Pilorcarpine (Ophthalmic)

Pilocarpine is a drug used to treat heightened pressure inside the eye, and thus is an effective treatment for angle com/health/coma/">glaucoma, ocular hypertension, and angle closure glaucoma until the time of surgery.

Overview

Pilocarpine ophthalmic minimizes the volume of fluid in the eye, which in turn decreases pressure in the eye. This medication is effective in treating glaucoma and ocular hypertension in patients. Sometimes it's used to induce constriction of the pupils once they dilate, and may also be used for other purposes not found in this guide. This medicine works by activating the cholinergic receptors, which cause the pupil of the eye to shrink and decrease the volume of fluid inside the eye. This medication is available only with a doctor's prescription and usually comes in a gel or jelly, device, suspension, and solution dosage forms.

Conditions Treated?

Type Of Medicine?

  • Antiglaucoma treatment

Side Effects

A) For the consumer

The below side effects may occur in patients who use different types of pilocarpine products such as ophthalmic device, ophthalmic solution, ophthalmic gel, and ophthalmic suspension.

Along with its striking benefits, any medicine may cause unpleasant or bothersome side effects in patients. Although not all of these symptoms may occur, it's important to have them checked by the healthcare provider right away in case they appear.

  • Muscle tremors

The above symptoms usually occur in patients who take this drug in excess than what they should.

Less common

  • Eye pain

Some side effects may occur in patients that don't require any medical attention. These side effects may disappear during treatment as the patient's body adjusts to the medicine. The healthcare provider should tell his or her patients about ways to prevent or reduce some of these side effects. Patients should check with their healthcare specialist if any of the below side effects continue or become bothersome or they have any questions about them:

More common

  • Blurred vision or change in near or far vision

Less common

B) For healthcare professionals

Some of the below side effects may appear in patients who use different kinds of pilocarpine products such as compounding powder, ophthalmic insert, ophthalmic gel, and ophthalmic solution.

Ocular

  • Common (1%-10%): Blurred vision, accommodative change, visual impairment, eye irritation, and eye pain
  • Frequency not reported: Burning, itching, conjunctival vascular congestion and sensitization of the lids, ciliary spasm, transient myopia, lens changes with chronic use, decrease in visual acuity in poor illumination, increased pupilary block, retinal detachment and vitreous hemorrhaging.

General

  • The most widespread side effects among patients include blurred vision, accommodative change, visual impairment, eye irritation, and eye pain

Cardiovascular

  • Frequency not reported: Changes in blood pressure and cardiac rhythm

Dermatologic

  • Frequency not reported: Increased salivation, sweating, and lacrimation

Nervous system

  • Common (1%-10%): A headache or browache

Respiratory

  • Frequency not reported: Pulmonary edema and bronchial spasm

Gastrointestinal

  • Frequency not reported: Vomiting, nausea, and diarrhea

Some patients may experience other side effects besides those found in this guide. If a patient realizes other effects, make sure to check with the healthcare professional right away. Patients may also call their doctor for medical advice about side effects or may report them to the FDA at 1-800-FDA-1088.

Dosage

The dose of this drug is different from person to person. It's important for patients to follow doctor's orders or the direction on the label. The below information provides only the average doses of this particular medication. If a patient finds his or her dose different, they should not change it unless told so by the doctor. The amount of medicine a patient takes depends on the strength of the drug. Also, the volume of doses patients should take each day, the time allowed between doses, and the period through which a patient should take this medicine depend on the health issue being treated.

A) Usual Adult Dose for Intraocular Hypertension

  • Reduction of heightened intraocular pressure (IOP) in persons with ocular hypertension or open-angle glaucoma: Apply a single drop of 1%, 2%, or 4% solution in either one or both eyes at least four times every day

B) Usual Adult Dose for Glaucoma (Open Angle)

  • Reduction of heightened intraocular pressure in persons with ocular hypertension or open-angle glaucoma: Apply one drop of 1%, 2%, or 4% in either one or both eyes at least four times every day

C) Usual Adult Dose for Glaucoma (Narrow Angle)

  • Insert a single drop of 1% or 2% solution in either one or both eyes at least three times over a 30-minute period

D) Usual Adult Dose for Production of Miosis

  • Apply a single dose or two drops of 1%, 2%, or 4% solution in either one or both eyes every day. Be careful to administer this drug five minutes apart when using double drops

E) Usual Pediatric Dose for Glaucoma

Under 2 years:

  • Apply a single drop of 1% solution in either one eye or both eyes at least three times every day

2 years or order:

  • Reduction of heightened intraocular pressure in persons with ocular hypertension or open-angle glaucoma: Use a single drop of 1%, 2%, or 4% solution in either one or both eyes at least four times every day
  • Management of Acute Angle-Closure Glaucoma: Use one drop of 1% or 2% solution in either one or both eyes at least three times over a 30-minute period

F) Usual Pediatric Dose for Intraocular Hypertension

Under 2 years:

  • Use a single drop of 1% solution in either one or both eyes at least three times every day

2 years or older:

