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Dorzolamide Hydrochloride) 1880 Miotics Mydriatics and Antiglaucoma Drugs Systemic toxicity. Ten of 66 patients (29 males and 37 fe- Demecarium Bromide (BAN, rINN) CAS — 120279-96-1 (dorzolamide); 130693-82-2 (dor- males) who received one drop of 2% cyclopentolate in each eye BC-48; Bromuro de demecario; Demecarii Bromidum; Démé- zolamide hydrochloride). developed mild to moderate systemic toxicity; 9 of the 10 were ATC — S01EC03. female.1 Toxic signs included physical weakness, nausea, light- carium, Bromure de; Demekariumbromid; Demekariumbromidi. headedness, changes in emotional attitude, unprovoked weeping, N,N′-Decamethylenebis(N,N,N-trimethyl-3-methylcarbamoyl- ATC Vet — QS01EC03. and loss of equilibrium; tachycardia was always present but oxyanilinium) dibromide. changes in blood pressure were insignificant. Spontaneous re- Демекария Бромид covery occurred within 1 hour to several days. C32H52Br2N4O4 = 716.6. OO As with atropine, it has been recommended that cyclopentolate CAS — 16505-84-3 (demecarium); 56-94-0 (demecarium H S S O eye drops should not be used during the first 3 months of life bromide). O because of the possible association with development of ambly- ATC — S01EB04. H3C S opia. Systemic toxicity has also been reported in neonates given ATC Vet — QS01EB04. ocular cyclopentolate.2 NH2 A 4-year-old boy with cerebral palsy and paraplegia suffered NHH + + tonic-clonic seizures, facial flushing, and tachycardia 70 minutes N (CH ) after one drop of a 1% cyclopentolate solution was instilled into 3 3 N (CH3)3 each eye to dilate his pupils.3 The child had no history of convul- CH3 O O 2 Br sions and had received 1% cyclopentolate eye drops on 2 previ- (CH ) ous occasions without incident. In a more recent case,4 a 23- 2 10 O N N O (dorzolamide) month-old boy experienced a tonic-clonic seizure lasting 30 min- CH utes after the use of cyclopentolate 1% and phenylephrine 10% 3 CH3 eye drops. One drop of each was instilled into both eyes every 5 Pharmacopoeias. In Eur. (see p.vii) and US. minutes for 3 doses; the seizure occurred 45 minutes after the last Pharmacopoeias. In US. Ph. Eur. 6.2 (Dorzolamide Hydrochloride). A white or almost dose. The child was found to have low pseudocholinesterase ac- USP 31 (Demecarium Bromide). A white or slightly yellow, white, crystalline powder. Soluble in water; very slightly soluble tivity, an enzyme likely to be involved in the metabolism of cy- in anhydrous alcohol; slightly soluble in methyl alcohol. It exhib- clopentolate. slightly hygroscopic, crystalline powder. Freely soluble in water and in alcohol; sparingly soluble in acetone; soluble in ether. pH its polymorphism. 1. Awan KJ. Adverse systemic reactions of topical cyclopentolate of a 1% solution in water is between 5.0 and 7.0. Store in airtight USP 31 (Dorzolamide Hydrochloride). A white to off-white hydrochloride. Ann Ophthalmol 1976; 8: 695–8. containers. Protect from light. crystalline powder. Soluble in water. Store at 15° to 30°. Protect 2. Bauer CR, et al. Systemic cyclopentolate (Cyclogyl) toxicity in from light. the newborn infant. J Pediatr 1973; 92: 501–5. Profile 3. Fitzgerald DA, et al. Seizures associated with 1% cyclopentolate Demecarium is a quaternary ammonium compound that is a re- eyedrops. J Paediatr Child Health 1990; 26: 106–7. versible inhibitor of cholinesterase with a long duration of action Adverse Effects and Precautions 4. Demayo AP, Reidenberg MM. Grand mal seizure in a child 30 similar to that of ecothiopate iodide (p.1881). It has been used as Local ocular adverse effects may occur with dorzola- minutes after Cyclogyl (cyclopentolate hydrochloride) and 10% a 0.125 or 0.25% ophthalmic solution in the treatment of open- mide eye drops and include conjunctivitis, keratitis, Neo-Synephrine (phenylephrine hydrochloride) eye drops were angle glaucoma and in the diagnosis and management of accom- instilled. Abstract: Pediatrics 2004; 113: 1390–1. Full version: burning or stinging, eyelid inflammation or irritation, http://pediatrics.aappublications.org/cgi/reprint/113/5/e499 (ac- modative convergent strabismus. and blurred vision. Dorzolamide may be absorbed sys- cessed 24/11/05) Preparations temically, resulting in adverse effects and precautions USP 31: Demecarium Bromide Ophthalmic Solution. similar to those of acetazolamide (see p.1875). Other Interactions Proprietary Preparations (details are given in Part 3) adverse effects reported are headache, bitter taste, As for antimuscarinics in general (see Atropine Sul- USA: Humorsol†. epistaxis, fatigue, and nausea. fate, p.1220). Interactions Uses and Administration Diclofenamide (BAN, rINN) ⊗ Cyclopentolate hydrochloride is a tertiary amine an- Systemic absorption may occur after topical applica- Dichlorphenamide; Diclofenamida; Diclofénamide; Diclofenami- tion of dorzolamide to the eye and there is a theoretical timuscarinic with actions similar to those of atropine dum; Diklofenamid; Diklofenamidi. 