Pilocarpine Dosage

Usual Adult Dose for Xerostomia

Initial - Head and Neck cancer patients:
5 mg three times a day. Titrate upwards, not to exceed 10 mg per dose, to a maximum of 30 mg per day.

Sjögren's syndrome patients:
5 mg four times a day.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Initial: 5 mg twice daily, in patients with moderate hepatic insufficiency.

No dosage adjustments are required in patients with mild hepatic insufficiency (Child-Pugh score of 5 to 6).

Dose Adjustments

The lowest effective dosage should be used for maintenance.

Precautions

Pilocarpine is contraindicated in patients with uncontrolled asthma and in conditions when miosis is undesirable (e.g., acute iritis and in narrow-angle glaucoma).

In patients with significant cardiovascular disease, cholelithiasis or biliary tract disease, or nephrolithiasis, pilocarpine should be used with caution. Contractions of the gallbladder or biliary smooth muscle could precipitate complications including cholangitis, cholecystitis, and biliary obstruction.

The dose-related cardiovascular side effects of pilocarpine include hypotension, hypertension, bradycardia, and tachycardia.

The following parasympathomimetic effects of pilocarpine may occur with increased dosage: headache, visual disturbance, lacrimation, sweating, respiratory distress, gastrointestinal spasm, nausea, vomiting, diarrhea, atrioventricular block, tachycardia, bradycardia, hypotension, hypertension, shock, mental confusion, cardiac arrhythmia, and tremors.

Because pulmonary edema has been reported with administration of high ocular doses, pilocarpine should be administered with caution to patients with significant cardiovascular disease.

Increased airway resistance, bronchial smooth muscle tone, and bronchial secretions have been reported with pilocarpine therapy. Patients with controlled asthma, chronic bronchitis, or chronic obstructive pulmonary disease requiring drug treatment, should use pilocarpine with caution and under close medical supervision.

Pilocarpine may increase ureteral smooth muscle tone and could theoretically precipitate renal colic, particularly in patients with nephrolithiasis.

In general, because cholinergic agonists may have dose-related central nervous system effects, caution is advised when administering pilocarpine to patients with underlying cognitive or psychiatric disturbances.

Safety and efficacy in pediatric patients have not been established.

Dialysis

It is not known if pilocarpine is dialyzable.

Other Comments

A minimum of 12 weeks of continuous therapy is recommended in head and neck cancer patients to assess if full benefits will be achieved.