Before Using This Medicine

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

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

Pregnancy—Because of the toxicity of these medicines in general, demecarium, echothiophate, and isoflurophate are not recommended during pregnancy.

Breast-feeding—Demecarium, echothiophate, and isoflurophate may be absorbed into the body. These medicines are not recommended during breast-feeding, because they may cause unwanted effects in nursing babies. It may be necessary for you to use another medicine or to stop breast-feeding during treatment. Be sure you have discussed the risks and benefits of the medicine with your doctor.

Children—Demecarium, echothiophate, or isoflurophate can cause serious side effects in any patient. When this medicine is used for a long time, eye cysts may occur. These eye cysts occur more often in children than in adults. Therefore, it is especially important that you discuss with the child's doctor the good that this medicine may do as well as the risks of using it.

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. There is no specific information comparing use of these medicines in the elderly with use in other age groups. However, demecarium, echothiophate, or isoflurophate can cause serious side effects in any patient.

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. When you are taking demecarium, echothiophate, or isoflurophate, it is especially important that your health care professional know if you are taking any of the following:

• Amantadine (e.g., Symmetrel) or
• Anticholinergics (medicine for abdominal or stomach spasms or cramps) or
• Antidepressants (medicine for depression) or
• Antidyskinetics (medicine for Parkinson's disease or other conditions affecting control of muscles) or
• Antihistamines or
• Antimyasthenics (ambenonium [e.g., Mytelase], neostigmine [e.g., Prostigmin], pyridostigmine [e.g., Mestinon]) or
• Antipsychotics (medicine for mental illness) or
• Buclizine (e.g., Bucladin) or
• Carbamazepine (e.g., Tegretol) or
• Cyclizine (e.g., Marezine) or
• Cyclobenzaprine (e.g., Flexeril) or
• Disopyramide (e.g., Norpace) or
• Flavoxate (e.g., Urispas) or
• Ipratropium (e.g., Atrovent) or
• Meclizine (e.g., Antivert) or
• Methylphenidate (e.g., Ritalin) or
• Orphenadrine (e.g., Norflex) or
• Oxybutynin (e.g., Ditropen) or
• Procainamide (e.g., Pronestyl) or
• Promethazine (e.g., Phenergan) or
• Quinidine (e.g., Quinidex) or
• Trimeprazine (e.g., Temaril)—May increase the possibility of side effects or toxic effects; use of these medicines with demecarium, echothiophate, or isoflurophate is not recommended except under close supervision by your doctor

• Malathion (topical) (e.g., Prioderm)—May increase the possibility of side effects or toxic effects, especially if large amounts of malathion are used

Pesticides or insecticides—Make sure you tell your doctor if you have been exposed recently to pesticides or insecticides.

Other medical problems—The presence of other medical problems may affect the use of demecarium, echothiophate, or isoflurophate. Make sure you tell your doctor if you have any other medical problems, especially:

• Asthma or
• Epilepsy or
• Heart disease or
• High or low blood pressure (severe) or
• Myasthenia gravis or
• Overactive thyroid or
• Parkinsonism or
• Stomach ulcer or other stomach problems or
• Urinary tract blockage—If this medicine is absorbed into the body, it may make the condition worse

• Down's syndrome (mongolism)—This medicine may cause these children to become hyperactive

• Eye disease or problems (other)—May increase absorption of this medicine into the body or this medicine may make the condition worse