Phospholine Iodide® for Uncontrolled IOP (echothiophate iodide for ophthalmic solution)

A valuable therapy option for glaucoma patients with uncontrolled IOP

IOP decreased in 31 of 32 eyes in a retrospective study of children with aphakic or pseudophakic glaucoma1

  • Mean baseline IOP decreased from 29.1 ± 5.3 mm Hg to 19.6 ± 6.7 mm Hg in patients who were initially taking at least one other medication
  • 4 eyes eventually required surgery for uncontrolled IOP
  • 6 eyes had IOP spikes that could not be controlled with other medications when Phospholine Iodide was discontinued due to product unavailability
chart circle

A retrospective study of 32 eyes (27 aphakic and 5 pseudophakic) in 21 children aged 40 days to 12 years with echothiophate iodide exposure after infantile cataract surgery. Glaucoma was defined as IOP >21 mm Hg with one or more of the following: corneal enlargement; asymmetrical progressive myopic shift coupled with enlargement of the corneal diameter and/or axial length; increased optic nerve cupping. Phospholine Iodide dosage was 0.125% BID for a mean of 3.5 years. 

IOP=intraocular pressure.

IOP decreased in 23 of 24 eyes in a retrospective study of elderly patients with pseudophakic glaucoma2

  • Mean baseline IOP decreased from 29.54 ± 7.9 mm Hg to 17.8 ± 5.4 mm Hg after addition of Phospholine Iodide to maximal medical therapy (average of 2.8 ± 1.1 medications)
  • While IOP was reduced in the majority of eyes, 4 eyes remained uncontrolled after addition of Phospholine Iodide
  • Mean IOP increased to 27.4 ± 8.2 mm Hg when Phospholine Iodide was discontinued due to product unavailability
an old man using medicine

A retrospective study of 24 eyes in 24 elderly patients (mean age 74 years; 11 men and 13 women) with uncontrolled IOP despite maximal medical therapy, including prostaglandin analogs, alpha-2 agonists, and topical carbonic anhydrase inhibitors. Exclusions: Patients with ocular inflammation, high myopia, conditions affecting applanation tonometry, laser or intraocular surgery within 12 months, contraindication to cholinergic drugs, initiation of systemic treatment with medications that may influence IOP or corticosteroids, and any other alteration in medication. Phospholine Iodide dosage was 0.125% 1 drop BID. The average follow-up was 11.2 months. 

These retrospective studies had multiple limitations, including small sample size and lack of a control group and standardized initial treatment.

References:
  1. Kraus, CL, Trivedi, RH, Wilson, ME.  Intraocular pressure control with echothiophate iodide in children’s eyes with glaucoma after cataract extraction. JAAPOS.  2015 Apr;19(2):116-8.el. doi: 10.1016/j.jaapos.2014.11.006.
  2. Schmidt, KG, Horowitz, Y, Buckman, G, et al. Lowering of IOP by echothiophate iodide in pseudophakic eyes with glaucoma. Curr Eye Res. 2010 Aug;35(8):698-702. doi: 10.3109/02713681003794076

How to prescribe Phospholine Iodide®️

Help them get where they’re going

Phospholine Iodide is available through Walgreens Specialty Pharmacy. The pharmacy verifies insurance, administers patient financial programs as applicable, coordinates overnight delivery direct to patients for new and refill prescriptions, and provides pharmacist consultation about Phospholine Iodide treatment.

Phospholine Iodide

Patient programs to help support access

Co-pay Assistance

Patients with commercial insurance may pay no more than $100 for their prescription

QuickStart Program (QS)

Provides a one-time, 28-day supply at no cost to eligible new patients who experience an insurance-related delay

Patient Assistance Program (PAP)

Provides eligible patients with their medication at no cost

To prescribe Phospholine Iodide®️

Complete and download the referral form and fax to 877-231-8302
or
E-prescribe to Walgreens Specialty Pharmacy –PENNSYLVANIA
or
Call Walgreens Specialty Pharmacy at 888-347-3416

Important Safety Information

Contraindications

1. Active uveal inflammation.
2. Most cases of angle-closure glaucoma without iridectomy, due to the possibility of increasing angle block.
3. Hypersensitivity to the active or inactive ingredients.