  • Reduction of heightened intraocular pressure in persons with ocular hypertension or open-angle glaucoma: Apply a single drop of 1%, 2%, or 4% in either one or both eyes at least four times every day
  • Management of Acute Angle-Closure Glaucoma: Use a single drop of 1% or 2% solution in either one or both eyes at least three times over a 30-minute period

Usual Pediatric Dose for Production of Miosis

Under 2 years:

  • Apply a single drop of 1% solution in either one or both eyes at least 3 times every day

2 years or older:

  • Reduction of elevated intraocular pressure in patients with ocular hypertension or open angle glaucoma: Apply a single drop of 1%, 2% or 4% solution in either one or both eyes at least four times every day
  • Management of Acute Angle-Closure Glaucoma: Apply a single drop of 1% or 2% solution in either one or both eyes at least 3 times over a 30-minute period

IMPORTANT:

  • Patients who appear naive to this medication should be started on or given a 1% concentration
  • The frequency of instillation and concentration of this medicine, very much depends on the severity of the miotic response and elevated intraocular pressure tolerance of the patient
  • Patients may be asked to perform punctal occlusion for about 2 minutes following instillation to minimize systemic exposure from this drug
  • This medicine may be used in combination with other drugs such as beta-blockers, sympathomimetics, carbonic anhydrase inhibitors, or hypersomotic agents
  • If multiple topical ophthalmic medications are being used, the drugs should be given at least five minutes apart
  • And finally, where the patient misses a dose, he or she should apply the drug as soon as they remember. If it's near the time of the next dose, they should skip the missed dose and resume their normal dosing schedule. A patient should not double their missed dose to catch up

USES:

  • Reduction of heightened intraocular pressure (IOP) in persons with ocular hypertension or open-angle glaucoma
  • Management of acute angle-closure glaucoma
  • Induction of miosis
  • Prevention of postoperative elevated IOP linked with laser surgery

Interactions

Although some medications shouldn't be used together at all, sometimes two different drugs may be used together even if an interaction might occur. On such occasions, the healthcare professional may want to change the dose or take other precautions he or she deems important. Patients taking this drug should tell their healthcare provider if they are taking any of the below medications. The below interactions are selected based on their potential significance and aren't necessarily all-inclusive.

Moreover, using this drug with any of the below medicines is usually not recommended but may be required on some occasions. If both drugs are prescribed together, the healthcare provider may change the dose or how often a patient uses one or both of the medicines.

  • Tegafur

Other Interactions

Some medicines shouldn't be used at or around the time of eating food or eating some types of food because interactions may occur. Mixing tobacco or alcohol with certain drugs may also cause interactions to occur. Patients should talk with their healthcare professional about the use of this medicine with food, tobacco, or alcohol.

Other medical problems

The presence of other health complications may affect the use of this drug. It's important for patients to tell their doctor if they have any of the below ailments.

Warnings

  • It's important for the healthcare provider to check the eye pressure of his or her patients regularly. Eye exams should also be performed periodically to keep track of a patient's progress or check for side effects.
  • Patients may experience blurred vision or may experience a change in their near or far vision, particularly at night after a short time of applying this particular medication.
  • Patients should make sure their vision is clear before they drive, operate heavy machinery, or do anything else that could otherwise be dangerous if they're not seeing well.
  • Insert this unit in the eye at bedtime when the body is ready to calm and relax from any scheduled tasks or exercise.
  • A patient shouldn't use this drug if they're allergic to pilocarpine, or if they have pupillary block glaucoma, uveitis, or are pregnant.
  • Before using this drug, a patient should tell their doctor if they're allergic to any drugs.
  • Don't let the dropper tip touch any surface, including the hands or eyes, as this can cause infection in the eye and bring about vision loss or severe damage to the eye.
  • Don't use any other eye medication the doctor hasn't prescribed.
  • Systemic absorption of drugs from ophthalmic compounds may be reduced by pressure on the tear-duct right after use.
  • Before using this medicine, patients should tell their pharmacist or doctor their medical history, especially of asthma, eye problems (detached retina, iritis, etc), heart problems (recent heart attack, heart failure, etc), and stomach problems (spasms, ulcers, etc).
  • This drug may be harmful if swallowed.
  • If someone suffers from an overdose and experiences severe symptoms such as fainting or labored breathing, seek medical care right away.
  • Always wash hands before and after using this medicine to minimize the risk of contamination
  • Use this drug as ordered or prescribed by the healthcare provider at all times, and do not share this drug with other patients.

Storage

  • Store this medicine at room temperature between 2 C to 8 C (36 F-46 F)

Summary

Pilocarpine medicine is used alone or together with other drugs to treat high pressure inside the eye arising from glaucoma or other eye disorders. Minimizing high pressure inside the patient's eye helps stop and prevent vision loss, blindness, and nerve damage. This drug may also be used to enlarge the pupil during an eye examination. Common side effects of the eye drops include a headache, irritation of the eye, increased tearing, and blurry vision.

Some patients may experience other symptoms besides the ones described above, so it's important to check with the healthcare provider right away to examine the underlying symptoms and determine an effective treatment for that particular condition. It's also crucial to use this medication only as directed or prescribed by the doctor in order to get satisfactory results from this treatment.