2. Eyelids or conjunctiva

a.Erythema

b.Conjunctivitis – non-specific

c.Photosensitivity

3. Mydriasis – may precipitate angle-closure glaucoma 4. Decreased accommodation

Probable

1. Decreased lacrimation

2. Visual hallucinations

Conditional/Unclassified

1. Diplopia

2. Blepharospasm

Clinical significance

The anticholinergic effects of disopyramide can cause blurred ­vision and fluctuation of visual acuity, by up to 28% in one series. Since this drug can cause mydriasis there are cases in the literature and the National Registry of narrow-angle glaucoma occurring shortly after or up to 3 weeks after the patient started taking the medication. Nine cases of diplopia, two cases of paralysis of extraocular muscles and two cases of blepharospasms have also been reported to the National Registry. Some of these patients were also on other cardiac drugs, and some had other illnesses, which clouded a cause-and-effect relationship.

References And Further Reading

Ahmad S. Disopyramide: pulmonary complications and glaucoma. Mayo Clin Proc 65: 1030–1031, 1990.

Frucht J, Freimann I, Merin S. Ocular side effects of disopyramide. Br J Ophthalmol 68: 890, 1984.

Keefe DLD, Kates RE, Harrison DC. New antiarrhythmic drugs: their place in therapy. Drugs 22: 363, 1981.

Schwartz JB, Keefe D, Harrison DC. Adverse effects of antiarrhythmic drugs. Drugs 21: 23, 1981.

Trope GE, Hind VMD. Closed-angle glaucoma in patients on disopyramide. Lancet 1: 329, 1978.

Wayne K, Manolas E, Sloman G. Fatal overdose with disopyramide. Med J Aust 1: 231, 1980.

Generic name: Methacholine chloride.

Proprietary name: Provocholine.

Primary use

Systemic

This quaternary ammonium parasympathomimetic agent is primarily used in the management of paroxysmal tachycardia, Raynaud’s syndrome and scleroderma.

Ophthalmic

This topical agent is used in the management of angle-closure glaucoma and in the diagnosis of Adie’s pupil.

Local ophthalmic use or exposure

Certain

1. Pupils

a.No effect – normal pupil

b.Miosis – Adie’s pupil

2. Decreased intraocular pressure

3. Eyelids or conjunctiva

a.Allergic reactions

b.Hyperemia

4. Myopia

5. Blepharoclonus

6. Lacrimation

Systemic side effects

Local ophthalmic use or exposure – retrobulbar injection­

Certain

1. Nausea

2. Vomiting

3. Heart block

4. Incontinence

5. Cardiac arrest

Clinical significance

Topical ocular application of methacholine causes a number of ocular side effects, but all are reversible and have minimal clinical importance. While miosis normally occurs with topical ocular 10% methacholine solutions, no effect is seen with 2.5% solutions, except in patients with Adie’s pupil or familial dysautonomia.

References And Further Reading

Crandall DC, Leopold IH. The influence of systemic drugs on tear constituents. Ophthalmology 86: 115, 1979.

Ellis PP. Ocular Therapeutics and Pharmacology, 6th edn, Mosby, St Louis, p 57, 1981.

Gilman AG, Goodman LS, Gilman A (eds). The Pharmacological Basis of Therapeutics, 6th edn, Macmillan, New York, pp 91–96, 1980.

Havener WH. Ocular Pharmacology, 5th edn, Mosby, St Louis, 316–317, 1983. Leopold IH. The use and side effects of cholinergic agents in the manage-

ment of intraocular pressure. In: Glaucoma: Applied Pharmacology in Medical Treatment. Drance SM, Neufeld AH (eds), Grune & Stratton, New York, p 357–393, 1984.

Spaeth GL. The effect of autonomic agents on the pupil and the intraocular pressure of eyes treated with dexamethasone. Br J Ophthalmol 64: 426, 1980.

Sweetman SC (ed). Martindale: The Complete Drug Reference. 34th edn, Pharmaceutical Press, London, p 1492–1494, 2004.

Generic name: 1. Oxprenolol hydrochloride; 2. propranolol hydrochloride.

Proprietary names: 1. Kerpin; 2. Innopran XL, Inderal, Inderal LA.

Primary use

These beta-adrenergic blocking agents are effective in the management of angina pectoris, certain arrhythmias, hypertrophic suba­ ortic stenosis, pheochromocytoma and certain hypertensive states.