution becomes discolored.
- First, wash your hands. With the middle finger, apply pressure to the inside corner of the eye (and continue to apply pressure for 1 or 2 minutes after the medicine has been placed in the eye). Tilt the head back and with the index finger of the same hand, pull the lower eyelid away from the eye to form a pouch. Drop the medicine into the pouch and gently close the eyes. Do not blink. Keep the eyes closed for 1 or 2 minutes to allow the medicine to be absorbed.
- Immediately after using the eye drops, wash your hands to remove any medicine that may be on them.
- To keep the medicine as germ-free as possible, do not touch the applicator tip to any surface (including the eye). Also, keep the container tightly closed.
To use the ointment form of physostigmine:
- First, wash your hands. Pull the lower eyelid away from the eye to form a pouch. Squeeze a thin strip of ointment into the pouch. A 1-cm (approximately 1/3-inch) strip of ointment is usually enough unless otherwise directed by your doctor. Gently close the eyes and keep them closed for 1 or 2 minutes to allow the medicine to be absorbed.
- Immediately after using the eye ointment, wash your hands to remove any medicine that may be on them.
- To keep the medicine as germ-free as possible, do not touch the applicator tip to any surface (including the eye). After using the eye ointment, wipe the tip of the ointment tube with a clean tissue and keep the tube tightly closed.
Use physostigmine only as directed. Do not use more of it and do not use it more often than your doctor ordered. To do so may increase the chance of too much medicine being absorbed into the body and the chance of side effects.
The dose of physostigmine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of physostigmine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
- For glaucoma:
- For ophthalmic ointment dosage form:
- Adults and children—Use in each eye one to three times a day.
- For ophthalmic solution (eye drops) dosage form:
- Adults and children—One drop in each eye up to four times a day.
- For ophthalmic ointment dosage form:
If you miss a dose of physostigmine, apply it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule.
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.
Precautions While Using physostigmine
Your doctor should check your eye pressure at regular visits.
For a short time after you apply physostigmine, your vision may be blurred or there may be a change in your near or distant vision, especially at night. Make sure your vision is clear before you drive, use machines, or do anything else that could be dangerous if you are not able to see well .
Physostigmine Side Effects
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
Symptoms of too much medicine being absorbed into the body
- Increased sweating
- loss of bladder control
- muscle weakness
- nausea, vomiting, diarrhea, or stomach cramps or pain
- shortness of breath, tightness in chest, or wheezing
- slow or irregular heartbeat
- unusual tiredness or weakness
- watering of mouth
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
- Blurred vision or change in near or distant vision
- eye pain
- Burning, redness, stinging, or other eye irritation
- headache or browache
- twitching of eyelids
- watering of eyes
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
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