Eserine (Ophthalmic)

Physostigmine is used to treat specific types of glaucoma.

This medicine is available only with a doctor's prescription.

Your doctor should check your eye pressure during regular visits.

After applying this medicine, your vision may be blurry, or you may notice changes in your ability to see things up close or far away, particularly at night. Ensure your vision is clear before driving, operating machinery, or doing anything else that could be risky if you cannot see clearly.

In deciding to use a medicine, you and your doctor need to consider the risks of taking the medicine against the benefits it may provide. Here are some important points to think about for this medicine:

Allergies

Inform your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also, let your healthcare professional know if you have any other allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, carefully read the label or package ingredients.

Pediatric

There is no specific information comparing the use of this medicine in children to its use in other age groups. It is not expected to cause different side effects or problems in children than it does in adults.

Geriatric

Many medicines have not been specifically studied in older adults. Therefore, it may not be known if they work in the same way or if they cause different side effects or problems in older people. Although there is no specific information comparing the use of physostigmine in elderly patients to younger adults, it is not expected to cause different side effects or problems in older people than it does in younger adults.

Breast Feeding

There are no adequate studies in women to determine the risk to infants when using this medication during breastfeeding. Consider the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Some medicines should not be used together at all, while in other cases, two different medicines may be used together even if an interaction might occur. If you are taking this medicine, it is especially important for your healthcare professional to know if you are using any of the medicines listed below. The following interactions are important and may not be a complete list.

Using this medicine with any of the following medicines is usually not recommended, but may be necessary in some cases. If both medicines are prescribed together, your doctor may adjust the dose or frequency of one or both medicines.

• Amifampridine
• Bupropion
• Donepezil

Using this medicine with any of the following medicines may increase the risk of certain side effects, but taking both may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or frequency of one or both medicines.

• Succinylcholine

Interactions with Food/Tobacco/Alcohol

Some medicines should not be taken at the same time as certain foods or types of food due to possible interactions. Consuming alcohol or tobacco with some medicines may also lead to interactions. Discuss with your healthcare professional about using your medicine with food, alcohol, or tobacco.

Other Medical Problems

Having other medical conditions may affect the use of this medicine. Be sure to inform your doctor if you have any other medical problems, especially:

• Eye disease or problems (other)—Physostigmine may worsen the condition.

Along with its necessary effects, a medicine may cause some unwanted effects. Not all of these side effects will happen, but if they do, they may require medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

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

Some side effects may occur that usually do not require medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Your health care professional may also 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, are bothersome, or if you have any questions about them:

More common

• Blurred vision or change in near or distant vision
• eye pain

Less common

• Burning, redness, stinging, or other eye irritation
• 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.

In the U.S.

• Eserine
• Isopto Eserine

Pharmacologic Class: Cholinesterase Inhibitor

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

• Do not use if the solution becomes discolored.
• First, wash your hands. With the middle finger, apply pressure to the inside corner of the eye (and continue to apply pressure for 1 or 2 minutes after the medicine has been placed in the eye). Tilt the head back and with the index finger of the same hand, pull the lower eyelid away from the eye to form a pouch. Drop the medicine into the pouch and gently close the eyes. Do not blink. Keep the eyes closed for 1 or 2 minutes to allow the medicine to be absorbed.
• Immediately after using the eye drops, wash your hands to remove any medicine that may be on them.
• To keep the medicine as germ-free as possible, do not touch the applicator tip to any surface (including the eye). Also, keep the container tightly closed.

To use the ointment form of this medicine:

• First, wash your hands. Pull the lower eyelid away from the eye to form a pouch. Squeeze a thin strip of ointment into the pouch. A 1-cm (approximately 1/3-inch) strip of ointment is usually enough unless otherwise directed by your doctor. Gently close the eyes and keep them closed for 1 or 2 minutes to allow the medicine to be absorbed.
• Immediately after using the eye ointment, wash your hands to remove any medicine that may be on them.
• To keep the medicine as germ-free as possible, do not touch the applicator tip to any surface (including the eye). After using the eye ointment, wipe the tip of the ointment tube with a clean tissue and keep the tube tightly closed.

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.

Dosing

The dose of this medicine 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 this medicine. 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.

• For glaucoma: For ophthalmic ointment dosage form: Adults and children—Use in each eye one to three times a day. For ophthalmic solution (eye drops) dosage form: Adults and children—One drop in each eye up to four times a day.

Missed Dose

If you miss a dose of this medicine, apply it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule.

Storage

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

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.