What Are Pilocarpine Eye Drops?

Pilocarpine is a common, generic medication used for glaucoma treatment. It belongs to a class of drugs called miotics. Your eye doctor may prescribe ophthalmic pilocarpine to help drain excess fluid from the eye. 

In the United States (U.S.), brand names for pilocarpine include:

• Carpine®
• Pilopine® HS

• Betoptic® Pilo (containing Betaxolol, Pilocarpine)
• Isopto Carpine®
• Ocu-Carpine®
• Ocusert Pilo®
• Pilocar®
• Salagen®

In Canada, brand names for pilocarpine include:

• Minims Pilocarpine 2
• Minims Pilocarpine 4

If your eye doctor recommends using pilocarpine, follow the care instructions. Not adhering to proper treatment could result in unwanted side effects and health consequences. 

Potential Side Effects of Pilocarpine Eye Drops

Pilocarpine eye medication can cause side effects. The following is a complete list of possible side effects:

• Severe stinging, burning, swelling, or redness of your eye
• Vision changes (blurred vision) due to miosis (constriction of the pupil)
• Eye pain or watering
• Possible eye infection, including swelling, redness, severe discomfort, crusting, or drainage
• Severe headache
• Eyebrow pain
• Trouble seeing in low-light settings
• Light sensitivity

Always remember to follow the prescription label instructions. Doing otherwise could lead to an overdose and other complications. 

If you experience an overdose, seek medical attention or a doctor immediately. 

How to Use Pilocarpine

Ophthalmic pilocarpine comes in a solution (liquid) or gel form.

If you have pilocarpine eye drops, your doctor may have you use them 2 to 4 times per day. If you have the eye gel, you may need to apply it once daily at bedtime. 

To apply the eye drops, you will need to:

1. Wash your hands thoroughly 
2. Do not touch the dropper tip against the eye or anything else 
3. Lean your head back and drag the lower eyelid with your index finger to create a pocket
4. Place the dropper tip as close as possible without touching the eye to squeeze and administer the first drop
5. Close your eye immediately after for 2 to 3 minutes
6. Do not blink or press your eyelids hard together
7. Apply slight pressure to the tear duct with your finger
8. Wipe off any excess liquid with a napkin or tissue
9. If you have to place another drop, wait until at least 5 minutes have passed
10. Place the dropper tip back into its bottle and make sure not to wash or rinse it
11. Wash your hands to get rid of any leftover medication

Additionally, while pilocarpine can manage glaucoma, it cannot cure it. You should continue treatment with pilocarpine, even when you feel well, unless otherwise directed by your doctor. Do not stop treatment suddenly without consulting medical advice first. 

How Long Does it Take for Pilocarpine to Start Working?

Pilocarpine eye drops can take effect within 10 to 30 minutes after administration. 

If you use pilocarpine to induce (cause) miosis, the condition may last up to 8 hours. Pilocarpine concentration will also determine how long the effects will persist. 

You can speak to your healthcare professional to understand the drug’s mechanism of action and when you can experience changes in eye health. 

How Long Does Pilocarpine Take to Wear Off?

If you use pilocarpine as either an eye drop or gel, you may observe changes in vision for a short time afterward. It could last up to several hours. 

In these cases, you may experience vision problems like blurry vision. Your near or far vision may also be different, especially at night.

For this reason, it is important not to drive or handle heavy machinery if your sight is unstable. 

What Should I Do if I Forget a Dose?

You may forget a dose from time to time. However, you must not double your next dose. You should adhere to your regular dosing schedule as best as possible. 

If you have a missed dose, take the following recommended dose immediately. 

Is Pilocarpine Safe to Take?

Pilocarpine is a safe drug to take for long-term use. The FDA has approved its use for conditions like glaucoma, radiation-induced xerostomia, and Sjogren's Syndrome.

However, you should speak with a healthcare professional before taking pilocarpine to ensure proper dosing and treatment. This will ensure that you are taking the drug safely and that it is not causing any adverse effects. 

Additionally, you should avoid using pilocarpine if you:

• Are pregnant or breastfeeding
• Are allergic to any of the medication’s ingredients
• Have untreated or uncontrolled asthma

Other Uses for This Medicine

Pilocarpine has received Food and Drug Administration (FDA) approval for glaucoma treatment.  While the medication isn’t the first line of treatment for glaucoma, it does help reduce intraocular pressure (IOP).

Oral pilocarpine can also help treat other conditions, including: 

• Sjogren’s syndrome. An immune system disorder that causes dry mouth and eyes, joint pain, prolonged fatigue, and more
• Radiation-induced xerostomia. Often occurs in patients who received radiation for head and neck cancer. In cases of xerostomia, salivary glands cannot produce enough saliva to keep the mouth moist

However, healthcare professionals may not recommend pilocarpine use if you have certain diseases or health problems, like: 

• Chronic obstructive pulmonary disease (COPD)
• Peptic ulcer disease
• Arrhythmias (irregular heartbeat)
• Coronary vascular disease
• Hyperthyroidism 
• Intestinal resection 
• Urinary obstruction 
• Orthostatic hypotension (when your blood quickly plummets when you get up from a sitting or lying position)
• Severe cases of miosis (excessive pupil constriction)
• Drug-induced xerostomia

What Should I Avoid While Taking Pilocarpine? 

Here are some things to avoid while taking pilocarpine:

Taking Certain Drugs or Medications

If you take pilocarpine, you should check with your doctor about taking other medications. Drug interactions may occur. 

For instance, if you take tegafur (a chemotherapy drug for cancers), make sure to speak with your healthcare provider. Drug interactions between the two medications can occur, and your doctor may make a dosage adjustment. 

Drinking Alcohol

You should not consume alcohol while taking pilocarpine. Alcohol is a central nervous system (CNS) depressant. This substance can lower your heart rate and increase the risk of side effects. 

Wearing Soft Contact Lenses

You should not wear soft contact lenses while using pilocarpine. Drugs containing pilocarpine may also carry a preservative that could permanently stain the lenses. Therefore, you should wait at least 10 minutes before putting in your contact lenses after using the medication. 

Is There an Alternative to Pilocarpine?

Yes, these are different alternatives to pilocarpine. In glaucoma cases, pilocarpine is not a first-line treatment. Other eye drops can help reduce eye pressure, including: 

• Prostaglandins
• Nitric oxides
• Rho kinase inhibitor 

Similarly, some generic eye drops can decrease the fluid the eye produces. These include: 

• Alpha-adrenergic agonists
• Beta-blockers
• Carbonic anhydrase inhibitors

Finally, you may speak with your eye doctor about the possibility of surgery.

• If you have open-angle glaucoma, you may be a candidate for trabeculoplasty 
• If you have angle-closure glaucoma, you may be eligible for iridotomy

Summary

Pilocarpine is a safe drug for eye conditions like glaucoma, radiation-induced xerostomia, and Sjogren's Syndrome. 

However, before taking pilocarpine, speak with a healthcare professional to ensure proper dosing and treatment. You should also follow safety precautions to avoid any potential side effects.