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Pilocarpine (Systemic)

Medically reviewed by Last updated on Aug 26, 2020.


(pye loe KAR peen)

Index Terms

  • Pilocarpine HCl
  • Pilocarpine Hydrochloride

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral, as hydrochloride:

Salagen: 5 mg

Salagen: 7.5 mg [contains fd&c blue #2 aluminum lake]

Generic: 5 mg, 7.5 mg

Brand Names: U.S.

  • Salagen

Pharmacologic Category

  • Cholinergic Agonist


Binds to muscarinic (cholinergic) receptors, causing an increase in secretion of exocrine glands (such as salivary and sweat glands) and increase tone of smooth muscle in gastrointestinal and urinary tracts



Onset of Action

20 minutes; Maximum effect: 1 hour

Time to Peak

Serum: 0.85 to 1.25 hours (increased to 1.47 hours with a high-fat meal)

Duration of Action

3 to 5 hours

Half-Life Elimination

0.76 to 1.35 hours; Mild to moderate hepatic impairment: 2.1 hours

Special Populations: Hepatic Function Impairment

Clearance decreased ~30% in patients with mild to moderate impairment, resulting in an increase in Cmax and half-life.

Special Populations: Gender

Elderly women had Cmax and AUC approximately twice that of elderly and younger men.

Use: Labeled Indications

Xerostomia: Treatment of symptoms of dry mouth from salivary gland hypofunction caused by radiotherapy for cancer of the head and neck; treatment of symptoms of dry mouth in patients with Sjögren syndrome.


Hypersensitivity to pilocarpine or any component of the formulation; uncontrolled asthma; when miosis is undesirable (eg, acute iritis, angle-closure glaucoma)

Dosing: Adult

Xerostomia: Oral:

Associated with head and neck cancer: Initial: 5 mg 3 times daily; may titrate dose based on response and tolerability; usual dosage range: 15 to 30 mg/day; maximum: 10 mg/dose

Sjögren syndrome: 5 mg 4 times daily

Dosing: Geriatric

Refer to adult dosing.


Avoid administering with high-fat meal. Ensure adequate water intake (dehydration may develop with use).


Store at 15°C to 30°C (59°F to 86°F).

Drug Interactions

Acetylcholinesterase Inhibitors: May enhance the adverse/toxic effect of Cholinergic Agonists. Specifically, cholinergic effects may be enhanced or increased. Monitor therapy

Beta-Blockers: May enhance the adverse/toxic effect of Cholinergic Agonists. Of particular concern are the potential for cardiac conduction abnormalities and bronchoconstriction. Monitor therapy

Cimetropium: Cholinergic Agonists may diminish the anticholinergic effect of Cimetropium. Monitor therapy

Sincalide: Drugs that Affect Gallbladder Function may diminish the therapeutic effect of Sincalide. Management: Consider discontinuing drugs that may affect gallbladder motility prior to the use of sincalide to stimulate gallbladder contraction. Consider therapy modification

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.


Cardiovascular: Flushing (8% to 13%)

Central nervous system: Chills (3% to 15%), dizziness (5% to 12%), headache (11%)

Gastrointestinal: Nausea (6% to 15%)

Genitourinary: Urinary frequency (9% to 12%)

Neuromuscular & skeletal: Weakness (2% to 12%)

Respiratory: Rhinitis (5% to 14%)

Miscellaneous: Diaphoresis (29% to 68%)

1% to 10%:

Cardiovascular: Edema (<1% to 5%), facial edema, hypertension (3%), palpitation, tachycardia

Central nervous system: Pain (4%), fever, somnolence

Dermatologic: Pruritus, rash

Gastrointestinal: Diarrhea (4% to 7%), dyspepsia (7%), vomiting (3% to 4%), constipation, flatulence, glossitis, salivation increased, stomatitis, taste perversion

Genitourinary: Vaginitis, urinary incontinence

Neuromuscular & skeletal: Myalgias, tremor

Ocular: Lacrimation (6%), amblyopia (4%), abnormal vision, blurred vision, conjunctivitis

Otic: Tinnitus

Respiratory: Cough increased, dysphagia, epistaxis, sinusitis

Miscellaneous: Allergic reaction, voice alteration

<1%: Abnormal dreams, abnormal thinking, alopecia, angina pectoris, anorexia, anxiety, aphasia, appetite increased, arrhythmia, arthralgia, arthritis, bilirubinemia, body odor, bone disorder, bradycardia, breast pain, bronchitis, cataract, cholelithiasis, colitis, confusion, contact dermatitis, cyst, deafness, depression, dry eyes, dry mouth, dry skin, dyspnea, dysuria, ear pain, ECG abnormality, eczema, emotional lability, eructation, erythema nodosum, esophagitis, exfoliative dermatitis, eye hemorrhage, eye pain, gastritis, gastroenteritis, gastrointestinal disorder, gingivitis, glaucoma, hematuria, hepatitis, herpes simplex, hiccup, hyperkinesias, hypoesthesia, hypoglycemia, hypotension, hypothermia, insomnia, intracranial hemorrhage, laryngismus, laryngitis, leg cramps, leukopenia, liver function test abnormal, lymphadenopathy, mastitis, melena, menorrhagia, metrorrhagia, migraine, moniliasis, myasthenia, MI, neck pain, photosensitivity reaction, nervousness, ovarian disorder, pancreatitis, paresthesia, parotid gland enlargement, peripheral edema, platelet abnormality, pneumonia, pyuria, salivary gland enlargement, salpingitis, seborrhea, skin ulcer, speech disorder, sputum increased, stridor, syncope, taste loss, tendon disorder, tenosynovitis, thrombocythemia, thrombocytopenia, thrombosis, tongue disorder, twitching, urethral pain, urinary impairment, urinary urgency, vaginal hemorrhage, vaginal moniliasis, vesiculobullous rash, WBC abnormality, yawning


Disease-related concerns:

• Cardiovascular disease: Use with caution in patients with significant cardiovascular disease; may have difficulty compensating for transient changes in hemodynamics or rhythm induced by pilocarpine.

• Cholelithiasis: Use with caution in patients with cholelithiasis or biliary tract disease.

• Hepatic impairment: Use with caution in patients with moderate impairment; dosage adjustment recommended; use is not recommended in patients with severe impairment.

• Nephrolithiasis: Use caution in patients with a history of nephrolithiasis; may induce smooth muscle spasms, precipitating renal colic or ureteral reflux in patients with nephrolithiasis.

• Respiratory disorders: Use with caution in patients with controlled asthma, chronic bronchitis, or COPD; may increase airway resistance, bronchial smooth muscle tone, and bronchial secretions.

Pregnancy Considerations

Adverse events have been observed in some animal reproduction studies.

Patient Education

What is this drug used for?

• It is used to treat dry mouth.

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

• Flushing

• Loss of strength and energy

• Chills

• Runny nose

• Passing a lot of urine

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Severe dizziness

• Passing out

• Shortness of breath

• Swelling

• Abdominal pain

• Fast heartbeat

• Slow heartbeat

• Abnormal heartbeat

• Severe nausea

• Vomiting

• Vision changes

• Eye pain

• Severe eye irritation

• Severe headache

• Increased tears

• Sweating a lot

• Severe diarrhea

• Confusion

• Tremors

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a limited summary of general information about the medicine's uses from the patient education leaflet and is not intended to be comprehensive. This limited summary does NOT include all information available about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not intended to provide medical advice, diagnosis or treatment and does not replace information you receive from the healthcare provider. For a more detailed summary of information about the risks and benefits of using this medicine, please speak with your healthcare provider and review the entire patient education leaflet.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.