Home Drug Guide Pilocarpine Hydrochloride

Drug Guide

Generic Name

Pilocarpine Hydrochloride

Brand Names Pilopine Hs, Salagen, Isopto Carpine, Vuity, Qlosi

Classification

Therapeutic: Cholinergic agent, Miotic agent, Eye drops for glaucoma and ocular conditions

Pharmacological: Muscarinic receptor agonist

FDA Approved Indications

  • Glaucoma (Open-angle and Angle-closure)
  • Ocular Hypertension
  • Xerostomia (Salagen)
  • Presbyopia (Vuity)

Mechanism of Action

Pilocarpine stimulates muscarinic receptors, leading to increased aqueous humor outflow in the eye, thereby reducing intraocular pressure. It also stimulates salivary glands, increasing saliva production.

Dosage and Administration

Adult: For glaucoma: 1-2 drops in the affected eye(s) up to 4 times daily. For xerostomia: 5 mg orally three times daily. For presbyopia (Vuity): 1 drop in each eye once daily.

Pediatric: Dose adjustments depend on condition; for xerostomia, typically 5 mg taken orally three times daily under medical supervision.

Geriatric: No specific dose adjustment but monitor for side effects as elderly may be more sensitive.

Renal Impairment: Use with caution; adjust dose based on tolerability.

Hepatic Impairment: Limited data; use with caution.

Pharmacokinetics

Absorption: Rapid absorption after oral administration.

Distribution: Widely distributed, crosses blood-brain barrier and placental barrier.

Metabolism: Metabolized minimally; primarily excreted unchanged.

Excretion: Primarily renal excretion.

Half Life: Approximately 1-2 hours.

Contraindications

  • Hypersensitivity to pilocarpine or other muscarinic agents.
  • Uncontrolled asthma.
  • Acute inflammatory eye conditions.

Precautions

  • Use with caution in patients with cardiovascular disease, bronchospasm, or urinary tract obstruction. Pregnant or breastfeeding women should consult healthcare providers before use.

Adverse Reactions - Common

  • Miosis (pupil constriction) (Common)
  • Headache, brow ache (Common)
  • Visual disturbances, including halos around lights (Common)
  • Sweating, salivation, nausea, vomiting (Common)

Adverse Reactions - Serious

  • Acute angle-closure glaucoma exacerbation (Rare)
  • Cardiovascular effects: tachycardia, hypotension (Rare)
  • Bronchospasm (Rare)

Drug-Drug Interactions

  • Other cholinergic agents (risk of additive effects)
  • Sympathomimetics (may reduce efficacy)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor intraocular pressure, visual acuity, and for signs of cholinergic overstimulation.

Diagnoses:

  • Risk for decreased visual acuity
  • Risk for cholinergic excess

Implementation: Administer as prescribed; instruct patients on proper eye drop technique; monitor for adverse reactions.

Evaluation: Assess intraocular pressure response, symptom relief, and side effects.

Patient/Family Teaching

  • Use medication exactly as prescribed.
  • Report any vision changes, eye pain, or systemic side effects.
  • Avoid operating heavy machinery until response is known.
  • Use proper technique when administering eye drops.

Special Considerations

Black Box Warnings:

  • None specified.

Genetic Factors: No specific genetic considerations.

Lab Test Interference: None known.

Overdose Management

Signs/Symptoms: Nausea, vomiting, increased salivation, abdominal cramps, diarrhea, hypotension, bronchospasm.

Treatment: Discontinue drug immediately. Provide supportive care, including atropine for cholinergic symptoms, and monitor vital signs.

Storage and Handling

Storage: Store at room temperature, away from light and moisture.

Stability: Stable under recommended conditions for shelf life.

This guide is for educational purposes only and is not intended for clinical use.