Echothiophate is a topically used long-acting cholinesterase inhibitor that is indicated for the treatment of patients with accommodative esotropia and chronic glaucoma.

Echothiophate Uses:

• Accommodative esotropia:

  • Accommodative component of concomitant esotropias.

• Elevated intraocular pressure:

  • It reduces elevated intraocular pressure.

Echothiophate Dose in Adults

Echothiophate Dose in elevated intraocular pressure: Ophthalmic:

• Initial: Instill one drop twice daily, in the morning and before sleeping, in the affected eye.
• Maintenance:
  • The preferable dose is twice daily but a significant result has also been seen with a once-daily dose.
  • Also, alternate doses with 1 dose prior to sleeping has been used as a treatment regimen.

Echothiophate Dose in Childrens

Echothiophate Dose in accommodative Esotropia:

• Children and Adolescents: Ophthalmic:

  • Diagnosis: Instill 1 drop once daily into both eyes before sleeping for 2-3 then taper off the dose.
  • Maximum daily dose:
    • 1 drop once daily in both eyes.
  • Note:
    • Use a lower therapeutic dose.
    • The dose can be increased according to the severity of the disease.

Echothiophate Pregnancy Risk Category: C

• Studies on animal reproduction have not been done.

Use of echothiophate while breastfeeding

• It is unknown if Ecothiophate is secreted in breast milk.
• It is up to the mother to decide if it should be given to breastfeeding mothers. 
• It all depends on the severity and importance of the drug for the mother's treatment.

Dose in Kidney Disease:

• There are no dosage adjustments provided in the manufacturer's labeling.

Dose in Liver disease:

• There are no dosage adjustments provided in the manufacturer's labeling.

Side effects of Echothiophate.

• Cardiovascular:

  • Bradycardia
  • Cardiac Abnormality
  • Flushing
  • Hypotension

• Central Nervous System:

  • Brow Ache
  • Myasthenia

• Dermatologic:

  • Diaphoresis

• Gastrointestinal:

  • Diarrhea
  • Nausea
  • Vomiting

• Ophthalmic:

  • Blepharospasm
  • Blurred Vision
  • Burning Sensation Of Eyes
  • Cataract
  • Conjunctival Abnormalities (Thickening)
  • Conjunctival Erythema
  • Eye Redness
  • Increased Intraocular Pressure (Paradoxical)
  • Iris Cyst
  • Iritis (Latent)
  • Lacrimal Duct Obstruction (Nasolacrimal Canal)
  • Lacrimation
  • Miosis
  • Myopia
  • Retinal Detachment
  • Stinging Of Eyes
  • Uveitis (Activation)

• Respiratory:

  • Dyspnea

Contraindications to Echothiophate:

• Any allergic reaction to the drug's formulation.
• Angle-closure Glaucoma is not possible without iridectomy. This is due to active inflammation and increasing angle block.

Warnings and precautions

• Cardiac irregularities

  • If you experience cardiac irregularities, discontinue use permanently

• Cholinergic effects

  • Do not take cholinergic activity symptoms (eg, urine incontinence, sweating or salivation) and discontinue use.
  • Overdosage can mimic myasthenia gravis, which should be recognized.

• Asthma

  • Patients with asthma should not use this product.

• Cardiovascular disease

  • Patients with recent MI, bradycardia, or hypotension should not use this medication.
  • According to the American Heart Association's scientific statement, ophthalmic cholesterol agents may increase myocardial dysfunction.

• Gastrointestinal Disease:

  • Patients with GIT disorders, e.g peptic ulcer, are not recommended.

• Parkinsonism

  • Patients with Parkinsonism should not use this product.

• Seizure disorder:

  • Patients with seizure history or epilepsy are not recommended.

• Vagotonia

  • Patients with vagotonia should not use this product.

Echothiophate: Drug Interaction

Note: Drug Interaction Categories:

• Risk Factor C: Monitor When Using Combination
• Risk Factor D: Consider Treatment Modification
• Risk Factor X: Avoid Concomitant Use

Monitoring parameters:

• When treating esotropias routine lens examination is required.
• It is important to measure the anterior chamber angle and intraocular pressure at different times of the day.

How to administer Echothiophate?

Ophthalmic:

• Efficacy depends on the proper way of administration.
• After instilling the drops compress the nasolacrimal duct for 1-2 mins. Remove excess fluid by using a napkin or tissue after instillation.

Mechanism of action of Echothiophate:

• Inhibition of cholinesterase increases the activity of endogenous Acetylcholine. 
• An increase in the destruction acetylcholine results in stimulation of theciliary muscle, which produces miosis.
• Other effects include potentiation and an increased aqueous humor flow that causes a decrease intraocular pressure.

The beginning of action:

• Miosis: ≤60 minutes

Peak effect: Intraocular pressure decrease:

• After 24 hours

Duration:

• Miosis: 1 to 4 weeks;
• Intraocular pressure: Days to weeks.

International Brand Names of Echothiophate:

• Phospholine Iodide
• Phospholine Jodide
• Phospholinjodid

Echothiophate Brand Names in Pakistan:

No Brands Available in Pakistan.