PILOCARPINE (Ophthalmic)

Some commonly used brand names are:

In the U.S.?

• Adsorbocarpine
• Akarpine
• Isopto Carpine
• Ocu-Carpine
• Ocusert Pilo-20
• Ocusert Pilo-40
• Pilagan
• Pilocar
• Pilopine HS
• Piloptic-1/2
• Piloptic-1
• Piloptic-2
• Piloptic-3
• Piloptic-4
• Piloptic-6
• Pilostat

In Canada?

• Isopto Carpine
• Minims Pilocarpine
• Miocarpine
• Ocusert Pilo-20
• Ocusert Pilo-40
• Pilopine HS
• Pilostat
• P.V. Carpine Liquifilm
• Spersacarpine

Generic name product may be available in the U.S.

Category

• Antiglaucoma agent, ophthalmic
• Miotic

Description

Pilocarpine (pye-loe-KAR-peen) is used to treat glaucoma and other eye conditions.

This medicine is available only with your doctor's prescription, in thefollowing dosage forms:

Ophthalmic
• Ocular system (eye insert) (U.S. and Canada)
• Ophthalmic gel (eye gel) (U.S. and Canada)
• Ophthalmic solution (eye drops) (U.S. and Canada)

Before Using This Medicine

In deciding to use a medicine,the risks of taking the medicine must be weighed against the good it willdo. This is a decision you and your doctor will make. For pilocarpine, thefollowing should be considered:

Allergies?Tell your doctor if you have ever had any unusual orallergic reaction to pilocarpine. Also tell your health care professionalif you are allergic to any other substances, such as preservatives.

Pregnancy?Ophthalmic pilocarpine may be absorbed into the body.However, studies on effects in pregnancy have not been done in either humansor animals.

Breast-feeding?Ophthalmic pilocarpine may be absorbed into thebody. However, it is not known whether pilocarpine passes into the breastmilk. Although most medicines pass into breast milk in small amounts, manyof them may be used safely while breast-feeding. Mothers who are using thismedicine and who wish to breast-feed should discuss this with their doctor.

Children?Although there is no specific information comparinguse of this medicine in children with use in other age groups, pilocarpineis not expected to cause different side effects or problems in children thanit does in adults.

Older adults?Many medicines have not been studied specificallyin older people. Therefore, it may not be known whether they work exactlythe same way they do in younger adults or if they cause different side effectsor problems in older people. Although there is no specific information comparinguse of pilocarpine in the elderly with use in other age groups, this medicineis not expected to cause different side effects or problems in older peoplethan it does in younger adults.

Other medicines?Although certain medicines should not be usedtogether at all, in other cases two different medicines may be used togethereven if an interaction might occur. In these cases, your doctor may want tochange the dose, or other precautions may be necessary. Tell your health careprofessional if you are using any other prescription or nonprescription (over-the-counter[OTC]) medicine.

Other medical problems?The presence of other medicalproblems may affect the use of pilocarpine. Make sure you tell your doctorif you have any other medical problems, especially:

• Asthma or
• Eye disease or problems (other)?Pilocarpine may make the conditionworse

Proper Use of This Medicine

To use the eye drop form of pilocarpine:

• First, wash your hands. Tilt the head back and, pressing your fingergently on the skin just beneath the lower eyelid, pull the lower eyelid awayfrom the eye to make a space. Drop the medicine into this space. Let go ofthe eyelid and gently close the eyes. Do not blink. Keep the eyes closed andapply pressure to the inner corner of the eye with your finger for 1 or 2minutes to allow the medicine to be absorbed by the eye.
• Immediately after using the eye drops, wash your hands to removeany medicine that may be on them.
• To keep the medicine as germ-free as possible, do not touch the applicatortip to any surface (including the eye). Also, keep the container tightly closed.

To use the eye gel form of pilocarpine:

• First, wash your hands. Tilt the head back and, pressing your fingergently on the skin just beneath the lower eyelid, pull the lower eyelid awayfrom the eye to make a space. Squeeze a thin strip of gel into this space.A 11/2-cm (approximately 1/2-inch) strip of gel is usually enough,unless you have been told by your doctor to use a different amount. Let goof the eyelid and gently close the eyes. Keep the eyes closed for 1 or 2 minutesto allow the medicine to be absorbed by the eye.
• Immediately after using the eye gel, wash your hands to remove anymedicine that may be on them.
• To keep the medicine as germ-free as possible, do not touch the applicatortip to any surface (including the eye). After using the eye gel, wipe thetip of the gel tube with a clean tissue and keep the tube tightly closed.

