Echothiophate iodide, also known by its brand name Phospholine iodide, is a medication used to treat glaucoma and certain eye conditions like accommodative esotropia. It belongs to a class of drugs called cholinesterase inhibitors. Echothiophate works by inhibiting the enzyme acetylcholinesterase, thereby increasing the concentration of acetylcholine at nerve endings. This results in the stimulation of cholinergic receptors, leading to pupil constriction and increased drainage of aqueous humor from the eye, which helps to reduce intraocular pressure.

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

Ophthalmic: Echothiophate Dose in Elevated Intraocular Pressure

If someone's eye pressure is too high, they might use a medicine called Echothiophate eye drops.

• At first, they put one drop in the affected eye or eyes two times a day. They do this before going to bed and in the morning.
• After that, they continue using it twice a day to keep the eye pressure under control. But sometimes, the doctor might suggest using it just once a day or even every other day. If they use it once a day, they should do it before going to bed.

Echothiophate Dose in Children

Echothiophate Dose in accommodative Esotropia: 

For children and teenagers with accommodative esotropia (a type of crossed eyes), here's how Echothiophate eye drops are typically used:

• Diagnosis: At the start, they put one drop in each eye once a day before bedtime for about 2 to 3 weeks.
• Treatment: After that initial period, they switch to using one drop in each eye every other day. As treatment progresses, the doctor may lower the dose gradually.
• The most they should use in a day is one drop in each eye.
• Doctors often recommend using the lowest dose that works well. If needed, they might suggest using it more often for a short time.

Echothiophate Pregnancy Risk Category: C

• No tests on how this medicine affects animal babies have been done.

Use of echothiophate while breastfeeding

• It's uncertain if echothiophate passes into breast milk.
• Because it could cause severe problems for the baby nursing, a decision needs to be made about whether to stop breastfeeding or stop taking the medication, considering how important the treatment is for the mother.

Dose in Kidney Disease:

• The manufacturer's instructions don't include any changes to the dosage for people with kidney problems.

Dose in Liver disease:

• The manufacturer's instructions don't suggest any changes to the dosage for individuals with liver issues.

Side effects of Echothiophate.

• Central Nervous System:
  • Brow Ache
  • Myasthenia
• Cardiovascular:
  • Bradycardia
  • Hypotension
  • Cardiac Abnormality
  • Flushing
• Dermatologic:
  • Diaphoresis
• Gastrointestinal:
  • Vomiting
  • Diarrhea
  • Nausea
• Respiratory:
  • Dyspnea
• Ophthalmic:
  • Blepharospasm
  • Blurred Vision
  • Stinging Of Eyes
  • Uveitis (Activation)
  • Conjunctival Abnormalities (Thickening)
  • Conjunctival Erythema
  • Burning Sensation Of Eyes
  • Cataract
  • Eye Redness
  • Increased Intraocular Pressure (Paradoxical)
  • Iris Cyst
  • Lacrimation
  • Miosis
  • Iritis (Latent)
  • Lacrimal Duct Obstruction (Nasolacrimal Canal)
  • Myopia
  • Retinal Detachment

Contraindications to Echothiophate:

• Echothiophate should not be used if someone is allergic to it or any of its ingredients.
• It's also not recommended for most cases of angle-closure glaucoma if the patient hasn't had a procedure to create an opening in the iris (iridectomy) because it could make the blockage worse.
• Additionally, it's not suitable for individuals with active inflammation in the uvea (the middle layer of the eye).

Warnings and precautions

Cardiac irregularities

• If someone experiences irregularities in their heartbeat while using echothiophate, they should stop using it either temporarily or permanently, depending on the severity of the irregularities.

Cholinergic effects

• If someone experiences symptoms like excessive saliva, sweating, or urinary incontinence, which are signs of too much cholinergic activity while using echothiophate, they should stop using it.
• Overdosing on this medication can lead to a cholinergic crisis, which needs to be differentiated from a myasthenic crisis.

Asthma

• Echothiophate is generally not advised for individuals with asthma.

Cardiovascular disease

• Echothiophate is not typically recommended for individuals with certain cardiovascular conditions such as bradycardia (slow heart rate), hypotension (low blood pressure), or recent myocardial infarction (heart attack).
• According to a statement from the American Heart Association, medications like echothiophate, which affect cholinergic activity in the eyes, could potentially worsen underlying heart problems, although the effect is considered minor.

Gastrointestinal Disease:

• Echothiophate is generally not recommended for individuals with conditions like spastic gastrointestinal disturbances or peptic ulcer disease.

Parkinsonism

• Echothiophate is generally not recommended for individuals with Parkinsonism.

Seizure disorder:

• Echothiophate is generally not recommended for individuals with a history of seizure disorder.

Vagotonia

• Echothiophate is typically not recommended for individuals with vagotonia.

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:

Baseline Measurement of Anterior Chamber Angle:

• Before starting treatment, doctors will measure the angle inside the front part of the eye.
• This helps them understand the condition and decide on the right treatment plan.

Routine Lens Examinations:

• Regular check-ups of the lenses in the eye are necessary.
• This is important, especially during treatment for accommodative esotropia, a type of crossed eyes.
• It helps doctors detect any cloudiness or other issues with the lenses early on.

Intraocular Pressure (IOP) Monitoring:

• Doctors will measure the pressure inside the eye at different times of the day.
• This helps keep track of how well the treatment is working and if any adjustments are needed.
• Monitoring IOP is crucial for managing conditions like glaucoma.

How to administer Echothiophate?

Proper Administration Technique:

• It's important to administer the eye drops correctly to get the best results.
• After putting in the drops, gently press on the inner corner of the eye near the nose (nasolacrimal duct) for 1 to 2 minutes. This helps prevent the medicine from draining away too quickly.
• Any extra fluid around the eye should be carefully blotted away with tissue.
• After administering the drops, wash your hands to prevent any potential contamination.

Mechanism of action of Echothiophate:

• Long-acting inhibition of cholinesterase boosts the activity of natural acetylcholine in the body.
• By slowing down the breakdown of acetylcholine, it keeps stimulating the ciliary muscle for a longer time, causing pupil constriction (miosis).
• It also helps with focusing (accommodation) and improves the flow of fluid in the eye, leading to lower eye pressure.

Onset of Action:

• Miosis (Pupil Constriction): Typically occurs within 60 minutes after administration.

Peak Effect:

• Intraocular Pressure Decrease: The maximum reduction in eye pressure is usually observed after 24 hours.

Duration:

• Miosis: Pupil constriction may last for 1 to 4 weeks.
• Intraocular Pressure: The decrease in eye pressure can last from days to weeks.

International Brand Names of Echothiophate:

• Phospholine Iodide
• Phospholine Jodide
• Phospholinjodid

Echothiophate Brand Names in Pakistan:

No Brands Available in Pakistan.