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Monographs of Topical Drugs that Have Caused Contact Allergy/Allergic Contact Dermatitis
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
Echothiophate is a potent, long-acting cholinesterase inhibitor with parasympathomimetic activity. Its iodide salt echothiophate iodide (CAS number 513-10-0, EC number 208-152-1, molecular formula C9H23INO3PS) potentiates the action of endogenous acetylcholine by inhibiting acetylcholinesterase that hydrolyzes acetylcholine. When applied topically to the eye, this agent prolongs stimulation of the parasympathetic receptors at the neuromuscular junctions of the longitudinal muscle of the ciliary body. Contraction of longitudinal muscle pulls on the scleral spur, and opens the trabecular meshwork, thereby increasing aqueous humor outflow from the eye and reducing intraocular pressure. Echothiopate iodide is indicated for use in the treatment of subacute or chronic angle-closure glaucoma after iridectomy or where surgery is refused or contraindicated (1).
Medical Management of Chemical Warfare Agents
Published in Brian J. Lukey, James A. Romano, Salem Harry, Chemical Warfare Agents, 2019
In addition to the organophosphate nerve agents and insecticides (organophosphates and carbamates), certain drugs employed in clinical medicine also inhibit cholinesterases. These include edrophonium and the carbamates pyridostigmine (Mestinon®), neostigmine (Prostigmin®), and physostigmine, all of which treat myasthenia gravis and reverse competitive neuromuscular blocking drugs employed in the operating room (OR). The first generation of anti-Alzheimer’s drugs are also cholinesterase inhibitors, including donepezil (Aricept®), rivastigmine (Exelon®), and galantamine (Reminyl®). Memantine (Namenda®), a second-generation anti-Alzheimer’s drug, is not a cholinesterase inhibitor but a moderate-affinity N-methyl-d-aspartate (NMDA) receptor antagonist. The drug echothiophate (Phospholine Iodine®), used in the treatment of chronic open angle glaucoma, is also an organophosphate and a cholinesterase inhibitor (Medscape, 2006; Wikipedia Contributors, 2006). There is some evidence that phenothiazines may also inhibit cholinesterase (Keeler, 1990).
Medical risks and management
Published in Alan Weiss, The Electroconvulsive Therapy Workbook, 2018
It is recommended that ophthalmological advice be sought in patients who have advanced glaucoma before commencing ECT (Abrams, 2002; Edwards et al., 1990). It is good practice to administer anti-glaucoma drops before each ECT treatment for patients who take them routinely. Caution should be utilised when using long-acting anticholinesterase ophthalmic drops like echothiophate (Messer et al., 1992) as they can greatly prolong the suxamethonium-induced apnoea and alternatives need to be found (Packman, Meyer and Verdun, 1978).
Treating organophosphates poisoning: management challenges and potential solutions
Published in Critical Reviews in Toxicology, 2020
Maria Alozi, Mutasem Rawas-Qalaji
Despite their high toxicity profiles, smaller doses of certain OP have shown some therapeutic benefits. As a long-acting inhibitor, echothiophate iodide (Phospholine®) eye drop formulation is approved for treating glaucoma. Phospholine® helps treat glaucoma by sustaining ACh levels to mitigate intraocular pressure (Phospholine Iodide® Ophthalmic 2018). Additionally, the short-term safety of metrifonate for treating schistosomiasis led researchers to investigate its efficacy for treating dementia by enhancing central cholinergic neurotransmission. Despite its proven efficacy, its long-term use during phase III clinical trials was found to induce respiratory paralysis and led to the discontinuation of the clinical trial and subsequent FDA withdrawal (Sharma 2019).
Systemic side effects of glaucoma medications
Published in Clinical and Experimental Optometry, 2022
Amirmohsen Arbabi, Xuan Bao, Wesam Shamseldin Shalaby, Reza Razeghinejad
Echothiophate (Phospholine) is a long-acting irreversible inhibitor of acetylcholinesterase. Its topical use could be associated with severe headache, dizziness, sweating, bradycardia, and gastrointestinal symptoms (salivation, nausea, vomiting, and diarrhoea) (Table 1).50,51