pilocarpine hydrochloride
pilocarpine nitrate
Pregnancy Risk Category C
How supplied
pilocarpine
Extended-release insert: 20 mcg/hour, 40 mcg/hour for 7 days
pilocarpine hydrochloride
Ophthalmic solution: 0.25%, 0.5%, 1%, 2%, 3%, 4%, 5%, 6%, 8%, 10%
Ophthalmic gel: 4%
pilocarpine nitrate
Ophthalmic solution: 1%, 2%, 4%
Action
A cholinergic that causes contraction of iris sphincter muscles, resulting in miosis, and that produces ciliary spasm, deepening of the anterior chamber, and vasodilation of conjunctival vessels of the outflow tract.
Indications & dosage
Primary open-angle glaucoma--
Adults and children: 1 to 2 drops instilled up to q.i.d. or 1-cm ribbon of 4% gel applied h.s. Or, one Ocusert Pilo system (20 or 40 mcg/hour) applied q 7 days.
Emergency treatment of acute angle-closure glaucoma--
Adults and children: 1 drop of 2% solution instilled q 5 to 10 minutes for three to six doses; then 1 drop q 1 to 3 hours until pressure is controlled.
Mydriasis due to mydriatic or cycloplegic drugs--
Adults and children: 1 drop of 1% solution.
Adverse reactions
CV: hypertension, tachycardia, hypotension.
EENT: periorbital or supraorbital headache, myopia, ciliary spasm, blurred vision, conjunctival irritation, transient stinging and burning, keratitis, lens opacity, retinal detachment, lacrimation, changes in visual field, brow pain.
GI: nausea, vomiting, diarrhea, salivation.
Respiratory: bronchoconstriction, pulmonary edema.
Skin: diaphoresis.
Other: hypersensitivity reactions.
Interactions
Drug-drug. Carbachol, echothiophate: additive effect. Don't use together.
Cyclopentolate, ophthalmic belladonna alkaloids, such as atropine, scopolamine: decreased pilocarpine antiglaucoma effectiveness and blocked mydriatic effects of these drugs. Avoid concomitant use.
Phenylephrine: decreased dilation by phenylephrine. Don't use together.
Effects on diagnostic tests
None reported.
Contraindications
Contraindicated in patients with hypersensitivity to drug and in conditions in which cholinergic effects such as constriction are undesirable (for example, acute iritis, some forms of secondary glaucoma, pupillary block glaucoma, acute inflammatory disease of the anterior chamber).
Nursing considerations
Patient teaching
*Liquid contains alcohol. **May contain tartrazine. †Canada ‡Australia §U.K. OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING