Pilocarpine Eye Medication

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What is Pilocarpine for Glaucoma?

Pilocarpine is a common, generic medication used for glaucoma treatment. It belongs to a class of drugs called miotics

Glaucoma is an eye condition that can result in a gradual loss of vision. Decreased sight occurs because of increased pressure caused by optic nerve damage. 

graphic showing the development of glaucoma

Your eye doctor may prescribe ophthalmic pilocarpine to help drain excess fluid from the eye. 

However, oral pilocarpine can also help treat other conditions, including Sjogren's syndrome and radiation-induced xerostomia. 

Sjogren’s syndrome is 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. This can cause dry mouth, sore throat, altered taste, dental decay, and other symptoms. 

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, you should follow the care instructions. Not adhering to proper treatment could have unwanted side effects and health consequences. 

According to the American Academy of Ophthalmology (AAO), people aged 65 years or older should undergo a glaucoma eye exam every 1 to 2 years. African Americans and people with a family history of glaucoma should be tested for glaucoma beginning at 40. 1

Other Uses for This Medicine

Pilocarpine has received Food and Drug Administration (FDA) approval for glaucoma treatment. The medication is not the first-line treatment for the eye condition. However, it does help reduce intraocular pressure (IOP)

Healthcare professionals may also use pilocarpine to manage other health problems, such as Sjogren’s Syndrome and radiation-induced xerostomia. 

Nevertheless, 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

Scientific evidence is scarce when supporting the use of any other drug for radiation-induced xerostomia treatment. 

How to Use Pilocarpine

You can receive ophthalmic pilocarpine as either a solution (liquid) or gel. 

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. 

It is important to adhere to prescription label directions to avoid unwanted side effects or health problems. Exceeding dosage can result in an overdose, with symptoms including sweating, nausea, tremors, or slow heart rate. 

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. Without touching the eye, place the dropper tip as close as possible 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. 

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

How Long Does it Take for Pilocarpine to Start Working?

Pilocarpine eye drops can begin to take effect within 10 to 30 minutes after dose administration. However, if you use pilocarpine to induce (cause) miosis, the condition may last for up to 8 hours. 

However, pilocarpine concentration will determine how long 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 are using pilocarpine as either eye drops 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 not stable. 

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 soon after. 

Potential Side Effects of Pilocarpine Eye Medication

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

  • Severe stinging, burning, swelling, or redness of your eye
  • Changes in vision (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

It is important to follow the prescription label instructions. Doing otherwise could lead to an overdose. If you experience an overdose, seek medical attention or a doctor immediately. 

What Should I Avoid While Taking Pilocarpine? 

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

You should also 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. 

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 after using the medication before putting in your contact lenses. 

Pilocarpine: Common Questions & Answers

Is pilocarpine safe to take?

Pilocarpine is a safe drug to take. 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. 

Is pilocarpine safe to take while pregnant?

If you are pregnant, you should speak with your doctor before taking pilocarpine. There is not enough scientific evidence to conclude if the drug results in fetal harm. It is also not clear if pilocarpine can affect reproduction capacity. 

Can you use pilocarpine long term?

Yes. Pilocarpine is effective and safe for long-term use. However, you should speak to your doctor about its continued use and effects. You should also not stop taking pilocarpine unless otherwise directed by your medical provider. 

Can pilocarpine raise blood pressure?

Yes. Pilocarpine can raise blood pressure. However, the expected effect of this drug is vasodepression (reduced tone in blood vessels). Vasodepression caused by pilocarpine can result in a short episode of hypotension (low blood pressure) before producing hypertension (high blood pressure). 

Additionally, pilocarpine can lead to either bradycardia (slow heart rate) or tachycardia (fast heart rate).

Is there an alternative to pilocarpine?

Yes. In glaucoma cases, pilocarpine is not a first-line treatment. Other types of eye drops can help reduce eye pressure, including prostaglandins, nitric oxides, or a Rho kinase inhibitor. 

Similarly, there are generic eye drops that decrease the amount of fluid the eye produces, including alpha-adrenergic agonists, beta blockers, and 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. 

Resources
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The Facts about Glaucoma.Harvard Health, 15 June 2020.

Isopto® Carpine Label. Food and Drug Administration.

Nusair, S, and A Rubinow. “The Use of Oral Pilocarpine in Xerostomia and Sjögren's Syndrome.Seminars in Arthritis and Rheumatism, U.S. National Library of Medicine, 1999.

Panarese, Victoria. “Pilocarpine.” StatPearls [Internet]., U.S. National Library of Medicine, 23 Dec. 2020, www.ncbi.nlm.nih.gov/books/NBK556128/.

Pilocarpine (Ophthalmic Route) Side Effects.Mayo Clinic, Mayo Foundation for Medical Education and Research, 1 Feb. 2021.

Pilocarpine Ophthalmic.Pilocarpine Ophthalmic | Michigan Medicine.

Pilocarpine Ophthalmic: MedlinePlus Drug Information.MedlinePlus, U.S. National Library of Medicine. 

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