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Pilocarpine ophthalmic Disease Interactions

There are 4 disease interactions with pilocarpine ophthalmic.

Major

Miotics (applies to pilocarpine ophthalmic) retinal detachment

Major Potential Hazard, High plausibility. Applicable conditions: Aphakia, Myopia, Retinal Disorder

The use of miotic agents may occasionally cause retinal detachment due to drug-induced ciliary or accommodative spasm, which causes the lens and vitreous to move forward and create a retinal tear. Therapy with miotic agents should be administered with extreme caution, if at all, in patients with risk factors for retinal detachment, such as old age, retinal degenerative changes or other retinal disorders, aphakia, prior cataract extraction, or a history of severe myopia or retinal detachment.

References

  1. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  2. Zimmerman TJ, Wheeler TM "Miotics: side effects and ways to avoid them." Ophthalmology 89 (1982): 76-80
  3. Benedict WL, Shami M "Impending macular hole associated with topical pilocarpine." Am J Ophthalmol 114 (1992): 765-6
  4. "Product Information. Phospholine iodide (echothiophate iodide)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  5. "Product Information. Humorsol Ophthalmic Solution (demecarium bromide ophthalmic)." Merck & Co, Inc, West Point, PA.
  6. "Product Information. Eserine (physostigmine ophthalmic)." Ciba Vision Ophthalmics, Duluth, GA.
  7. Braunwald E, Hauser SL, Kasper DL, Fauci AS, Isselbacher KJ, Longo DL, Martin JB, eds., Wilson JD "Harrison's Principles of Internal Medicine." New York, NY: McGraw-Hill Health Professionals Division (1998):
  8. "Product Information. Isopto Carpine (pilocarpine ophthalmic)." Alcon Laboratories Inc (2001):
  9. "Product Information. Isopto Carbachol (carbachol ophthalmic)." Alcon Laboratories Inc (2001):
View all 9 references
Major

Miotics (applies to pilocarpine ophthalmic) uveitis

Major Potential Hazard, High plausibility. Applicable conditions: Uveitis (Anterior)

The use of miotic agents is contraindicated in patients with active anterior uveitis and/or glaucoma associated with iridocyclitis. Pupillary constriction produced by these agents may aggravate the inflammation and predispose these patients to the development of posterior synechiae.

References

  1. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  2. Benjamin KW "Toxicity of ocular medications." Int Ophthalmol Clin 19 (1979): 199-255
  3. "Product Information. Phospholine iodide (echothiophate iodide)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  4. "Product Information. Humorsol Ophthalmic Solution (demecarium bromide ophthalmic)." Merck & Co, Inc, West Point, PA.
  5. "Product Information. Eserine (physostigmine ophthalmic)." Ciba Vision Ophthalmics, Duluth, GA.
  6. "Product Information. Isopto Carpine (pilocarpine ophthalmic)." Alcon Laboratories Inc (2001):
  7. "Product Information. Isopto Carbachol (carbachol ophthalmic)." Alcon Laboratories Inc (2001):
View all 7 references
Moderate

Miotics (applies to pilocarpine ophthalmic) cataracts

Moderate Potential Hazard, Moderate plausibility.

The use of miotic agents has been associated with the development of lens opacities characterized by the appearance of anterior subcapsular vacuoles. The incidence of cataracts appears to be highest in patients treated with long-acting cholinesterase inhibitors (e.g., demecarium and echothiophate) and may also be related to age (higher in patients > 60 years of age), drug concentration, frequency of use, and duration of therapy (>= 6 months). Lens opacities usually regress if miotic therapy is withdrawn early in their development but often become progressive once they are established. Therapy with miotic agents should be administered cautiously in patients with or predisposed to cataracts. Slit-lamp examinations should be performed regularly, and miotic therapy discontinued if necessary.

References

  1. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  2. Benjamin KW "Toxicity of ocular medications." Int Ophthalmol Clin 19 (1979): 199-255
  3. Zimmerman TJ, Wheeler TM "Miotics: side effects and ways to avoid them." Ophthalmology 89 (1982): 76-80
  4. "Product Information. Phospholine iodide (echothiophate iodide)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  5. "Product Information. Humorsol Ophthalmic Solution (demecarium bromide ophthalmic)." Merck & Co, Inc, West Point, PA.
  6. "Product Information. Eserine (physostigmine ophthalmic)." Ciba Vision Ophthalmics, Duluth, GA.
  7. "Product Information. Isopto Carpine (pilocarpine ophthalmic)." Alcon Laboratories Inc (2001):
View all 7 references
Moderate

Miotics (applies to pilocarpine ophthalmic) systemic vagotonic effects

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Corneal Abrasion, Asthma, Chronic Obstructive Pulmonary Disease, Dyspepsia, Hypotension, Irritable Bowel Syndrome, Myocardial Infarction, Parkinsonism, Peptic Ulcer, Post MI Syndrome, Seizures, Sinus Node Dysfunction, Urinary Tract Obstruction, Congestive Heart Failure, Hypertension, Arrhythmias

