Pilocarpine ophthalmic (patient information)

# Why is this medication prescribed
Pilocarpine is used to treat glaucoma, a condition in which increased pressure in the eye can lead to gradual loss of vision. Pilocarpine relieves the symptoms of glaucoma.
This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

# How should this medicine be used
Pilocarpine comes in eyedrops, eye gel, and a controlled-release system (Ocusert Pilo). The eyedrops usually are applied two to four times daily. The gel usually is applied once daily and at bedtime. The controlled-release system is used once a week and should be applied at bedtime. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use pilocarpine exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.
Pilocarpine controls glaucoma, but does not cure it. Continue to use pilocarpine even if you feel well. Do not stop using pilocarpine without talking to your doctor.
To use the eyedrops, follow these steps:
- Wash your hands thoroughly with soap and water.
- Use a mirror or have someone else put the drops in your eye.
- Remove the protective cap. Make sure that the end of the dropper is not chipped or cracked.
- Avoid touching the dropper tip against your eye or anything else.
- Hold the dropper tip down at all times to prevent drops from flowing back into the bottle and contaminating the remaining contents.
- Lie down or tilt your head back.
- Holding the bottle between your thumb and index finger, place the dropper tip as near as possible to your eyelid without touching it.
- Brace the remaining fingers of that hand against your cheek or nose.
- With the index finger of your other hand, pull the lower lid of the eye down to form a pocket.
- Drop the prescribed number of drops into the pocket made by the lower lid and the eye. Placing drops on the surface of the eyeball can cause stinging.
- Close your eye and press lightly against the lower lid with your finger for 2-3 minutes to keep the medication in the eye. Do not blink.
- Replace and tighten the cap right away. Do not wipe or rinse it off.
- Wipe off any excess liquid from your cheek with a clean tissue. Wash your hands again.
To use the eye gel, follow these instructions:
- Wash your hands thoroughly with soap and water.
- Use a mirror or have someone else apply the gel.
- Remove the protective cap. Avoid touching the tip of the tube against your eye or anything else. The gel must be kept clean.
- Tilt your head forward slightly.
- Holding the tube between your thumb and index finger, place the tube as near as possible to your eyelid without touching it.
- Brace the remaining fingers of that hand against your cheek or nose.
- With the index finger of your other hand, pull the lower lid of your eye down to form a pocket.
- Place a small amount of gel into the pocket made by the lower lid and the eye. A 1/2-inch strip of gel usually is enough unless otherwise directed by your doctor.
- Gently close your eyes and keep them closed for 1-2 minutes to allow the medication to be absorbed.
- Replace and tighten the cap right away.
- Wipe off any excess gel from your eyelids and lashes with a clean tissue. Wash your hands again.
To use the controlled-release system:
- Wash your hands thoroughly with soap and water before handling it.
- Follow the written patient instructions, and place the system in your eye at bedtime.
- Place the system either in the pocket formed at the lower part of the eye by the lower eyelid and eyeball or, preferably, at the upper part of the eye under the upper eyelid. (It is less likely to come out when placed at the upper part of the eye.)
- The system is to stay in your eye for 7 days. If it comes out, rinse it with cool tap water and replace it in your eye. *Discard the system if it is damaged or contaminated, and insert a new one.
- To prevent the system from coming out at night, work the system from the lower part of your eye to the upper part (under the upper eyelid) by gently pressing it (with a clean finger) through your closed eyelid at bedtime.
- Check to be sure that the system is in place each night when you go to bed and when you wake up. If one becomes lost, you can either replace it or replace the systems in both eyes so that both eyes are on the same replacement schedule.

# What special precautions should I follow
Before using pilocarpine eyedrops
- tell your doctor and pharmacist if you are allergic to pilocarpine or any other drugs.
- tell your doctor and pharmacist what prescription and nonprescription medications you are taking, including vitamins.
- tell your doctor if you have or have ever had asthma, intestinal disease, ulcers, high blood pressure, heart disease, an overactive thyroid gland, seizures, Parkinson's disease, or an obstruction in the urinary tract.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using pilocarpine, call your doctor immediately.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are using pilocarpine.
- if you are using another eyedrop medication, use the eye medications at least 10 minutes apart.

# What should I do if I forget a dose
Apply the missed drops or gel as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule.
Do not apply a double dose to make up for a missed one.

# Side effects

## Mild side effects
Pilocarpine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- blurred or dim vision
- stinging, burning, or discomfort in the eye
- itching or redness of the eye
- tearing or swelling of the eye
- redness of the eyelids
- headache

## Severe side effects
If you experience any of the following symptoms, call your doctor immediately:
- sweating
- muscle tremors
- upset stomach
- vomiting
- diarrhea
- difficulty breathing
- watering of the mouth
- dizziness
- weakness
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online  or by phone .

# What storage conditions are needed for this medicine
Keep the drops and gel in the container they came in, tightly closed, and out of reach of children. Store them at room temperature and away from excess heat and moisture (not in the bathroom). Store the controlled-release system in the refrigerator. Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

# What other information should I know
Keep all appointments with your doctor. Your doctor will order certain eye tests to check your response to pilocarpine.
Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription.

# Brand names
- Adsorbocarpine
- Akarpine
- Isopto Carpine
- Ocu-Carpine
- Ocusert Pilo
- Pilagan Liquifilm
- Pilocar
- Pilopine HS

# Brand names of combination products
- E-Pilo-1 containing Pilocarpine Hydrochloride and Epinephrine Bitartrate
- E-Pilo-2 containing Pilocarpine Hydrochloride and Epinephrine Bitartrate
- E-Pilo-4 containing Pilocarpine Hydrochloride and Epinephrine Bitartrate
- E-Pilo-6 containing Pilocarpine Hydrochloride and Epinephrine Bitartrate
- P1E1 containing Pilocarpine Hydrochloride and Epinephrine Bitartrate
- P2E1 containing Pilocarpine Hydrochloride and Epinephrine Bitartrate
- P3E1 containing Pilocarpine Hydrochloride and Epinephrine Bitartrate
- P4E1 containing Pilocarpine Hydrochloride and Epinephrine Bitartrate
- P6E1 containing Pilocarpine Hydrochloride and Epinephrine Bitartrate