Drug Detail:Pilocarpine hydrochloride (monograph) (Salagen)
Drug Class:
Usual Adult Dose for Intraocular Hypertension
Reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension: One drop of 1%, 2%, or 4% solution applied in the eye(s) up to four times a day
Comments:
- Patients who are naive to this drug should be started on the 1% concentration.
- The frequency of instillation and concentration of this drug is determined by the severity of the elevated intraocular pressure and miotic response of the patient.
- Patients may be instructed to perform punctal occlusion for 2 minutes after instillation to limit systemic exposure to this drug.
- This drug may be used in combination with beta-blockers, carbonic anhydrase inhibitors, sympathomimetics, or hyperosmotic agents.
- If more than one topical ophthalmic drug is being used, the drugs should be administered at least 5 minutes apart.
Prevention of Postoperative Elevated IOP Associated with Laser Surgery: One drop of the 1%, 2%, or 4% solution (or two drops administered five minutes apart) should be applied in the eye(s) 15 to 60 minutes prior to surgery
Comments:
- This drug may be used in combination with beta-blockers, carbonic anhydrase inhibitors, sympathomimetics or hyperosmotic agents.
- If more than one topical ophthalmic drug is being used, the drugs should be administered at least 5 minutes apart.
Usual Adult Dose for Glaucoma (Open Angle)
Reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension: One drop of 1%, 2%, or 4% solution applied in the eye(s) up to four times a day
Comments:
- Patients who are naive to this drug should be started on the 1% concentration.
- The frequency of instillation and concentration of this drug is determined by the severity of the elevated intraocular pressure and miotic response of the patient.
- Patients may be instructed to perform punctal occlusion for 2 minutes after instillation to limit systemic exposure to this drug.
- This drug may be used in combination with beta-blockers, carbonic anhydrase inhibitors, sympathomimetics, or hyperosmotic agents.
- If more than one topical ophthalmic drug is being used, the drugs should be administered at least 5 minutes apart.
Prevention of Postoperative Elevated IOP Associated with Laser Surgery: One drop of the 1%, 2%, or 4% solution (or two drops administered five minutes apart) should be applied in the eye(s) 15 to 60 minutes prior to surgery
Comments:
- This drug may be used in combination with beta-blockers, carbonic anhydrase inhibitors, sympathomimetics or hyperosmotic agents.
- If more than one topical ophthalmic drug is being used, the drugs should be administered at least 5 minutes apart.
Usual Adult Dose for Glaucoma (Narrow Angle)
One drop of the 1% or 2% solution applied in the eye(s) up to three times over a 30-minute period
Comments:
- Prior to use, treatment with secretory suppressants and hyperosmotic agents may be needed to lower IOP below 50 mmHg and relieve iris ischemia.
- If laser iridoplasty or iridomy is used to break the attack, one drop of the 4% solution should be administered prior to the procedure.
- Following laser iridoplasty, one drop of the 1% solution should be administered four times daily until an iridotomy can be performed.
- This drug may be used in combination with beta-blockers, carbonic anhydrase inhibitors, sympathomimetics or hyperosmotic agents.
- If more than one topical ophthalmic drug is being used, the drugs should be administered at least 5 minutes apart.
Use: Management of Acute Angle-Closure Glaucoma
Usual Adult Dose for Production of Miosis
One drop of 1%, 2%, or 4% solution (or two drops administered five minutes apart) should be applied in the eye(s)
Comments:
- This drug may be used in combination with beta-blockers, carbonic anhydrase inhibitors, sympathomimetics or hyperosmotic agents.
- If more than one topical ophthalmic drug is being used, the drugs should be administered at least 5 minutes apart.
Use: Induction of Miosis
Usual Pediatric Dose for Glaucoma
Under 2 years:
One drop of 1% solution should be applied in the eye(s) three times a day
2 years or older:
Reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension: One drop of 1%, 2% or 4% solution applied in the eye(s) up to four times a day
Management of Acute Angle-Closure Glaucoma: One drop of the 1% or 2% solution applied in the eye(s) up to three times over a 30-minute period
Prevention of Postoperative Elevated IOP Associated with Laser Surgery: One drop of the 1%, 2% or 4% solution (or two drops administered five minutes apart) should be applied in the eye(s) 15 to 60 minutes prior to surgery
Comments:
- Patients who are naive to this drug should be started on the 1% concentration.
- The frequency of instillation and concentration of this drug is determined by the severity of the elevated intraocular pressure and miotic response of the patient.
