Patients w/ significant CV disease. High ocular doses for acute angle-closure glaucoma may cause pulmonary edema. May increase airway resistance, bronchial smooth muscle tone & secretions. Patients w/ controlled asthma, chronic bronchitis or COPD requiring pharmacotherapy. Toxicity is characterized by exaggeration of parasympathomimetic effects. Dose-related CV pharmacologic effects including hypotension, HTN, bradycardia & tachycardia. Patients w/ known or suspected cholelithiasis or biliary tract disease. May increase ureteral smooth muscle tone & may precipitate renal colic particularly in patients w/ nephrolithiasis. Risk of dose-related CNS effects. Patients w/ underlying cognitive or psychiatric disturbances. Patient who sweats excessively & cannot drink enough liqd; dehydration may develop. May cause visual blurring, decreased visual acuity especially at night & in patients w/ central lens changes; depth perception impairment; may impair ability to drive or perform hazardous activities in reduced lighting. Pregnancy & lactation. Ped patients.
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