terminology and guidelines for glaucoma ii - Kwaliteitskoepel
terminology and guidelines for glaucoma ii - Kwaliteitskoepel
terminology and guidelines for glaucoma ii - Kwaliteitskoepel
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3.3.1.4 - Category: PARASYMPATHOMIMETICS (CHOLINERGIC DRUGS) 44,45<br />
Generics<br />
Tradenames<br />
Direct-acting: Pilocarpine 0.5-4% E-pilo, Isopto Carpine, Pilagan, Pilocar,<br />
Pilogel, Pilomann, Pilopine, Pilopine HS Gel,<br />
Pilostat, Spersacarpine, Isopto Carpine<br />
Aceclidine 2%<br />
Glaucostat Glaucostate, Glaunorm<br />
Carbachol 0.75-3%<br />
Isopto Carbachol, Karbakolin Isopto<br />
Acetylcholine 1%<br />
Miochol<br />
Indirect-acting: Demecarium bromide 0.125, 0.25% Humorsol, Tosmilen<br />
Ecothiophate iodide 0.03-0.25%<br />
Phospholine Iodide, Echodide<br />
Physostigmine<br />
Eserine<br />
Combinations: Pilocarpine + Physostigmine Piloeserine<br />
Carbachol 0.75% + Pilocarpine 2%<br />
+HCl Procaine 2%<br />
Mios<br />
Action<br />
Increase in facility of outflow of aqueous humor.<br />
Direct action on longitudinal ciliary muscle.<br />
Dosage <strong>and</strong> administration<br />
Direct-acting:<br />
Pilocarpine 1-4%<br />
Pilocarpine gel<br />
Ocuserts 20 or 40 µg/hr<br />
Carbachol 0.75%, 1.5%, 2.25%, <strong>and</strong> 3%<br />
Acetylcholine 1:100 solution<br />
Aceclidine 2%<br />
Indirect-acting:<br />
Demecarium bromide 0.125 <strong>and</strong> 0.25%<br />
Ecothiophate iodide 0.03-0.25%<br />
Lowers IOP after 1 hr, lasts 6-7 hrs; usually<br />
given QID or TID in solutions with<br />
hydrophilic polymers.<br />
Once daily at bedtime.<br />
Usually once weekly<br />
Three times daily.<br />
For intracameral use during surgery<br />
BID (induces less accommodative spasm, a<br />
smaller increase in lens thickness <strong>and</strong> a<br />
lower reduction of the chamber depth<br />
compared to pilocarpine).<br />
Twice a day, at bedtime <strong>and</strong> in the morning.<br />
Once or twice a day, at bedtime <strong>and</strong> in the<br />
morning.<br />
Indications<br />
Direct-acting:<br />
Elevation of intraocular pressure in patients where the IOP can be deleterious <strong>for</strong> the preservation of<br />
visual function.<br />
Indirect-acting: POAG in aphakia / pseudophakia where surgery is refused or not feasible, in cases that are not con<br />
trolled on other less potent agents.<br />
These cases may respond satisfactory to ecothiophate iodide 0.03% or demecarium bromide 0.125%<br />
twice a day.<br />
Major contraindications<br />
Direct-acting: Age < 40 yrs, cataract, uveitis <strong>and</strong> neovascular <strong>glaucoma</strong>. Assess possible worsening of pupillary<br />
block in each case of angle-closure <strong>glaucoma</strong>.<br />
Indirect-acting: Active uveitis.<br />
Ch. 3 - 16 EGS