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ecothiopate

S01EB03

Forms & Strengths

Ophthalmic solution 0.5% (w/v)
Ophthalmic solution 0.2% (w/v) in some regions

Adult Dosing

Instill 1 drop in each affected eye 2–3 times daily
May increase to 4 times daily if intraocular pressure control is inadequate
Do not exceed 6 drops per day per eye

Pediatric Dosing

Children >2 years: 1 drop in each affected eye 2–3 times daily
Use with caution; consider 0.2% strength if available
Not recommended for children <2 years due to risk of excessive cholinergic effects

Indications

Primary open‑angle glaucoma
Ocular hypertension
Secondary glaucoma (e.g., neovascular)
Adjunctive therapy when other agents insufficient

Mechanism of Action

Reversible inhibition of acetylcholinesterase in ocular tissues
Increases acetylcholine → contraction of ciliary muscle → opening of trabecular meshwork
Induces miosis, reducing aqueous humor formation and enhancing outflow

Contraindications

Known hypersensitivity to ecothiopate or other cholinesterase inhibitors
Acute angle‑closure (narrow‑angle) glaucoma
Severe iritis or uveitis
Uncontrolled asthma, COPD, or obstructive uropathy
Severe bradycardia or sick sinus syndrome

Adverse Reactions

Transient blurred vision and brow ache
Conjunctival hyperemia, tearing, and ocular irritation
Photophobia due to miosis
Systemic cholinergic effects: nausea, salivation, sweating, bronchospasm, bradycardia
Rare: retinal detachment, corneal epithelial defects

Drug Interactions

Anticholinergic agents (e.g., atropine) antagonize ocular effect
Systemic cholinesterase inhibitors (e.g., neostigmine) produce additive cholinergic toxicity
Topical beta‑blockers may increase risk of bradycardia
Other miotics (pilocarpine) may cause excessive miosis
Topical anesthetics may enhance corneal irritation

Curated Content: Needs Vetting Before Put to Clinical Use