Pilocarpine

Know the basics

What is pilocarpine used for?

Pilocarpine reduces the amount of fluid in the eye, which decreases pressure inside the eye.

Pilocarpine ophthalmic (for the eyes) is used to treat glaucoma or ocular hypertension (high pressure inside the eye).

Pilocarpine ophthalmic may also be used for other purposes not listed in this medication guide.

How should I take pilocarpine?

Use this medication exactly as prescribed by your doctor. Do not use it in larger amounts or for longer than recommended. Follow the directions on your prescription label.

Wash your hands before using the eye drops.

To apply the eye drops:

• Tilt your head back slightly and pull down your lower eyelid to create a small pocket. Hold the dropper above the eye with the dropper tip down. Look up and away from the dropper as you squeeze out a drop, then close your eye.
• Gently press your finger to the inside corner of the eye (near your nose) for about 1 minute to keep the liquid from draining into your tear duct.
• If you use any other eye medications, wait about 5 minutes after using pilocarpine eye drops before using the other medication.
• Do not allow the dropper tip to touch any surface, including the eyes or hands. If the dropper becomes contaminated it could cause an infection in your eye, which can lead to vision loss or serious damage to the eye.
• Do not use the eye drops if the liquid has changed colors or has particles in it. Call your doctor for a new prescription.

Store the drops at room temperature away from heat and moisture. Keep the bottle tightly closed when not in use.

How do I store pilocarpine?

Pilocarpine is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store pilocarpine in the bathroom or the freezer. There may be different brands of pilocarpine that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush pilocarpine down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Know the precautions & warnings

What should I know 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 this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine 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 this medicine 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, this medicine is not expected to cause different side effects or problems in older people than it does in younger adults.

Is it safe to take pilocarpine during pregnancy or breast-feeding?

There isn’t enough information about the safety of using this medication during pregnancy and breast-feeding. Please always consult with your doctor to weigh the potential benefits and risks before taking this medication.

Know the side effects

What are the side effects of pilocarpine?

Sweating, nausea, runny nose, chills, flushing, frequent urge to urinate, dizziness, weakness, diarrhea, and blurred vision may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

This medication may cause an increase in tears. This can be helpful if you have dry eyes (such as with Sjogren’s syndrome). Tell your doctor if runny eyes become a problem.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor immediately if any of these unlikely but serious side effects occur: slow/fast heartbeat, shakiness (tremor), fainting, lung problems (such as increased wheezing/cough/phlegm), mental/mood changes (such as confusion, agitation), severe stomach/abdominal pain.

A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Know the interactions

What drugs may interact with pilocarpine?

Pilocarpine may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval, especially:

• Tegafur

Does food or alcohol interact with pilocarpine?

Pilocarpine may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with pilocarpine?

Pilocarpine may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have, especially:

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

Understand the dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using this medication.

What is the dose of pilocarpine for an adult?

Usual Adult Dose for Glaucoma:

Ophthalmic Solution: Instill 1 to 2 drops in the affected eye 3 to 4 times daily. Wait at least 5 minutes before instilling other eyedrops. Remove contact lenses before administration of benzalkonium chloride-containing solutions and wait at least 15 minutes before reinserting them.

Ophthalmic Gel: Apply one-half inch ribbon of gel in the lower conjunctival sac of the affected eye daily at bedtime. If other eyedrops are used, they should be instilled at least 5 minutes before the gel is applied.

Ophthalmic Insert: Insert one system into lower conjunctival cul-de-sac at bedtime. Replace every 7 days.

Usual Adult Dose for Intraocular Hypertension:

Ophthalmic Solution: Instill 1 to 2 drops in the affected eye 3 to 4 times daily. Wait at least 5 minutes before instilling other eyedrops. Remove contact lenses before administration of benzalkonium chloride-containing solutions and wait at least 15 minutes before reinserting them.

Ophthalmic Gel: Apply one-half inch ribbon of gel in the lower conjunctival sac of the affected eye daily at bedtime. If other eyedrops are used, they should be instilled at least 5 minutes before the gel is applied.

Ophthalmic Insert: Insert one system into lower conjunctival cul-de-sac at bedtime. Replace every 7 days.

What is the dose of pilocarpine for a child?

Usual Pediatric Dose for Glaucoma:

1 to 18 years:

Ophthalmic Solution: Instill 1 to 2 drops in the affected eye 3 to 4 times daily.

Wait at least 5 minutes before instilling other eyedrops. Remove contact lenses before administration of benzalkonium chloride-containing solutions and wait at least 15 minutes before reinserting them.

Ophthalmic Gel: Apply one-half inch ribbon of gel in the lower conjunctival sac of the affected eye daily at bedtime. If other eyedrops are used, they should be instilled at least 5 minutes before the gel is applied.

Usual Pediatric Dose for Intraocular Hypertension:

1 to 18 years:

Ophthalmic Solution: Instill 1 to 2 drops in the affected eye 3 to 4 times daily.

Wait at least 5 minutes before instilling other eyedrops. Remove contact lenses before administration of benzalkonium chloride-containing solutions and wait at least 15 minutes before reinserting them.

Ophthalmic Gel: Apply one-half inch ribbon of gel in the lower conjunctival sac of the affected eye daily at bedtime. If other eyedrops are used, they should be instilled at least 5 minutes before the gel is applied.

How is pilocarpine available?

Pilocarpine is available in the following dosage forms and strengths:

PILOPINE HS® (pilocarpine hydrochloride ophthalmic gel) 4% is supplied as a 4% sterile aqueous gel in 4 gram tubes with ophthalmic tip.

Gel, Ophthalmic, as hydrochloride:

Pilopine HS: 4% (4g) [contains benzalkonium chloride, edetete disodium]

Solution, Ophthalmic, as hydrochloride:

Isopto Carpine: 1% (15 mL); 2% (15 mL); 4% (15 mL);

Generic: 1% (15 mL); 2% (15 mL); 4% (15 mL)

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a 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 take your regular dose as scheduled. Do not take a double dose.