In the U.S.—

• Antiglaucoma agent, ophthalmic
• Miotic

Physostigmine (fi-zoe-STIG-meen ) is used to treat certain types of glaucoma.

This medicine is available only with your doctor's prescription, in the following dosage forms:

Ophthalmic
• Ophthalmic ointment (U.S.)
• Ophthalmic solution (eye drops) (U.S.)

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For physostigmine, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to physostigmine. Also tell your health care professional if you are allergic to any other substances, such as preservatives.

Pregnancy—Ophthalmic physostigmine may be absorbed into the body. However, studies on effects in pregnancy have not been done in either humans or animals.

Breast-feeding—Ophthalmic physostigmine may be absorbed into the mother's body. However, physostigmine has not been reported to cause problems in nursing babies.

Children—Although there is no specific information comparing use of this medicine in children with use in other age groups, it is not expected to cause different side effects or problems in children than it does in adults.

Older adults—Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. Although there is no specific information comparing use of physostigmine in the elderly with use in other age groups, it is not expected to cause different side effects or problems in older people than it does in younger adults.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your health care professional if you are using any other prescription or nonprescription (over-the-counter [OTC]) medicine.

• Eye disease or problems (other)—Physostigmine may make the condition worse

To use the ophthalmic solution (eye drops) form of this medicine:

• Do not use if the solution becomes discolored.
• First, wash your hands. With the middle finger, apply pressure to the inside corner of the eye (and continue to apply pressure for 1 or 2 minutes after the medicine has been placed in the eye). Tilt the head back and with the index finger of the same hand, pull the lower eyelid away from the eye to form a pouch. Drop the medicine into the pouch and gently close the eyes. Do not blink. Keep the eyes closed for 1 or 2 minutes to allow the medicine to be absorbed.
• Immediately after using the eye drops, wash your hands to remove any medicine that may be on them.
• To keep the medicine as germ-free as possible, do not touch the applicator tip to any surface (including the eye). Also, keep the container tightly closed.

To use the ointment form of this medicine:

• First, wash your hands. Pull the lower eyelid away from the eye to form a pouch. Squeeze a thin strip of ointment into the pouch. A 1-cm (approximately 1/3-inch) strip of ointment is usually enough unless otherwise directed by your doctor. Gently close the eyes and keep them closed for 1 or 2 minutes to allow the medicine to be absorbed.
• Immediately after using the eye ointment, wash your hands to remove any medicine that may be on them.
• To keep the medicine as germ-free as possible, do not touch the applicator tip to any surface (including the eye). After using the eye ointment, wipe the tip of the ointment tube with a clean tissue and keep the tube tightly closed.

Use this medicine only as directed. Do not use more of it and do not use it more often than your doctor ordered. To do so may increase the chance of too much medicine being absorbed into the body and the chance of side effects.

Dosing—

The dose of ophthalmic physostigmine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of ophthalmic physostigmine. If your dose is different, do not change it unless your doctor tells you to do so.

The number of doses you use each day, the time allowed between doses, and the length of time you use the medicine depend on the medical problem for which you are using ophthalmic physostigmine.

• For glaucoma:
  • For ophthalmic ointment dosage form:
    • Adults and children—Use in each eye one to three times a day.
  • For ophthalmic solution (eye drops) dosage form:
    • Adults and children—One drop in each eye up to four times a day.

Missed dose—

If you miss a dose of this medicine and your dosing schedule is:

• One dose a day—Apply the missed dose as soon as possible. However, if you do not remember the missed dose until the next day, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
• More than one dose a day—Apply the missed dose as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage—

To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Keep the medicine from freezing.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

Your doctor should check your eye pressure at regular visits.

For a short time after you apply this medicine, your vision may be blurred or there may be a change in your near or distant vision, especially at night. Make sure your vision is clear before you drive, use machines, or do anything else that could be dangerous if you are not able to see well .

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• Symptoms of too much medicine being absorbed into the body
  • Increased sweating;  loss of bladder control;  muscle weakness;  nausea, vomiting, diarrhea, or stomach cramps or pain;  shortness of breath, tightness in chest, or wheezing;  slow or irregular heartbeat;  unusual tiredness or weakness;  watering of mouth 
  
  

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:

• More common
  • Blurred vision or change in near or distant vision;  eye pain 
  
  

• Less common
  • Burning, redness, stinging, or other eye irritation;  headache or browache;  twitching of eyelids ;  watering of eyes 
  
  

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.