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Pilocar and Alcohol/Food Interactions

There is 1 alcohol/food/lifestyle interaction with Pilocar (pilocarpine ophthalmic).

Moderate

High Blood Pressure (Hypertension)

Moderate Potential Hazard, Low plausibility

miotics - systemic vagotonic effects

Topically applied cholinergic agents are systemically absorbed, with the potential for producing rare but clinically significant systemic effects, including urinary incontinence, tightness of the bladder, increased gastric contractility and acid secretion, bradycardia, severe hypotension, bronchospasm, seizures, and coma. Increases in blood pressure may occur rarely due to a nicotinic effect on sympathetic ganglia. Therapy with ophthalmic cholinergic agents, particularly the long-acting cholinesterase inhibitors (e.g., demecarium and echothiophate), should be administered cautiously in patients with corneal abrasion (which may increase drug penetration), bronchospastic diseases, spastic gastrointestinal disturbances, urinary tract obstruction, peptic ulcer, pronounced bradycardia and hypotension, vascular hypertension, acute cardiac failure, recent myocardial infarction, epilepsy, parkinsonism, and other conditions that may respond adversely to vagotonic effects. The usual precautions should be followed to minimize the risk of systemic toxicity, including digital compression of the nasolacrimal ducts (1 to 2 minutes) following instillation to limit drainage into the nasal chamber, where extensive absorption may occur, and washing hands after use to prevent skin absorption. Excessive cholinergic effects may be reversed with parenterally administered atropine.

References

  1. Rasch D, Holt J, Wilson M, Smith RB (1983) "Bronchospasm following intraocular injection of acetylcholine in a patient taking metoprolol." Anesthesiology, 59, p. 583-5
  2. American Medical Association, Division of Drugs and Toxicology (1994) "Drug evaluations annual 1994." Chicago, IL: American Medical Association;
  3. Ellis PP (1971) "Systemic reactions to topical therapy." Int Ophthalmol Clin, 11, p. 1-11
  4. Benjamin KW (1979) "Toxicity of ocular medications." Int Ophthalmol Clin, 19, p. 199-255
  5. Zimmerman TJ, Wheeler TM (1982) "Miotics: side effects and ways to avoid them." Ophthalmology, 89, p. 76-80
  6. Treasure CB, Vita JA, Cox DA, Fish RD, Selwyn AP, Alexander RW, Ganz P (1990) "Acute myocardial infarction with normal coronary arteries associated with acetylcholine-induced vasoconstriction in the absence of a positive ergonovine test." Am J Cardiol, 65, p. 255-7
  7. Marmion VJ (1984) "Vascular hypotension and bradycardia following intraocular injection of acetylcholine during cataract surgery." Am J Ophthalmol, 97, p. 799-80
  8. Brinkley JR Jr, Henrick A (1984) "Vascular hypotension and bradycardia following intraocular injection of acetylcholine during cataract surgery." Am J Ophthalmol, 97, p. 40-2
  9. Rongey KA, Weisman H (1972) "Hypotension following intraocular acetylcholine." Anesthesiology, 36, p. 412
  10. Sekiya M, Okayama H, Suzuki M, Kobayashi T, Matsuoka H, Sumimoto T, Hamada M, Hiwada K (1993) "Acetylcholine-induced myocardial ischemia without epicardial coronary artery spasm: a possible vasospasm of small coronary arteries--a case report." Angiology, 44, p. 811-5
  11. Babinski M, Smith B, Wickerham EP (1976) "Hypotension and bradycardia following intraocular acetylcholine injection. Report of a case." Arch Ophthalmol, 94, p. 675-6
  12. Gombos GM (1982) "Systemic reactions following intraocular acetylcholine instillation." Ann Ophthalmol, 14, p. 529-30
  13. Gombos DS (1988) "Acetylcholine in ophthalmology: a revisit." Ann Ophthalmol, 20, 455,462
  14. Taytard A, Vergeret J, Auzerie J, Freour P (1983) "Acetylcholine-induced bronchospasm in asthma patients: dose/response curves." Eur J Respir Dis Suppl, 128(Pt 2), p. 513-4
  15. "Product Information. Miochol (acetylcholine ophthalmic)." Ciba Vision Ophthalmics
  16. "Product Information. Phospholine Iodide (echothiophate iodide ophthalmic)." Wyeth-Ayerst Laboratories
  17. "Product Information. Humorsol Ocumeter (demecarium bromide ophthalmic)." Merck & Co., Inc
  18. "Product Information. Eserine Sulfate Ophthalmic (PHYSostigmine ophthalmic)." Ciba Vision Ophthalmics
  19. (2001) "Product Information. Isopto Carpine (pilocarpine ophthalmic)." Alcon Laboratories Inc
  20. (2001) "Product Information. Isopto Carbachol (carbachol ophthalmic)." Alcon Laboratories Inc
View all 20 references

Pilocar drug interactions

There are 96 drug interactions with Pilocar (pilocarpine ophthalmic).

Pilocar disease interactions

There are 4 disease interactions with Pilocar (pilocarpine ophthalmic) which include:

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

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