pilocarpine ophthalmic (Rx)

Brand and Other Names:Isopto Carpine, Vuity
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

ophthalmic solution

  • 1% (Isopto Carpine; generic)
  • 1.25% (Vuity)
  • 2% (Isopto Carpine; generic)
  • 4% (Isopto Carpine; generic)

Open-Angle Glaucoma or Ocular Hypertension Intraocular Pressure

Indicated for reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension

1%, 2%, or 4% solution: Apply 1-2 gtt up to q6hr; adjust concentration and frequency as necessary to control IOP

Pilocarpine-naïve patients: Initiate with 1% concentration as higher concentrations are often not tolerated

Acute Angle-Closure Glaucoma

Prior to pilocarpine ophthalmic, treatment with secretory suppressants and hyperosmotic agents may be needed to lower IOP to <50 mmHg and relieve iris ischemia

Initial (1% or 2% solution): Instill 1 gtt to affected eye(s) up to 3 times over 30 minutes

If laser iridoplasty or iridomy is used to break the attack, 1 gtt of 4% solution should be administered before procedure

Following laser iridoplasty (1% solution): 1 gtt to affected eye(s) QID until an iridotomy can be performed

Postoperative Elevated IOP

Indicated for prevention of postoperative elevated IOP associated with laser surgery

1%, 2%, or 4% solution: Instill 1-2 gtt to eye(s) 15-60 minutes before surgery

If 2 drops administered, instill 5 minutes apart

Miosis Induction

1%, 2%, or 4% solution: Instill 1-2 gtt to eye(s)

If 2 drops administered, instill 5 minutes apart

Presbyopia

Vuity only

Indicated for the treatment of presbyopia in adults

1.25% solution: Instill 1 gtt in each eye qDay

Dosage Forms & Strengths

ophthalmic solution

  • 1% (Isopto Carpine; generic)
  • 2% (Isopto Carpine; generic)

Primary Congenital Glaucoma

For the induction of miosis before goniotomy or trabeculotomy

<2 years: Instill 1 gtt TID of 1% ophthalmic solution

≥2 years: Instil 1 gtt 15-60 minutes before surgery of 1% or 2% ophthalmic solution

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Adverse Effects

1-10%

≥5%

  • Isopto Carpine
    • Headache/brow ache
    • Accommodative change
    • Blurred vision
    • Eye irritation
    • Visual impairment (dim, dark, or “jumping” vision)
    • Eye pain
  • Vuity
    • Headache
    • Conjunctival hyperemia

1-5% (Vuity)

  • Blurred vision
  • Eye pain
  • Visual impairment
  • Eye irritation
  • Increased lacrimation
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Warnings

Contraindications

Hypersensitivity to drug or component

Cautions

Advised caution if driving at night and other hazardous occupations in poor illumination; miotics may cause accommodative spasm; caution patient not to drive or use machinery if vision is not clear

Miotics may cause rare cases of retinal detachment when used in certain susceptible individuals and those with preexisting retinal disease; thorough examination of the retina including funduscopy advised in all patients before initiating

Do not use when iritis is present

Blurred vision

  • Miotics, including this medication, may cause accommodative spasm; patients should be advised not to drive or operate machinery if vision is not clear (eg, blurred vision)
  • In addition, patients may experience temporary dim or dark vision with miotics, including this medication; patients should be advised to exercise caution in night driving and other hazardous activities in poor illumination

Risk of retinal detachment

  • Rare cases of retinal detachment and retinal tear have been reported with miotics, including this medication
  • Individuals with pre-existing retinal disease are at increased risk; examination of the retina including funduscopy is advised in all patients prior to initiation of therapy
  • Patients should be advised to seek immediate medical care with sudden onset of flashing lights, floaters, or vision loss

Pediatric use

  • Caution advised with use in pediatric patients with primary congenital glaucoma for control of IOP as cases of a paradoxical increase in IOP have been reported
  • Not recommended in pediatric patients diagnosed with glaucoma secondary to anterior segment dysgenesis or uveitis (especially if uveitis is active)
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Pregnancy & Lactation

Pregnancy

No adequate and well-controlled trials have been conducted in pregnant women

In a retrospective case series of 15 women with glaucoma, 4 patients used ophthalmic pilocarpine either prepregnancy, during pregnancy, or postpartum; there were no adverse effects observed in patients or in their infants

Animal studies

  • Oral administration to pregnant rats throughout organogenesis and lactation did not produce adverse effects at clinically relevant doses

Lactation

Unknown if excreted in human milk

Pilocarpine and/or its metabolites are excreted in the milk of lactating rats

Systemic levels of pilocarpine following topical ocular administration are low and it is not known whether measurable levels would be present in maternal milk following topical ocular administration

Pregnancy Categories

A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA: Information not available.

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Pharmacology

Mechanism of Action

The drug acts through direct stimulation of muscarinic receptors and smooth muscle including the iris and secretory glands. Contracts the ciliary muscle, causing increased tension on scleral spur and opening of trabecular meshwork spaces to facilitate outflow of aqueous humor; outflow resistance is reduced, lowering intraocular pressure (IOP).

