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

Pregnancy Category: C Lactation: Excretion in breast milk unknown; use with caution

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

Cholinergic parasympathomimetic with predominant muscarinic action; increases secretion of exocrine glands (sweat, lacrimal, salivary, intestinal, pancreatic glands, and mucous cells of the respiratory tract may be stimulated. Tone and mobility of gallbladder, biliary duct, and urinary tract may be increased Pilocarpine directly stimulates cholinergic receptors in the eyes causing pupillary constriction, spasm of accommodation and a transient rise in IOP followed by a fall.