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Conditions obstructing aqueous outflow, such as synechial formation, that are amenable to miotic therapy
DOSAGE AND ADMINISTRATION
As HUMORSOL (demecarium) is an extremely potent drug, the physician should thoroughly familiarize himself with its use and the technic of instillation.
The required dose is applied in the conjunctival sac, with the patient supine, care being taken not to touch the cornea with the tip of the OCUMETER* ophthalmic dispenser. The patient or person administering the medication should apply continuous gentle pressure on the lacrimal duct with the index finger for several seconds immediately following instillation of the drops. This is to prevent drainage overflow of solution into the nasal and pharyngeal spaces, which might cause systemic absorption. Wash the hands immediately after administration.
HUMORSOL (demecarium) should not be used more often than directed. Caution is necessary to avoid overdosage.
Initial titration and dosage adjustments with HUMORSOL (demecarium) must be individualized to obtain maximal therapeutic effect. The patient must be closely observed during the initial period. If the response is not adequate within the first 24 hours, other measures should be considered.
For initial therapy with HUMORSOL (demecarium) (0.125 percent or 0.25 percent) place 1 drop (children) or 1 or 2 drops (adults) in the glaucomatous eye. A decrease in intraocular pressure should occur within a few hours. During this period, keep the patient under supervision and make tonometric examinations at least hourly for 3 or 4 hours to be sure that no immediate rise in pressure occurs (see ADVERSE REACTIONS ).
Duration of effect varies with the individual. The usual dosage can vary from as much as 1 or 2 drops twice a day to as little as 1 or 2 drops twice a week. The 0.125 percent strength used twice a day usually results in smooth control of the physiologic diurnal variation in intraocular pressure. This is probably the preferred dosage for most wide (open) angle glaucoma patients.
Essentially equal visual acuity of both eyes is a prerequisite to the successful treatment of esotropia with HUMORSOL (demecarium) . For initial evaluation it may be used as a diagnostic aid to determine if an accommodative factor exists. This is especially useful preoperatively in young children and in patients with normal hypermetropic refractive errors. One drop is given daily for 2 weeks, then 1 drop every 2 days for 2 to 3 weeks. If the eyes become straighter, an accommodative factor is demonstrated. This technic may supplement or complement standard testing with atropine and trial with glasses for the accommodative factor.
In esotropia uncomplicated by amblyopia or anisometropia, HUMORSOL (demecarium) may be instilled in both eyes, not more than 1 drop at a time every day for 2 to 3 weeks, as too severe a degree of miosis may interfere with vision. Then reduce the dosage to 1 drop every other day for 3 to 4 weeks and reevaluate the patient's status.
HUMORSOL (demecarium) may be continued in a dosage of 1 drop every 2 days to 1 drop twice a week. (The latter dosage may be maintained for several months.) Evaluate the patient's condition every 4 to 12 weeks. If improvement continues, change the schedule to 1 drop once a week and eventually to a trial without medication. However, if after 4 months, control of the condition still requires 1 drop every 2 days, therapy with HUMORSOL (demecarium) should be stopped.
*Registered trademark of MERCK & CO., INC.
Sterile Ophthalmic Solution HUMORSOL (demecarium) is a clear, colorless, aqueous solution and is supplied in a 5 mL white, opaque, plastic OCUMETER ophthalmic dispenser with a controlled-drop tip:
No. 3255 0.125 percent solution.
No. 3267 0.25 percent solution.
Protect from freezing and excessive heat.
COPYRIGHT © MERCK & CO., INC., 1987
All rights reservedThis monograph has been modified to include the generic and brand name in many instances.
Last reviewed on RxList: 12/8/2004
Additional Humorsol Information
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