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Contraindications: Active uveal inflammation Most cases of angle-closure glaucoma , due to the possibility of increasing angle block Hypersensitivity to the active or inactive ingredients Side Effects: Retinal detachment has been reported in a few cases Stinging, burning, lacrimation Iris cysts may form Lens opacities Cardiac irregularities Pharmacokinetics: Administered in eye drops to patients with glaucoma ) Forms an irreversible covalent bond with the ACh binding site on cholinesterase (duration of action is ~100 hrs Drug Interactions: Potentiates other cholinesterase inhibitors such as succinylcholine or organophosphate and carbamate insecticides Patients undergoing systemic anticholinesterase treatment should be warned of the possible additive effects References: Merck Manual Professional Edition (2026): Medications Used to Treat Glaucoma

But this isnt only due to tolerability concerns

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Both medications follow predictable patterns, but the experience differs significantly between the two