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Demecarium bromide is a potent, long-acting cholinesterase
inhibitor used topically in the treatment of acute glaucoma. Parasympathomimetic
drugs cause contraction of the muscles associated with the ciliary body and of
the iris sphincter. This allows increased outflow of aqueous humor by mechanically
opening the iridocorneal angle. Parasympathomimetic drugs also increase aqueous
humor protein and may cause vasodilation of the conjunctiva. In dogs, demacarium
bromide has been shown to decrease intra-ocular pressure for up to 48 hours.
The most commonly used parasympathomimetic in the treatment of
primary glaucoma is 2% pilocarpine. Demecarium bromide is an alternative drug.
Acute primary glaucoma is generally a breed- related, hereditary condition. It is a true medical emergency. Topical prostaglandins are the first line drug of choice in the affected eye. Demecarium bromide is often used in the medical management of the non-affected eye. Almost all cases of primary glaucoma will become bilateral if the contralateral eye is not monitored and appropriately medicated. One of the advantages to demecarium bromide is that it may be administered once or twice a day.
• Local inflammation of the eye. Topical ophthalmic corticosteroids may be used to diminish irritation.
• Systemic side effects are generally related to GI distress, although cardiac related symptoms are possible. Particular care should be exercised with small breed dogs, or when high doses are used.
• Demecarium bromide should be used with caution with other cholinesterase inhibitors and with succinylcholine.
• Demecarium bromide should not be used during pregnancy.
• Demecarium bromide should not be used in animals with secondary glaucoma due to active anterior uveitis. Under these circumstances, it will both increase the pain and other symptoms.
• Parasympathomimetic drugs may cause a flare up of iritis.
• Sympathomimetic drugs such as dipivefrin also increase the outflow of aqueous humor but by a different mechanism than the parasympathomimetic drugs, demecarium bromide. These drugs are synergistic and can be used in the same eye, although treatment should be spaced by 5 or 10 minutes.
• As with other parasympathomimetic drugs, overdose may cause GI distress, hypotension, bradycardia, and dyspnea.
Dr.
Barbara Forney is a veterinary practitioner in Chester County, Pennsylvania.
She has a master's degree in animal science from the University of Delaware
and graduated from the University of Pennsylvania School of Veterinary Medicine
in 1982.
She began to develop her interest in client education and medical writing 1997. Recent publications include portions of The Pill Book Guide to Medication for Your Dog and Cat, and most recently Understanding Equine Medications published by the Bloodhorse.
Dr. Forney is an FEI veterinarian and an active member of the AAEP, AVMA, and AMWA.
You can purchase books by Dr. Forney at www.exclusivelyequine.com
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