- This drug may be used in combination with beta-blockers, carbonic anhydrase inhibitors, sympathomimetics or hyperosmotic agents.
- If more than one topical ophthalmic drug is being used, the drugs should be administered at least 5 minutes apart.
- Prior to use, treatment with secretory suppressants and hyperosmotic agents may be needed to lower IOP below 50 mmHg and relieve iris ischemia.
- If laser iridoplasty or iridomy is used to break the attack, one drop of the 4% solution should be administered prior to the procedure.
- Following laser iridoplasty, one drop of the 1% solution should be administered four times daily until an iridotomy can be performed.
Uses:
- Reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension
- Management of acute angle-closure glaucoma
- Prevention of postoperative elevated IOP associated with laser surgery
- Induction of miosis
Usual Pediatric Dose for Intraocular Hypertension
Under 2 years:
One drop of 1% solution should be applied in the eye(s) three times a day
2 years or older:
Reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension: One drop of 1%, 2% or 4% solution applied in the eye(s) up to four times a day
Management of Acute Angle-Closure Glaucoma: One drop of the 1% or 2% solution applied in the eye(s) up to three times over a 30-minute period
Prevention of Postoperative Elevated IOP Associated with Laser Surgery: One drop of the 1%, 2% or 4% solution (or two drops administered five minutes apart) should be applied in the eye(s) 15 to 60 minutes prior to surgery
Comments:
- Patients who are naive to this drug should be started on the 1% concentration.
- The frequency of instillation and concentration of this drug is determined by the severity of the elevated intraocular pressure and miotic response of the patient.
- This drug may be used in combination with beta-blockers, carbonic anhydrase inhibitors, sympathomimetics or hyperosmotic agents.
- If more than one topical ophthalmic drug is being used, the drugs should be administered at least 5 minutes apart.
- Prior to use, treatment with secretory suppressants and hyperosmotic agents may be needed to lower IOP below 50 mmHg and relieve iris ischemia.
- If laser iridoplasty or iridomy is used to break the attack, one drop of the 4% solution should be administered prior to the procedure.
- Following laser iridoplasty, one drop of the 1% solution should be administered four times daily until an iridotomy can be performed.
Uses:
- Reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension
- Management of acute angle-closure glaucoma
- Prevention of postoperative elevated IOP associated with laser surgery
- Induction of miosis
Usual Pediatric Dose for Production of Miosis
Under 2 years:
One drop of 1% solution should be applied in the eye(s) three times a day
2 years or older:
Reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension: One drop of 1%, 2% or 4% solution applied in the eye(s) up to four times a day
Management of Acute Angle-Closure Glaucoma: One drop of the 1% or 2% solution applied in the eye(s) up to three times over a 30-minute period
Prevention of Postoperative Elevated IOP Associated with Laser Surgery: One drop of the 1%, 2% or 4% solution (or two drops administered five minutes apart) should be applied in the eye(s) 15 to 60 minutes prior to surgery
Comments:
- Patients who are naive to this drug should be started on the 1% concentration.
- The frequency of instillation and concentration of this drug is determined by the severity of the elevated intraocular pressure and miotic response of the patient.
- This drug may be used in combination with beta-blockers, carbonic anhydrase inhibitors, sympathomimetics or hyperosmotic agents.
- If more than one topical ophthalmic drug is being used, the drugs should be administered at least 5 minutes apart.
- Prior to use, treatment with secretory suppressants and hyperosmotic agents may be needed to lower IOP below 50 mmHg and relieve iris ischemia.
- If laser iridoplasty or iridomy is used to break the attack, one drop of the 4% solution should be administered prior to the procedure.
- Following laser iridoplasty, one drop of the 1% solution should be administered four times daily until an iridotomy can be performed.
Uses:
- Reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension
- Management of acute angle-closure glaucoma
- Prevention of postoperative elevated IOP associated with laser surgery
- Induction of miosis
Renal Dose Adjustments
Data not available
Liver Dose Adjustments
Data not available
Dialysis
Data not available
Other Comments
Patient advice:
- Patients should be instructed to wash their hands before use and avoid allowing the tip of the bottle to come into contact with the eye or surrounding structures.
- Systemic absorption of drugs from ophthalmic solutions may be minimized by
Storage requirements:
- Do not freeze
- Protect from light
- Pilocarpine nitrate: Store between 2 C to 8 C ( 36 F to 46 F)