Warnings and Precautions

  • Succinylcholine should be administered only with great caution, if at all, prior to or during general anesthesia to patients receiving anticholinesterase medication because of possible respiratory or cardiovascular collapse.
  • Caution should be observed in treating elevated IOP with echothiophate iodide for ophthalmic solution in patients who are at the same time undergoing treatment with systemic anticholinesterase medications, because of possible adverse additive effects.
  • Discontinue the medication if cardiac irregularities occur.
  • Anticholinesterase drugs should be used with caution, if at all, in patients with marked vagotonia, bronchial asthma, spastic gastrointestinal disturbances, peptic ulcer, pronounced bradycardia and hypotension, recent myocardial infarction, epilepsy, parkinsonism, and other disorders that may respond adversely to vagotonic effects.
  • Echothiophate iodide for ophthalmic solution should be used with caution, where there is a prior history of retinal detachment.
  • Temporary discontinuance of medication is necessary if salivation, urinary incontinence, diarrhea, profuse sweating, muscle weakness, or respiratory difficulties occur.
  • Certain types of pesticides, such as organophosphate and carbamate pesticides, may cause more side effects. Wearing a respiratory mask, and frequent washing and clothing change may be recommended around them.

Adverse Reactions

  • Phospholine Iodide may cause eye irritation, including redness, stinging, burning, tearing, eyelid twitching, and blurred eyesight.
  • Iris cysts may form more frequently in children. The cysts usually shrink upon discontinuation of the medication or reducing the frequency of instillation.

For additional information, please click here for Prescribing Information.

You are encouraged to report side effects to the FDA at http://www.FDA.gov/medwatch or 1-800-FDA-1088.

Important Safety Information

Contraindications

1. Active uveal inflammation.
2. Most cases of angle-closure glaucoma without iridectomy, due to the possibility of increasing angle block.
3. Hypersensitivity to the active or inactive ingredients.

Warnings and Precautions

  • Succinylcholine should be administered only with great caution, if at all, prior to or during general anesthesia to patients receiving anticholinesterase medication because of possible respiratory or cardiovascular collapse.
  • Caution should be observed in treating elevated IOP with echothiophate iodide for ophthalmic solution in patients who are at the same time undergoing treatment with systemic anticholinesterase medications, because of possible adverse additive effects.
  • Discontinue the medication if cardiac irregularities occur.
  • Anticholinesterase drugs should be used with caution, if at all, in patients with marked vagotonia, bronchial asthma, spastic gastrointestinal disturbances, peptic ulcer, pronounced bradycardia and hypotension, recent myocardial infarction, epilepsy, parkinsonism, and other disorders that may respond adversely to vagotonic effects.
  • Echothiophate iodide for ophthalmic solution should be used with caution, where there is a prior history of retinal detachment.
  • Temporary discontinuance of medication is necessary if salivation, urinary incontinence, diarrhea, profuse sweating, muscle weakness, or respiratory difficulties occur.
  • Certain types of pesticides, such as organophosphate and carbamate pesticides, may cause more side effects. Wearing a respiratory mask, and frequent washing and clothing change may be recommended around them.

Adverse Reactions

  • Phospholine Iodide may cause eye irritation, including redness, stinging, burning, tearing, eyelid twitching, and blurred eyesight.
  • Iris cysts may form more frequently in children. The cysts usually shrink upon discontinuation of the medication or reducing the frequency of instillation.

For additional information, please click here for Prescribing Information. You are encouraged to report side effects to the FDA at http://www.FDA.gov/medwatch or 1-800-FDA-1088.

Contraindications

1. Active uveal inflammation.
2. Most cases of angle-closure glaucoma without iridectomy, due to the possibility of increasing angle block.
3. Hypersensitivity to the active or inactive ingredients.

View Important Safety Information
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