Echothiophate chloride

Echothiophate is a potent, long-acting cholinesterase inhibitor used as a miotic in the treatment of glaucoma. Echothiophate covalently binds by its phosphate group to serine group at the active site of the cholinesterase. Once bound, the enzyme is permanently inactive and the cell has to make new enzymes. Echothiophate binds irreversibly to cholinesterase. Because of the very slow rate at which echothiophate is hydrolyzed by cholinesterase, its effects can last a week or more. It is used as an ocular antihypertensive in the treatment of chronic glaucoma and, in some cases, accommodative esotropia.