Miotic side effects

The acronym SLUDGE, which stands for salivation, lacrimation, urinary incontinence, diarrhea, gastrointestinal disorders, and emesis, is often used to describe the systemic side effects of cholinergic overdose. A miotic upper respiratory syndrome consisting of rhinorrhea, a sensation of chest constriction, cough, and conjimctival injection has also been reported. 

Topical miotic agents are historically important glaucoma medications but are less commonly used today. Miotics lower lOP by causing muscarinic-induced contraction of the ciliary muscle, which facilitates aqueous outflow. They do not affect aqueous production. Multiple miotic agents have been developed. Pilocarpine and carbachol are cholinomimetics that stimulate muscarinic receptors. Ecbotbiopbate (Phospholine iodide) is an organophosphate inhibitor of acetylcholinesterase it is relatively stable in aqueous solution and, by virtue of its quaternary ammonium structure, is positively charged and poorly absorbed. The usefulness of these medicines is lessened by their numerous side effects and the need to use them three to four times a day. 

Pilocarpine is marketed as tablets (Salogen), an ophthalmic solution, and gel. It penetrates the eye well and is the miotic of choice for open-angle glaucoma and to terminate acute angle closure attacks. It also is used for the treatment of xerostomia (dryness of the mouth) caused by radiatioh therapy of the head and neck, Sjogren s syndrome, or as a side effect of some psychotropic drugs. 

Carbaminoylcholine chloride, a synthetic derivative of choline, is not destroyed by cholinesterase. Carbachol is a rather long-acting and powerful miotic, which can cause various ocular side effects, i.e. headaches, ocular and periorbital pain, twitching of the eyelids, ciliary congestion and spasm of accommodation. Rapid formation of cataracts was observed in 3 patients. Carbachol must be formulated with a wetting agent to increase penetration. 

Anticholinesterase miotics are therapeutically effective in the treatment of primary open-angle glaucoma. The systemic side effects of anticholinesterase agents are the... 

The miotic effect induced by physostigmine lends itself to investigation of the interrelation of chemical constitution and pharmacological action, and Stedman has devoted much attention to this subject. Eseroline is devoid of miotic activity, so that the latter action in physostigmine must be mainly due to the fact that it is a methylurethane, and, since activity only becomes evident in the urethanes of phenolic bases or phenols with a basic side-chain, a basic nucleus for the urethanes appears also to be essential. 

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