Demecarium Ophthalmic

What is demecarium ophthalmic?

Demecarium ophthalmic (demecarium bromide) is an eye medication used to prevent the onset of glaucoma in the healthy eye of pets with glaucoma in one eye. It is occasionally prescribed for the treatment of active glaucoma, but is not as effective as other eye medications for this purpose.

Demecarium ophthalmic is used off label in dogs and rabbits, and is only available through compounding pharmacies. There are no veterinary formulations available and the human medication is no longer available.

Many drugs are commonly prescribed for off-label use in veterinary medicine. “Off label” means the drug is being used in a way that has not been reviewed or approved by the U.S. Food and Drug Administration (FDA) or Health Canada. In these instances, follow your veterinarian’s directions and cautions carefully, as they may be significantly different from those on the label.

How do I give my pet demecarium ophthalmic?

• Demecarium ophthalmic comes in a liquid drop format to be instilled directly in the eye (topically).
• Follow your veterinarian’s instructions and give this medication exactly as directed.
• Wash your hands before applying this medication.
• Do not allow anything to touch the dropper tip, including your hands, to avoid contamination.
• Gently wipe any medication residue from your pet’s face with a damp cloth.
• Wait 5 minutes after applying this medicine before applying any other medicines to the eye.
• DO NOT handle this medication if you are pregnant.

This medication should take effect quickly, within 1–2 hours; however, effects will not be noted outwardly and your veterinarian will require further testing to evaluate this medication’s effectiveness.

What if I miss giving my pet the medication?

If you miss a dose of demecarium ophthalmic, give it as soon as you remember, and then continue with the regular dosing schedule. However, if it is almost time for the next dose, skip the missed dose and resume the regular dosing schedule. Do not give the pet two doses at once.

Are there any potential side effects?

Demecarium ophthalmic may cause the following side effects:

• Burning and stinging of the eyes on application
• Redness of eyes or increased blood vessel appearance in the eyes
• Itchy eyes
• Excessive drooling
• Decrease in pupil size, which might decrease the ability to see
• Inflammation on the skin surrounding the eyes (if the medication is allowed to remain there)
• Humans taking this drug report experiencing headaches

Serious adverse reactions associated with this drug may occur without warning and could, in rare cases, lead to death. If any of the following signs develop, stop giving demecarium ophthalmic and contact your veterinarian immediately:

• Signs of an allergy (labored or noisy breathing or swelling of the throat)
• Nausea, vomiting, and diarrhea
• Irregular heartbeat
• Weakness or unusual tiredness
• Shivering

Drug sensitivities can develop over time, with repeated exposure. Your pet may have no reaction after the first few doses but may develop a sensitivity later. It is important to watch for signs of an allergic reaction over the entire course of treatment (e.g., irregular breathing, rash, fever, puffiness and swelling around the face) and notify your veterinarian if you have any concerns.

Other side effects may occur. If you notice anything unusual, contact your veterinarian immediately. This short-acting medication should stop working within 24 hours, although effects can be longer in pets with liver or kidney disease.

Are there any risk factors for this medication?

DO NOT USE demecarium ophthalmic in:

• Pets with inflammation of the interior eye (uveitis)
• Pets with a hypersensitivity or allergy to this medication
• Pets with narrow-angle glaucoma
• Pets with bronchial asthma
• Pets with GI ulceration or spastic GI conditions (e.g., irritable bowel syndrome)
• Pets with a very low heart rate (bradycardia)
• Pets with severely low blood pressure (hypotension)
• Pets with epilepsy
• Pets that are pregnant or nursing
• Pets that have difficulty maintaining their internal body temperature

USE WITH EXTREME CAUTION in:

• Pets with a history of retinal detachment
• Pets with increased blood pressure in the eye associated with intraocular inflammatory processes

USE WITH CAUTION in:

• Pets that are predisposed to certain forms of glaucoma
• Pets being treated with flea and tick products that contain organophosphate or carbamate
• Pets that are having surgery, including dental surgery
• Smaller breeds of dogs or rabbits, especially with high doses

Are there any drug interactions I should be aware of?

Certain medications may interact with demecarium ophthalmic, so be sure to tell your veterinarian about any medications (including vitamins, supplements, and herbal therapies) that your pet is taking before starting any new treatment.

DO NOT give demecarium ophthalmic with:

• Oxybutynin

Several medications should be used with caution when given with demecarium ophthalmic, including:

• Belladonna alkaloids
• Benzocaine
• Butacaine
• Butamben
• Cyclopentolate
• Flea and tick products that contain organophosphate or carbamate
• Neostigmine
• Oral glycerin
• Procaine
• Succinylcholine 9
• Tetracaine chloroprocaine
• Tropicamide

Is any monitoring needed with this medication?

• Before giving your pet demecarium ophthalmic, your veterinarian should confirm that the angle of the eye is open, through a gonioscopic examination.
• During treatment, your veterinarian will measure the intraocular pressure of the normal eye in pets with glaucoma in the other eye.
• Your veterinarian will let you know when they want to reassess your pet to ensure the medication is working and not causing side effects.
• At home, monitor for any side effects such as those noted above. If any side effects occur, discontinue use of the medication and contact your veterinarian.

How do I store demecarium ophthalmic?

• Store demecarium ophthalmic at 59°F–86°F (15°C–30°C).
• Do not freeze.
• Store upright and tightly closed in the original bottle.
• Protect from light and heat.
• Store compounded forms of this medication according to the label.
• Keep medication out of reach of children and pets.

What should I do in case of emergency?

If you suspect an overdose or an adverse reaction to the medication, call your veterinary office immediately. If they are not available, follow their directions in contacting an emergency facility. Be prepared to provide information about the product and your pet's weight and symptoms.