Health Guide
Drug Guide

Antiglaucoma agent, cholinergic, Long-acting (Ophthalmic route)

Brand Names:

Dosage Forms:

Uses of This Medicine:

Demecarium, echothiophate, and isoflurophate are used in the eye to treat certain types of glaucoma and other eye conditions, such as accommodative esotropia. They may also be used in the diagnosis of certain eye conditions, such as accommodative esotropia.

These medicines are available only with your doctor's prescription.

Before Using This Medicine:


Tell your doctor if you have ever had any unusual or allergic reaction to medicines in this group or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.


Demecarium, echothiophate, or isoflurophate can cause serious side effects in any patient. When this medicine is used for a long time, eye cysts may occur. These eye cysts occur more often in children than in adults. Therefore, it is especially important that you discuss with the child's doctor the good that this medicine may do as well as the risks of using it.

Older adults

Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing use of these medicines in the elderly with use in other age groups. However, demecarium, echothiophate, or isoflurophate can cause serious side effects in any patient.


Because of the toxicity of these medicines in general, demecarium, echothiophate, and isoflurophate are not recommended during pregnancy.


Demecarium, echothiophate, and isoflurophate may be absorbed into the body. These medicines are not recommended during breast-feeding, because they may cause unwanted effects in nursing babies. It may be necessary for you to use another medicine or to stop breast-feeding during treatment. Be sure you have discussed the risks and benefits of the medicine with your doctor.

Other medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking any of these medicines, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using medicines in this class with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Other interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other medical problems

The presence of other medical problems may affect the use of medicines in this class. Make sure you tell your doctor if you have any other medical problems, especially:

Proper Use of This Medicine:

To use the ophthalmic solution (eye drops) form of this medicine:

To use the ophthalmic ointment (eye ointment) form of this medicine:

It is very important that you use this medicine only as directed. Do not use more of it and do not use it more often than your doctor ordered. To do so may increase the chance of too much medicine being absorbed into the body and the chance of side effects.

If the applicator tip touches any surface (including the eye), it may become contaminated with bacteria, which may increase the chance of developing an eye infection. If you think the applicator has become contaminated, notify your doctor immediately.

Eye ointment usually causes blurred vision for a short time after you use it, and eye drops containing these medicines may affect your vision for several hours after you use them. Therefore, ask your doctor if the dose (or one of the doses if you use more than 1 dose a day) can be used at bedtime.


The dose medicines in this class will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

Missed dose

Call your doctor or pharmacist for instructions.

If you miss a dose of this medicine and your dosing schedule is:


Keep out of the reach of children.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Do not keep outdated medicine or medicine no longer needed.

Precautions While Using This Medicine:

If you are using this medicine for glaucoma, your doctor should check your eye pressure at regular visits to make sure the medicine is working.

If you will be using this medicine for a long time, your doctor should examine your eyes at regular visits to make sure this medicine does not cause unwanted effects.

Before you have any kind of surgery (including eye surgery), dental treatment, or emergency treatment, tell the medical doctor or dentist in charge and the anesthesiologist or anesthetist (the person who puts you to sleep) that you are using this medicine or have used it within the past month.

These medicines should not be used if an eye infection is present, or if the eye is wounded or injured. If redness, pain, or discharge develops, or if a foreign object becomes lodged in one or both eyes, or if you suffer a blow to the eye or eye area, notify your doctor immediately.

Avoid breathing in even small amounts of carbamate- or organophosphate-type insecticides or pesticides (for example, carbaryl [Sevin], demeton [Systox], diazinon, malathion, parathion, ronnel [Trolene], or TEPP). They may add to the effects of this medicine. Farmers, gardeners, residents of communities undergoing insecticide or pesticide spraying or dusting, workers in plants manufacturing such products, or other persons exposed to such poisons should protect themselves by wearing a mask over the nose and mouth, changing clothes frequently, and washing hands often.

Make sure your vision is clear before you drive, use machines, or do anything else that could be dangerous if you are not able to see well. This is because:

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Burning, redness, stinging, or other eye irritation
eye pain
veil or curtain appearing across part of vision
Symptoms of too much medicine being absorbed into the body
Increased sweating
loss of bladder control
muscle weakness
nausea, vomiting, diarrhea, or stomach cramps or pain
shortness of breath, tightness in chest, or wheezing
slow or irregular heartbeat
unusual tiredness or weakness
watering of mouth

The most common of these symptoms, especially in children, are nausea, vomiting, diarrhea, and stomach cramps or pain. Your doctor may tell you to stop taking the medicine if any of these side effects occur.

Too much medicine being absorbed is rare with the eye ointment form of this medicine.

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Blurred vision or change in near or distance vision
difficulty in seeing at night or in dim light
headache or browache
twitching of eyelids
watering of eyes

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Last Updated: 10/12/2016

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