Pilocarpine Eye Medications: Uses, Side Effects & More

Pilocarpine eye drops are used to treat certain kinds of glaucoma and to prepare the eye before surgery. In 2021, the FDA approved Vuity eye drops to treat age-related changes in vision. 

Pilocarpine is also used orally to treat dry mouth.

Pilocarpine Eye Drops vs. Oral Medication 

Eye drops are used to manage angle-closure glaucoma, most often until surgery is performed. 

Eye drops are also used before eye surgery to constrict the pupil after dilation. This is commonly used in ocular hypertension and primary open-angle glaucoma surgery. 

As an oral medication, pilocarpine tablets are used to treat dry mouth from radiation or Sjögren’s syndrome.

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Brand Names for Pilocarpine

Common brand names for pilocarpine eye solution are Adsorbocarpine, Akarpine, Isopto Carpine, Ocu-Carpine, and Pilocar. Canadian brand names include Minims Pilocarpine 2 and Minims Pilocarpine 4. 

Vuity eye drops are the first eye drops to be approved by the FDA to treat presbyopia, age-related vision, and eye problems. The FDA approved these drops in November 2021.

The common brand name for pilocarpine eye gel is Pilocarpine HS.

The most common brand name for pilocarpine tablets is Salagen.

How to Use Pilocarpine

Eye Drops

Only use pilocarpine eye drops in your eyes. Follow your health care provider’s instructions, and be sure to use good hygiene when applying the eye drops.

• Wash your hands before and after applying the eye solution.
• Apply gentle pressure with your middle finger to the inner corner of your eye.
• Tilt your head slightly back.
• Use your index finger to delicately pull your lower eyelid back.
• Hold this open, forming a pouch for the solution.
• Do not touch the dropper to any part of your eye or hand.
• Squeeze the prescribed number of drops into the pouch.
• Resist blinking for 30 seconds.
• Close your eyes to allow the drops to spread.
• Hold your eyes closed gently for 1 to 2 minutes.
• Do not rub your eyes.

Eye Gel

Use the eye gel according to your prescription’s instructions. Follow these steps to apply the gel:

• Wash your hands before and after using the gel.
• Warm the ointment by holding the tube in your hand for a minute or so.
• Squeeze out a bit of the gel and throw it away, as this first bit can be dry.
• Look up, as you do when applying the eye drops.
• Hold the tube above your eye without touching your eye or hands.
• Squeeze a short section of ointment into your eye pouch.
• Gently close your eyes to help spread the ointment.
• Don’t rub your eyes.

Both the eye drops and eye gel should be sterile and clean. Avoid touching the dropper on your hands, eyes, or other surfaces. Put the cap on tightly. 

Don’t share these medications with anyone else. Also, don’t use the eye drops if they’ve changed color.

Side Effects

Some side effects of pilocarpine are bothersome but don’t require attention from a health care provider. They may include blurry vision and sensitivity to light. 

Additional side effects may include headache, dizziness, and fatigue. If you are concerned about these side effects, contact your doctor.

Serious side effects include burning, itching, and irritating sensations in the eye. Rare side effects include problems with breathing, vomiting, and irregular heartbeat. If you experience serious side effects, contact your doctor right away.

What to Avoid While Using Pilocarpine

Pilocarpine can interact with medications, alcohol, herbs, non-prescription drugs, and supplements. Talk to your doctor about any medications or supplements you are using to confirm they won’t interact negatively with pilocarpine.

Alternatives to Pilocarpine for the Eyes

Medicated eye drops are one of the most common treatments for increased pressure due to angle-closure glaucoma. If you have dry eye disease or have difficulty using eye drops, you may want to seek other treatments.

Other treatment options for glaucoma include laser peripheral iridotomy, MIGS or minimally invasive glaucoma surgery, and surgical trabeculectomy. 

Talk with your health care provider to explore treatment alternatives to pilocarpine. They can recommend a different approach that may work well for your particular situation.

Pilocarpine Eye Medication FAQs

What is the mechanism of action of pilocarpine?

Pilocarpine acts on the muscarinic receptors, a type of receptor that is in almost all the major organs. In the eye, these receptors cause the pupil to get smaller, which opens up drainage channels in the eye. This can help fluid to leave the eye, relieving pressure.

Who should not use pilocarpine?

Pilocarpine may not be advised if you fit these criteria:

• Are taking atropine
• Wear contact lenses 
• Have a history of allergies to pilocarpine, sulfites, and other preservatives
• Are pregnant, trying to get pregnant, or breastfeeding
• Have asthma or bronchitis
• Have heart disease

What are the effects of pilocarpine on the eyes?

Pilocarpine reduces pressure in the eye, making it a popular medicine for some types of glaucoma and when preparing for surgery. It can also make your vision appear blurry. This medication may make you more sensitive to light. 

How should I store pilocarpine eye medication?

Keep the drops or gel at a cool room temperature, away from light, heat, or humidity. Keep the container closed and out of reach from children.

How long does it take for pilocarpine eye medication to start working? 

Studies show that the effects of the drops are typically felt within about an hour. Effects often last six hours or up to a day. 

What should I do if I forget a pilocarpine dose?

If you forget a dose, use the medication as soon as you remember. If you’ve forgotten and it’s time for your next dose, just take that one. Do not take extra doses or double up to make up for forgetting a dose. 

References

1. Topical Pilocarpine for Presbyopia. (May 2022). American Academy of Ophthalmology.

2. Angle-Closure Glaucoma (December 2013). American Academy of Ophthalmology.

3. What Is Ocular Hypertension? American Academy of Ophthalmology.

4. Pilocarpine Ophthalmic. National Library of Medicine.

5. FDA-Approved Eye Drops Target Presbyopia Patients. (November 2014). Ophthalmology Times.

6. Pilocarpine Eye Solution. Cleveland Clinic.

7. Pilocarpine Eye Gel. Cleveland Clinic.

8. Pilocarpine Tablet. Cleveland Clinic.

9. Management of Dry Mouth. John Hopkins Medicine.

10. Pilocarpine Ophthalmic Uses, Side Effects & Warnings. Drugs.com.

11. Pilocarpine Ophthalmic. National Library of Medicine.

12. Pilocarpine, Ophthalmic. Tufts Medical Center Community Care.

13. How to Discuss Alternatives to Eye Drops With Patients. (December 2019). Association of Optometrists.

14. Pilocarpine. StatPearls.