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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

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