4,5-Dichlorobenzene-1,3-di- (p.1219). It is used to produce mydriasis and cyclople- sulphonamide. possibility of interactions similar to those reported with acetazolamide (see p.1876). gia (p.1874) for ophthalmic diagnostic procedures and Диклофенамид also in the treatment of uveitis and iritis (p.1515). It C6H6Cl2N2O4S2 = 305.2. acts more quickly than atropine and has a shorter dura- CAS — 120-97-8. Uses and Administration tion of action; the maximum mydriatic effect is pro- ATC — S01EC02. Dorzolamide is a carbonic anhydrase inhibitor with ac- ATC Vet — QS01EC02. duced 30 to 60 minutes after instillation, and may per- tions similar to those of acetazolamide (p.1876). It is sist for up to 24 hours or longer in some patients; the used in the management of open-angle glaucoma, maximum cycloplegic effect is produced within 25 to O O O O pseudo-exfoliative glaucoma, and ocular hypertension 75 minutes and accommodation recovers within 6 to (p.1873), either alone or as an adjunct to a topical beta 24 hours. S S blocker. H2N NH2 For diagnostic procedures, instillation of a 0.5% oph- Dorzolamide is given as eye drops containing dorzola- thalmic solution of cyclopentolate hydrochloride, re- Cl mide hydrochloride equivalent to 2% of the base. For monotherapy it is usually given three times daily; a peated after about 5 to 15 minutes, is usually sufficient Cl for adults. Higher strengths have been used. For chil- twice-daily regimen is recommended when used with dren a 1% solution is instilled similarly, although some Pharmacopoeias. In Chin., Jpn, and US. a beta blocker. recommend that strengths greater than 0.5% should not Profile ◊ References. be used in infants and that cyclopentolate should not be Diclofenamide is an inhibitor of carbonic anhydrase with prop- 1. Martens-Lobenhoffer J, Banditt P. Clinical pharmacokinetics of used at all during the first 3 months of life. erties similar to those of acetazolamide (p.1875). When given dorzolamide. Clin Pharmacokinet 2002; 41: 197–205. In the treatment of uveitis and iritis, a 0.5% ophthalmic orally its effect begins within 1 hour and lasts for 6 to 12 hours. 2. Lesk MR, et al. Effectiveness and safety of dorzolamide-timolol Diclofenamide is used to reduce intra-ocular pressure in glauco- alone or combined with latanoprost in open-angle glaucoma or solution of cyclopentolate hydrochloride is instilled ma (p.1873). The usual initial oral dose is 100 to 200 mg, then ocular hypertension. Ann Pharmacother 2008; 42: 498–504. into the eye up to four times daily. 100 mg every 12 hours until the desired response is obtained, fol- Preparations Deeply pigmented eyes are more resistant to pupillary lowed by a maintenance dose of 25 to 50 mg one to three times daily. Diclofenamide sodium has been given by injection. dilatation and may require the use of a 1% solution. Proprietary Preparations (details are given in Part 3) Preparations Arg.: Biodrop†; Dorlamida; Poenglausil†; Trusopt; Austral.: Trusopt; Aus- tria: Tr usopt; Belg.: Trusopt; Braz.: Ocupress; Trusopt; Canad.: Trusopt; Preparations USP 31: Dichlorphenamide Tablets. Chile: Glaucotensil; Trusopt; Cz.: Trusopt; Denm.: Trusopt; Fin.: Trusopt; BP 2008: Cyclopentolate Eye Drops; Proprietary Preparations (details are given in Part 3) Fr.: Trusopt; Ger.: Tr usopt; Gr.: Trusopt; Hong Kong: Trusopt; Hung.: USP 31: Cyclopentolate Hydrochloride Ophthalmic Solution. Belg.: Oratrol†; Cz.: Oratrol†; Gr.: Oratrol†; Ital.: Antidrasi; Fenamide; Trusopt; India: Dorzox; Irl.: Tr usopt; Israel: Trusopt; Ital.: Tr usopt; Ma- Glaumid†; Spain: Glauconide; USA: Daranide†. laysia: Tr usopt; Mex.: Trusopt; Neth.: Trusopt; Norw.: Tr usopt; NZ: Tr u- Proprietary Preparations (details are given in Part 3) sopt; Philipp.: Trusopt; Pol.: Trusopt; Port.: Trusopt; Rus.: Trusopt Arg.: Ciclopenal; Austral.: Cyclogyl; Belg.: Cyclogyl; Cyclopentol†; Braz.: (Трусопт); S.Afr.: Trusopt; Singapore: Trusopt; Spain: Trusopt; Swed.: Ciclolato; Cicloplegico; Canad.: Cyclogyl; Diopentolate†; Chile: Cyclogyl; Trusopt; Switz.: Tr usopt; Thai.: Trusopt; Turk.: Tr usopt; UK: Tr usopt; Cz.: Cyclogyl†; Denm.: Cyclogyl; Fin.: Oftan Syklo†; Fr.: Skiacol; Ger.: USA: Tr usopt; Venez.: Dorzol; Glaucotensil D; Trusopt. Zykolat-EDO; Gr.: Cyclogyl; Hong Kong: Cyclogyl; Hung.: Humapent; In- Dorzolamide Hydrochloride Multi-ingredient: Arg.: Cosopt; Dorlamida T; Dorzoflax†; Glaucotensil dia: Bell Pentolate; Cyclate; Cyclogyl; Irl.: Mydrilate; Ital.: Ciclolux; Malay- TD; Timed D; Austral.: Cosopt; Austria: Cosopt; Timsopt; Belg.: Cosopt; sia: Colircusi Cicloplejico; Cyclogyl; Mex.: Refractyl; Neth.: Cyclogyl; Cy- (BANM, USAN, rINNM) ⊗ Braz.:
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