Ophthalmic glaucoma agents
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Pilocarpine Ophthalmic Dosage

Drug Detail:Pilocar (Pilocarpine ophthalmic [ pye-loe-kar-peen-off-thal-mik ])

Drug Class: Ophthalmic glaucoma agents

Contents
Uses Warnings Before Taking Dosage Side effects Interactions

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
pressure on the tear-duct immediately after application.

Storage requirements:
  • Do not freeze
  • Protect from light
  • Pilocarpine nitrate: Store between 2 C to 8 C ( 36 F to 46 F)
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