To use the eye insert form of pilocarpine:

• This medicine usually comes with patient directions. Read them carefullybefore using this medicine.
• If you think this medicine unit may be damaged, do not use it. Ifyou have any questions about this, check with your health care professional.
• If the unit seems to be releasing too much medicine into your eye,remove it and replace with a new unit. If you have any questions about this,check with your doctor.

Use this medicine only as directed. Do not usemore of it and do not use it more often than your doctor ordered. To do somay increase the chance of too much medicine being absorbed into the bodyand the chance of side effects.

Dosing?The dose of ophthalmic pilocarpine will bedifferent for different patients. Follow the doctor'sorders or the directions on the label. The following information includesonly the average doses of ophthalmic pilocarpine. Ifyour dose is different, do not change it unless your doctor tells you to doso.

The number of doses you use each day, the time allowedbetween doses, and the length of time you use the medicine depend on the medicalproblem for which you are using ophthalmic pilocarpine.

• For eye drop dosage form:
  • For chronic glaucoma:
    • Adults and children?One drop one to four times a day.
  • For acute angle-closure glaucoma:
    • Adults and children?One drop every five to ten minutes forthree to six doses. Then one drop every one to three hours until eye pressureis reduced.
• For eye gel dosage form:
  • For glaucoma:
    • Adults and teenagers?Use once a day at bedtime.
    • Children?Use and dose must be determined by your doctor.
• For eye insert dosage form:
  • For glaucoma:
    • Adults and children?Insert one ocular system every seven days.
    • Infants?Use and dose must be determined by your doctor.

Missed dose?

• For patients using the eye drop formof pilocarpine: If you miss a dose of this medicine, use it as soon as possible.However, if it is almost time for your next dose, skip the missed dose andgo back to your regular dosing schedule. Do not double doses.
• For patients using the eye gel form ofpilocarpine: If you miss a dose of this medicine, use it as soon as possible.However, if you do not remember the missed dose until the next day, skip themissed dose and go back to your regular dosing schedule. Do not double doses.
• For patients using the eye insert formof pilocarpine: If you forget to replace the eye insert at the proper time,replace it as soon as possible. Then go back to your regular dosing schedule.

Storage?To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Store the eye system form of this medicine in the refrigerator. However,keep the medicine from freezing.
• Store the 5-gram size of the gel form of this medicine in the refrigerator.Store the 3.5-gram size at room temperature. Also, keep both sizes of thegel form of this medicine from freezing.
• Keep the solution form of this medicine from freezing.
• Do not keep outdated medicine or medicine no longer needed. Be surethat any discarded medicine is out of the reach of children.

Precautions While Using This Medicine

Yourdoctor should check your eye pressure at regular visits.

For patients using the eye drop or gel formof this medicine:

• For a short time after you use this medicine, your vision may beblurred or there may be a change in your near or far vision, especially atnight. Make sure your vision is clear before you drive,use machines, or do anything else that could be dangerous if you are not ableto see well.

For patients using the eye insert form of thismedicine:

• For the first several hours after you insert this unit in the eye,your vision may be blurred or there may be a change in your near or far vision,especially at night. Therefore, insert this unit in the eye at bedtime, unlessotherwise directed by your doctor. If this unit is inserted in the eye atany other time of the day, make sure your vision is clearbefore you drive, use machines, or do anything else that could be dangerousif you are not able to see well.

Side Effects of This Medicine

Along with its needed effects, a medicine may cause some unwanted effects.Although not all of these side effects may occur, if they do occur they mayneed medical attention.

Check with your doctor as soon as possible if any of the following sideeffects occur:

Symptoms of too much medicine being absorbed into the body

Increased sweating; muscle tremors; nausea, vomiting, or diarrhea; troubledbreathing or wheezing; watering of mouth

Less common or rare

Eye pain

Other side effects may occur that usually do not need medicalattention. These side effects may go away during treatment as your body adjuststo the medicine. However, check with your doctor if any of the following sideeffects continue or are bothersome:

More common

Blurred vision or change in near or far vision; decrease in night vision

Less common

Eye irritation; headache or browache

Other side effects notlisted above may also occur in some patients. If you notice any other effects,check with your doctor.