pilocarpine (Ophthalmic route)

Pronunciation

pye-loe-KAR-peen

Commonly used brand name(s)

In the U.S.

  • Isopto Carpine
  • Ocu-Carpine
  • Ocusert Pilo
  • Pilocar
  • Pilopine-HS

In Canada

  • Minims Pilocarpine 2%
  • Minims Pilocarpine 4%

Available Dosage Forms:

  • Device
  • Suspension
  • Solution
  • Gel/Jelly

Therapeutic Class: Direct Acting Miotic

Pharmacologic Class: Cholinergic

Uses For pilocarpine

Pilocarpine is used to treat glaucoma and other eye conditions.

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pilocarpine is available only with your doctor's prescription.

Before Using pilocarpine

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

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to pilocarpine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Although there is no specific information comparing use of pilocarpine in children with use in other age groups, pilocarpine is not expected to cause different side effects or problems in children than it does in adults.

Geriatric

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. Although there is no specific information comparing use of pilocarpine in the elderly with use in other age groups, pilocarpine is not expected to cause different side effects or problems in older people than it does in younger adults.

Pregnancy

Pregnancy Category Explanation
All Trimesters C Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with 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 pilocarpine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using pilocarpine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Tegafur

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of pilocarpine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Asthma or
  • Eye disease or problems (other)—Pilocarpine may make the condition worse

Proper Use of pilocarpine

To use the eye drop form of pilocarpine:

  • First, wash your hands. Tilt the head back and, pressing your finger gently on the skin just beneath the lower eyelid, pull the lower eyelid away from the eye to make a space. Drop the medicine into this space. Let go of the eyelid and gently close the eyes. Do not blink. Keep the eyes closed and apply pressure to the inner corner of the eye with your finger for 1 or 2 minutes to allow the medicine to be absorbed by the eye.
  • Immediately after using the eye drops, wash your hands to remove any medicine that may be on them.
  • To keep the medicine as germ-free as possible, do not touch the applicator tip to any surface (including the eye). Also, keep the container tightly closed.

To use the eye gel form of pilocarpine:

  • First, wash your hands. Tilt the head back and, pressing your finger gently on the skin just beneath the lower eyelid, pull the lower eyelid away from the eye to make a space. Squeeze a thin strip of gel into this space. A 1½-cm (approximately ½-inch) strip of gel is usually enough, unless you have been told by your doctor to use a different amount. Let go of the eyelid and gently close the eyes. Keep the eyes closed for 1 or 2 minutes to allow the medicine to be absorbed by the eye.
  • Immediately after using the eye gel, wash your hands to remove any medicine that may be on them.
  • To keep the medicine as germ-free as possible, do not touch the applicator tip to any surface (including the eye). After using the eye gel, wipe the tip of the gel tube with a clean tissue and keep the tube tightly closed.

To use the eye insert form of pilocarpine:

  • pilocarpine usually comes with patient directions. Read them carefully before using pilocarpine.
  • If you think pilocarpine unit may be damaged, do not use it. If you have any questions about this, check with your health care professional.
  • If the unit seems to be releasing too much medicine into your eye, remove it and replace with a new unit. If you have any questions about this, check with your doctor.

Use pilocarpine only as directed. Do not use more of it and do not use it more often than your doctor ordered. To do so may increase the chance of too much medicine being absorbed into the body and the chance of side effects.

Dosing

The dose of pilocarpine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of pilocarpine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For eye drop dosage form:
    • For chronic glaucoma:
      • Adults and children—One drop one to four times a day.
    • For acute angle-closure glaucoma:
      • Adults and children—One drop every five to ten minutes for three to six doses. Then one drop every one to three hours until eye pressure is reduced.
  • For eye gel dosage form:
    • For glaucoma:
      • Adults and teenagers—Use once a day at bedtime.
      • Children—Use and dose must be determined by your doctor.
  • For eye insert dosage form:
    • For glaucoma:
      • Adults and children—Insert one ocular system every seven days.
      • Infants—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of pilocarpine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Store the eye system form of pilocarpine in the refrigerator. Keep from freezing. Store the 3.5-gram size (of the gel form) at room temperature.

Precautions While Using pilocarpine

Your doctor should check your eye pressure at regular visits.

For patients using the eye drop or gel form of pilocarpine:

  • For a short time after you use pilocarpine, your vision may be blurred or there may be a change in your near or far vision, especially at night. Make sure your vision is clear before you drive, use machines, or do anything else that could be dangerous if you are not able to see well.

For patients using the eye insert form of pilocarpine:

  • For the first several hours after you insert this unit in the eye, your vision may be blurred or there may be a change in your near or far vision, especially at night. Therefore, insert this unit in the eye at bedtime, unless otherwise directed by your doctor. If this unit is inserted in the eye at any other time of the day, make sure your vision is clear before you drive, use machines, or do anything else that could be dangerous if you are not able to see well.

pilocarpine Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

Symptoms of too much medicine being absorbed into the body
  • Increased sweating
  • muscle tremors
  • nausea, vomiting, or diarrhea
  • troubled breathing or wheezing
  • watering of mouth
Less common or rare
  • Eye pain

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Blurred vision or change in near or far vision
  • decrease in night vision
Less common
  • Eye irritation
  • headache or browache

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

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