P2E1 (epinephrine / pilocarpine ophthalmic) and Alcohol / Food Interactions
There is 1 alcohol/food/lifestyle interaction with P2E1 (epinephrine / pilocarpine ophthalmic):
High Blood Pressure (Hypertension)
Moderate Potential Hazard, Low plausibility
miotics - systemic vagotonic effects
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.
- Babinski M, Smith B, Wickerham EP "Hypotension and bradycardia following intraocular acetylcholine injection. Report of a case." Arch Ophthalmol 94 (1976): 675-6
- Ellis PP "Systemic reactions to topical therapy." Int Ophthalmol Clin 11 (1971): 1-11
- American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
- Gombos DS "Acetylcholine in ophthalmology: a revisit." Ann Ophthalmol 20 (1988): 455,462
- Zimmerman TJ, Wheeler TM "Miotics: side effects and ways to avoid them." Ophthalmology 89 (1982): 76-80
- Rasch D, Holt J, Wilson M, Smith RB "Bronchospasm following intraocular injection of acetylcholine in a patient taking metoprolol." Anesthesiology 59 (1983): 583-5
- Rongey KA, Weisman H "Hypotension following intraocular acetylcholine." Anesthesiology 36 (1972): 412
- 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
- Benjamin KW "Toxicity of ocular medications." Int Ophthalmol Clin 19 (1979): 199-255
- "Product Information. Eserine (physostigmine ophthalmic)." Ciba Vision Ophthalmics, Duluth, GA.
- Marmion VJ "Vascular hypotension and bradycardia following intraocular injection of acetylcholine during cataract surgery." Am J Ophthalmol 97 (1984): 799-80
- 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
- Gombos GM "Systemic reactions following intraocular acetylcholine instillation." Ann Ophthalmol 14 (1982): 529-30
- "Product Information. Phospholine iodide (echothiophate iodide)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
- Brinkley JR Jr, Henrick A "Vascular hypotension and bradycardia following intraocular injection of acetylcholine during cataract surgery." Am J Ophthalmol 97 (1984): 40-2
- "Product Information. Isopto Carpine (pilocarpine ophthalmic)" Alcon Laboratories Inc, Fort Worth, TX.
- "Product Information. Isopto Carbachol (carbachol ophthalmic)" Alcon Laboratories Inc, Ft Worth, TX.
- 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
- "Product Information. Miochol (acetylcholine chloride, intraocular)." Ciba Vision Ophthalmics, Duluth, GA.
- "Product Information. Humorsol Ophthalmic Solution (demecarium bromide ophthalmic)." Merck & Co, Inc, West Point, PA.
P2E1 (epinephrine / pilocarpine ophthalmic) drug Interactions
There are 430 drug interactions with P2E1 (epinephrine / pilocarpine ophthalmic)
P2E1 (epinephrine / pilocarpine ophthalmic) disease Interactions
There are 9 disease interactions with P2E1 (epinephrine / pilocarpine ophthalmic) which include:
- Retinal Detachment
- Narrow Angles
- Systemic Vagotonic Effects
Drug Interaction Classification
|Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.|
|Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.|
|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.|
|No information available.|
Do not stop taking any medications without consulting your healthcare provider.
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