Isopto Carbachol Ophthalmic Solution and Sildenafil Citrate

• Generic Name: carbachol ophthalmic
• Dosage Forms: ophthalmic solution
• Other Brand Names: Isopto Carbachol, Miostat, Carboptic, Carbastat

Reduction of elevated intraocular pressure (IOP) in patients with primary, open-angle (chronic simple, noncongestive) glaucoma.

Used mainly in patients refractory or hypersensitive to pilocarpine.

May use concomitantly with sympathomimetic agents, β-adrenergic blocking agents, or carbonic anhydrase inhibitors.

Production of miosis during surgery on the anterior chamber of the eye (e.g., cataract extraction, keratoplasty, peripheral iridectomy, cyclodialysis).

Reduction of the intensity of IOP elevation for the first 24 hours after cataract surgery.

Intraocular acetylcholine generally preferred.

Reduction of IOP in the emergency treatment of acute (congestive) angle-closure glaucoma prior to surgery.

Pilocarpine generally preferred.

Production of miosis to counteract mydriatic effects of sympathomimetic agents (e.g., hydroxyamphetamine, phenylephrine) after ophthalmoscopic examinations in glaucoma patients.

Pilocarpine generally preferred.

• Generic Name: sildenafil
• Dosage Forms: n.a.
• Other Brand Names: Revatio, Viagra

To facilitate attainment of a sexually functional erection in males with erectile dysfunction (ED, impotence).

Most experts currently recommend that selective PDE type 5 inhibitors be offered as first-line therapy for ED unless contraindicated. Insufficient evidence to support the superiority of one selective PDE type 5 inhibitor over another.

Has been used for the management of sexual dysfunction in women; however, additional study needed to establish role, if any, of such therapy.

Although sildenafil may improve physiologic response (e.g., increased blood flow to sexual organs), such changes have not been associated with overall improvement in sexual dysfunction in women.

Also has been used in women with sexual dysfunction induced by SSRI antidepressants and in women with neurogenic sexual dysfunction (e.g., due to spinal cord injury or multiple sclerosis); however, data limited.

Symptomatic management of PAH (WHO group 1 pulmonary hypertension) to improve exercise capacity and delay clinical worsening.

Parenteral preparation used for continued treatment in patients with PAH who are temporarily unable to take oral medication.

Efficacy established principally in patients with NYHA/WHO functional class II–III PAH (idiopathic or associated with connective tissue diseases).

Recommended as one of several treatment options for initial management of PAH in patients with NYHA/WHO functional class II, III, or IV symptoms who are not candidates for calcium-channel blocker therapy or in whom such therapy has failed. Individualize choice of therapy; consider factors such as disease severity, route of administration, potential adverse effects and costs of treatment, clinician experience, and patient preference.

In patients with inadequate response to initial monotherapy, may consider combination therapy with a prostanoid or endothelin-receptor antagonist (added sequentially). By targeting different pathophysiologic pathways of the disease, such combination therapy may provide additive and/or synergistic benefits.

Because increased mortality has been observed in children receiving higher (more effective) dosages of sildenafil, FDA currently does not recommend use of the drug in patients <18 years of age. (See Pediatric Use under Cautions.) Whether long-term sildenafil therapy has a beneficial effect on mortality in adults remains to be established.