Also produces miosis through contraction of iris sphincter muscle; miosis relieves appositional angle narrowing and closure, which lowers IOP in certain types of angle-closure glaucoma

Absorption

Isopto Carpine Day 8; 4% QID

  • Peak plasma time: 0.5-1 hr
  • Peak plasma concentration: 3.7 ng/mL
  • AUC: 7.7 ng⋅hr/mL

Vuity Day 30; once daily

  • Peak plasma time: 0.3 hr
  • Peak plasma concentration: 1.95 ng/mL
  • AUC: 4.14 ng⋅hr/mL
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Administration

Ophthalmic Administration

For topical ophthalmic use only

Avoid touching dispensing bottle to the eye or to any other surface to prevent eye injury or contamination

Contact lens wearers: Remove lenses before instillation of drops; wait 10 minutes after dose administration before reinserting contact lenses

Use with other topical ophthalmic medication

  • May be used in combination with beta-blockers, carbonic anhydrase inhibitors, sympathomimetics, or hyperosmotic agents
  • Administered ophthalmic drops at least 5 minutes apart

Storage

Isopto Carpine: Store at 20-25ºC (68-77ºF), excursions permitted to 15-30ºC (59-86ºF)

Vuity: Store at 15-25ºC (59-77ºF)

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Images

BRAND FORM. UNIT PRICE PILL IMAGE
Isopto Carpine ophthalmic (eye)
-
1 % drops
Isopto Carpine ophthalmic (eye)
-
2 % drops
Isopto Carpine ophthalmic (eye)
-
4 % drops
Salagen (pilocarpine) oral
-
7.5 mg tablet
Salagen (pilocarpine) oral
-
5 mg tablet
Salagen (pilocarpine) oral
-
7.5 mg tablet
pilocarpine ophthalmic (eye)
-
2 % drops
pilocarpine ophthalmic (eye)
-
4 % drops
pilocarpine ophthalmic (eye)
-
1 % drops
pilocarpine ophthalmic (eye)
-
4 % drops
pilocarpine ophthalmic (eye)
-
4 % drops
pilocarpine ophthalmic (eye)
-
2 % drops
pilocarpine ophthalmic (eye)
-
1 % drops
pilocarpine ophthalmic (eye)
-
4 % drops
pilocarpine ophthalmic (eye)
-
2 % drops
pilocarpine ophthalmic (eye)
-
1 % drops
pilocarpine oral
-
5 mg tablet
pilocarpine oral
-
5 mg tablet
pilocarpine oral
-
5 mg tablet
pilocarpine oral
-
5 mg tablet
pilocarpine oral
-
7.5 mg tablet
pilocarpine oral
-
7.5 mg tablet

Copyright © 2010 First DataBank, Inc.

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Patient Handout

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Patient Education
pilocarpine ophthalmic (eye)

PILOCARPINE 1.25% SOLUTION - OPHTHALMIC

(PYE-loe-KAR-peen)

COMMON BRAND NAME(S): Vuity

USES: This medication is used to treat age-related farsightedness (presbyopia). Pilocarpine works by causing the pupil of the eye to shrink, which may help with seeing things up close.

HOW TO USE: Use this medication in the affected eye(s) as directed by your doctor, usually once daily.To apply eye drops, wash your hands first. To avoid contamination, do not touch the dropper tip or let it touch your eye or any other surface.If you are wearing contact lenses, remove them before using eye drops. Wait at least 10 minutes before replacing your contact lenses.Tilt your head back, look upward, and pull down the lower eyelid to make a pouch. Hold the dropper directly over your eye and place one drop into the pouch. Look downward, gently close your eyes, and place one finger at the corner of your eye (near the nose). Apply gentle pressure for 1 to 2 minutes before opening your eyes. This will prevent the medication from draining out. Try not to blink or rub your eye. If directed to use this medication in both eyes, repeat these steps for your other eye. Do not rinse the dropper. Replace the dropper cap after each use.If you are using another kind of eye medication (such as drops or ointments), wait at least 5 minutes before applying other medications. Use eye drops before eye ointments to allow the drops to enter the eye.Use this medication regularly to get the most benefit from it. To help you remember, use it at the same time each day.Tell your doctor if your condition lasts or gets worse.

SIDE EFFECTS: Temporary irritation of the eye, temporary blurred vision, eye redness, poor vision in dim light, or headache may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: eye pain, vision changes (such as seeing floaters/flashes of light).A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

PRECAUTIONS: Before using pilocarpine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: other eye problems (such as iritis, detached retina).After you apply pilocarpine, your vision may become temporarily blurred or unstable. Vision in dim light may be affected. Do not drive (especially at night), use machinery, or do any activity that requires clear vision until you are sure you can perform such activities safely.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.

DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

OVERDOSE: This medicine may be harmful if swallowed. If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: increased saliva or sweating, tremors, slow heartbeat, dizziness.

NOTES: Do not share this medication with others.Lab and/or medical tests (such as eye exams) should be done while you are using this medication. Keep all medical and lab appointments. Consult your doctor for more details.

MISSED DOSE: If you miss a dose, apply it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Use your next dose at the regular time. Do not double the dose to catch up.

STORAGE: Store at room temperature. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

Information last revised August 2022. Copyright(c) 2022 First Databank, Inc.

IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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Tier Description
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Code Definition
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Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.