Topically applied cholinergic agents are systemically absorbed, with the potential for producing rare but clinically significant systemic effects, including urinary incontinence, tightness of the bladder, increased gastric contractility and acid secretion, bradycardia, severe hypotension, bronchospasm, seizures, and coma. Increases in blood pressure may occur rarely due to a nicotinic effect on sympathetic ganglia. Therapy with ophthalmic cholinergic agents, particularly the long-acting cholinesterase inhibitors (e.g., demecarium and echothiophate), should be administered cautiously in patients with corneal abrasion (which may increase drug penetration), bronchospastic diseases, spastic gastrointestinal disturbances, urinary tract obstruction, peptic ulcer, pronounced bradycardia and hypotension, vascular hypertension, acute cardiac failure, recent myocardial infarction, epilepsy, parkinsonism, and other conditions that may respond adversely to vagotonic effects. The usual precautions should be followed to minimize the risk of systemic toxicity, including digital compression of the nasolacrimal ducts (1 to 2 minutes) following instillation to limit drainage into the nasal chamber, where extensive absorption may occur, and washing hands after use to prevent skin absorption. Excessive cholinergic effects may be reversed with parenterally administered atropine.

References

  1. Rasch D, Holt J, Wilson M, Smith RB "Bronchospasm following intraocular injection of acetylcholine in a patient taking metoprolol." Anesthesiology 59 (1983): 583-5
  2. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  3. Ellis PP "Systemic reactions to topical therapy." Int Ophthalmol Clin 11 (1971): 1-11
  4. Benjamin KW "Toxicity of ocular medications." Int Ophthalmol Clin 19 (1979): 199-255
  5. Zimmerman TJ, Wheeler TM "Miotics: side effects and ways to avoid them." Ophthalmology 89 (1982): 76-80
  6. Treasure CB, Vita JA, Cox DA, Fish RD, Selwyn AP, Alexander RW, Ganz P "Acute myocardial infarction with normal coronary arteries associated with acetylcholine-induced vasoconstriction in the absence of a positive ergonovine test." Am J Cardiol 65 (1990): 255-7
  7. Marmion VJ "Vascular hypotension and bradycardia following intraocular injection of acetylcholine during cataract surgery." Am J Ophthalmol 97 (1984): 799-80
  8. Brinkley JR Jr, Henrick A "Vascular hypotension and bradycardia following intraocular injection of acetylcholine during cataract surgery." Am J Ophthalmol 97 (1984): 40-2
  9. Rongey KA, Weisman H "Hypotension following intraocular acetylcholine." Anesthesiology 36 (1972): 412
  10. Sekiya M, Okayama H, Suzuki M, Kobayashi T, Matsuoka H, Sumimoto T, Hamada M, Hiwada K "Acetylcholine-induced myocardial ischemia without epicardial coronary artery spasm: a possible vasospasm of small coronary arteries--a case report." Angiology 44 (1993): 811-5
  11. Babinski M, Smith B, Wickerham EP "Hypotension and bradycardia following intraocular acetylcholine injection. Report of a case." Arch Ophthalmol 94 (1976): 675-6
  12. Gombos GM "Systemic reactions following intraocular acetylcholine instillation." Ann Ophthalmol 14 (1982): 529-30
  13. Gombos DS "Acetylcholine in ophthalmology: a revisit." Ann Ophthalmol 20 (1988): 455,462
  14. Taytard A, Vergeret J, Auzerie J, Freour P "Acetylcholine-induced bronchospasm in asthma patients: dose/response curves." Eur J Respir Dis Suppl 128(Pt 2) (1983): 513-4
  15. "Product Information. Miochol (acetylcholine chloride, intraocular)." Ciba Vision Ophthalmics, Duluth, GA.
  16. "Product Information. Phospholine iodide (echothiophate iodide)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  17. "Product Information. Humorsol Ophthalmic Solution (demecarium bromide ophthalmic)." Merck & Co, Inc, West Point, PA.
  18. "Product Information. Eserine (physostigmine ophthalmic)." Ciba Vision Ophthalmics, Duluth, GA.
  19. "Product Information. Isopto Carpine (pilocarpine ophthalmic)." Alcon Laboratories Inc (2001):
  20. "Product Information. Isopto Carbachol (carbachol ophthalmic)." Alcon Laboratories Inc (2001):
View all 20 references

Pilocarpine ophthalmic drug interactions

There are 96 drug interactions with pilocarpine ophthalmic.

Pilocarpine ophthalmic alcohol/food interactions

There is 1 alcohol/food interaction with pilocarpine ophthalmic.


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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.