Table 3.8

Class: PARASYMPATHOMIMETICS (CHOLINERGIC DRUGS)

CompoundMode of actionIOP reductionContra-indicationsSide effects
Direct- actingPilocarpine 0.5-4% Carbachol 0.75-3%Facilitates aqueous out?ow by contraction of the ciliary muscle, tension on the scleral spur and traction on the trabecular meshwork20-25%Post-operative inflammation, uveitis neovascular glaucoma. Patient at risk for retinal detachment, spastic gastrointestinal disturbances, peptic ulcer, pronounced bradycardia, hypotension, recent myocardial infarction, epilepsy, ParkinsonismLocal: Reduced vision due to miosisand accommodative myopia, conjunctival, hyperaemia, retinal detachment, lens opacities, precipitation of angle closure, iris cysts Systemic: Intestinal cramps, bronchospasm, headache
Indirect- actingDemecarium bromide 0.125-0.25% Ecothiophate iodide 0.03% Diisopropyl ?uorophosphates 0.025-0.1%15-25%Same as direct acting drugsLocal and systemic: Side effects are similar but more pronounced than with direct acting compounds