Pilocarpine

· Generic Name: Pilocarpine hydrochloride

· Brand Name: Isopto Carpine, Pilopine HS Gel

· Mechanism of Action: direct acting cholinergic agonist, produces rapid miosis & contraction of the ciliary muscle

· Drug of choice for emergency lowering of IOP (used for both POAG & Closed-angle GLC - reduce pressure before surgery)

· Pilocarpine is a good starting point if B blockers (i.e. Timolol) cannot be prescribed for the patient due to CHF and/or asthma

· Treatment is for life & compliance is extremely important. If dosage is missed, apply immediately. If it's almost time for the next dose, skip the one missed and go back to regular schedule. Do not take two doses at once

· Usual regimen: 1-2 gtt 6x/day depending on the severity of GLC. During severe attacks, medication needs to be applied to both eyes (wait 5-10 min, b/w each eye). The effect usually last for almost 1 day. Store at room temp., tightly closed.

Common Side Effects:
      - cloudy vision, detached retina, headache over the eye, nearsightedness, reduced vision in poor light, spasms of the eyelid, tearing eyes

Rare Side Effects:
      - bronchial spasm, difficulty breathing, diarrhea, nausea, vomiting, excessive sweating & salivation, urinary urgency, decreased BP & bradycardia

· This medication should not be taken if breastfeeding or have any eye condition in which pupils should not be constricted

· No contraindications with other foods/drugs have been reported