Parasympathomimetic (Cholinergic)
PREGNANCY RECOMMENDATION: Limited Human Data—Probably Compatible
BREASTFEEDING RECOMMENDATION: No Human Data—Probably Compatible
PREGNANCY SUMMARY
Echothiophate is a long-acting, relatively irreversible organophosphate that is used in the eye for its anticholinesterase activity. One report of its use in pregnancy has been located.
FETAL RISK SUMMARY
As a quaternary ammonium compound, echothiophate is ionized at physiologic pH and transplacental passage in significant amounts would not be expected (see also Neostigmine). However, 1968 case report suggested otherwise. A 22-year-old woman was treated with echothiophate iodide 0.125% instilled daily into both eyes and acetazolamide 1 g/day (1). She became pregnant shortly after starting this treatment, which was continued until 32 weeks’ at which time the therapy was changed to pilocarpine and betamethasone eye drops. Two months later, a normal, full-term female infant was born. Pseudocholinesterase activity was measured in the mother and infant at 10 days, 28 days, and 3 months after birth. Increasing activity with time was shown in both mother and infant. The authors concluded that the drug had crossed the placenta to lower the enzyme activity in the fetus (1).
BREASTFEEDING SUMMARY
No reports describing the use of echothiophate during human lactation have been located.
Reference
1.Birks DA, Prior VJ. Echothiophate iodide treatment of glaucoma in pregnancy. Arch Ophthal 1968;79:283–5.