Isopto Eserine (Ophthalmic)

Physostigmine is used to treat certain types of glaucoma.

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

Your doctor should check your eye pressure during regular visits.

After you apply this medicine, your vision may be blurry for a short time, or you may notice a change in your ability to see things up close or far away, especially at night. Ensure your vision is clear before driving, using machines, or doing anything else that could be dangerous if you cannot see well.

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

Allergies

Let your doctor know if you have ever had any unusual or allergic reactions to this medicine or any other medicines. Also inform your healthcare provider about any other types of allergies you have, 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 with its use in other age groups, but it is not expected to cause different side effects or issues in children than it does in adults.

Geriatric

Many medicines have not been studied specifically in older adults. Therefore, it may not be clear if they work the same way in older people as they do in younger adults or if they cause different side effects or issues. Although there is no specific information comparing the use of physostigmine in the elderly with its use in other age groups, 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 on women to determine the risk to infants when using this medicine while breastfeeding. Weigh the potential benefits against any potential risks before taking this medicine 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 could happen. In these situations, your doctor may want to adjust the dose, or other precautions may be necessary. When taking this medicine, it is especially important for your healthcare provider to know if you are taking any of the medicines listed below. The following interactions have been highlighted for their potential importance and are not necessarily 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 change the dose or how often you take one or both of the medicines.

• Amifampridine
• Bupropion
• Donepezil

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

• Succinylcholine

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be taken around mealtime or with certain types of food due to possible interactions. Using alcohol or tobacco with certain medicines may also lead to interactions. Discuss with your healthcare provider about using your medicine with food, alcohol, or tobacco.

Other Medical Problems

Having other medical issues may affect how you can use 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 may occur, but if they do, they may require medical attention.

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

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 need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Your health care professional may also provide 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.