Pilocarpine Hydrochloride

Indications

Pilocarpine Hydrochloride is used for: Dry mouth, Sjogren's syndrome

Adult Dose

Oral Dry mouth after radiotherapy for malignant neoplasms of the head and neck Adult: Initially, 5 mg tid. If necessary, increase dose gradually after 4 wk until adequate response is achieved. Max: 10 mg tid. Hepatic impairment: Reduce dose in moderate to severe cirrhosis. Oral Sjogren's syndrome Adult: For dry eyes and mouth: 5 mg 4 times daily. Max: 30 mg daily. Stop treatment if no improvement after 3 mth. Hepatic impairment: Reduce dose in moderate to severe cirrhosis.

Child Dose

Renal Dose

Administration

May be taken with or without food.

Contra Indications

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

Precautions

CVD, cholelithiasis, biliary tract dz, COPD, chronic bronchitis, concomitant use of beta adrenergic agonist, renal insufficiency, PUD, Parkinson's, hyperthyroidism, urinary tract obstruction Lactation: unknown if drug is distributed into breast milk; use caution

Pregnancy-Lactation

Interactions

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.

Adverse Effects

Side effects of Pilocarpine Hydrochloride : >10% Sweating (29%),Headache (15%),Flushing (8-13%),Chills (3-15%) 1-10% Nervousness (10%),Nausea (6%),Dizziness (>3%),Asthenia (>3%) Frequency Not Defined Confusion,Hypotension,Hypertension,Bradycardia,Tachycardia,Increased airway resistance,Abdominal cramping,Diarrhea,Urinary frequency,Bladder tightness,Decreased visual acuity

Mechanism of Action

Pilocarpine is a tertiary parasympathomimetic that directly stimulates cholinergic receptors in the eyes causing pupillary constriction, spasm of accommodation and a transient rise in IOP followed by a fall.