Pilocarpine Hydrochloride 4% Eye prep

Open-angle glaucoma

Ophthalmic Open-angle glaucoma Adult: Apply 1-2 drops into the affected eye/s up to 4 times daily, adjusted according to response.

Safety and efficacy not established

Angle-closure glaucoma; acute iritis, anterior uveitis; hypersensitivity. Pregnancy.

Retinal detachment; corneal or conjunctival damage. Prolonged use may lead to lens opacities. May impair ability to drive or operate machines. Lactation.

Not Classi Pregnancy No adequate and well-controlled trials have been conducted in pregnant women In a retrospective case series of 15 women with glaucoma, 4 patients used ophthalmic pilocarpine either prepregnancy, during pregnancy, or postpartum; there were no adverse effects observed in patients or in their infants Animal studies Oral administration to pregnant rats throughout organogenesis and lactation did not produce adverse effects at clinically relevant doses Lactation Unknown if excreted in human milk Pilocarpine and/or its metabolites are excreted in the milk of lactating rats Systemic levels of pilocarpine following topical ocular administration are low and it is not known whether measurable levels would be present in maternal milk following topical ocular administration

Concomitant admin of 2 miotics may increase risk of toxic reactions. Aminoglycosides, clindamycin, colistin, cyclopropane and halogenated inhalational anaesthetics, quinine, procainamide, lithium and beta-blockers may reduce the efficacy of pilacarpine. Concurrent use with beta-blockers may lead to bradycardia. May prolong the action of suxamethonium. Potentially Fatal: Miotic and ocular hypotensive effect antagonised by anticholinergics. Conduction disturbances with beta-blockers.

1-10% >5% Headache/brow ache Accommodative change Blurred vision Eye irritation Visual impairment (dim, dark, or “jumping” vision) Eye pain

The drug acts through direct stimulation of muscarinic receptors and smooth muscle including the iris and secretory glands. Contracts the ciliary muscle, causing increased tension on scleral spur and opening of trabecular meshwork spaces to facilitate outflow of aqueous humor; outflow resistance is reduced, lowering intraocular pressure (IOP). Also produces miosis through contraction of iris sphincter muscle; miosis relieves appositional angle narrowing and closure, which lowers IOP in certain types of angle-closure glaucoma