pilocarpine hydrochloride at a glance
Medicine class
Direct-acting muscarinic agonist and parasympathomimetic.
Licensed roles
Selected products cover certain glaucoma and pupil-constriction uses, post-radiotherapy dry mouth, and dry mouth or eyes in Sjögren’s syndrome.
Form matters
Oral tablets and eye drops have different uses, precautions and administration methods; they are not interchangeable.
Driving and vision
Blurred vision, altered depth perception and difficulty seeing in poor light can occur; do not drive if affected.
What is pilocarpine hydrochloride used for?
Selected products are licensed for different indications according to formulation.
Tablets: relief of severe dry mouth caused by reduced salivary-gland function after irradiation for head and neck cancer.
Tablets: treatment of dry mouth and dry-eye symptoms in Sjögren’s syndrome.
Eye drops: chronic simple glaucoma.
Eye drops: acute closed-angle glaucoma, alone or with other treatment, to reduce pressure inside the eye before surgery.
Eye drops: producing miosis to reverse the effects of pupil-dilating or cycloplegic drops.
How does pilocarpine hydrochloride work?
Pilocarpine directly stimulates muscarinic acetylcholine receptors. It increases secretion from glands including salivary, tear and sweat glands. In the eye, it contracts muscles that constrict the pupil and widens drainage spaces so fluid can leave the eye more readily.
pilocarpine hydrochloride preparations and strengths
Eye drops
Route: Ophthalmic
Strengths: 1.0% w/v, 2.0% w/v, 4.0% w/v
Tablet
Route: Oral
Strengths: 5 mg
How to take pilocarpine hydrochloride
Use only the formulation prescribed and follow its label. Tablets are swallowed with a glass of water; meal-related instructions differ according to the condition treated. For eye drops, wash your hands, avoid touching the nozzle, place the drop into the lower-lid pocket, close the eye and press gently at the inner corner to reduce drainage into the body.
Do not wear soft contact lenses with the selected preserved eye drops.
Keep hydrated if oral treatment causes substantial sweating.
Do not drive or use machinery if dizziness, blurred vision or poor low-light vision occurs.
pilocarpine hydrochloride side effects
Common or expected effects
- Sweating, headache and needing to pass urine more often with tablets
- Dizziness, flushing or palpitations
- Nausea, indigestion, abdominal discomfort, diarrhoea or vomiting
- Increased saliva or tears
- Blurred or abnormal vision and eye discomfort
- With eye drops: brow ache, headache, stinging, itching, ciliary spasm and poorer vision in dim light
Get urgent medical advice
- Breathing difficulty or bronchospasm
- Marked changes in heart rate or rhythm, fainting or severe hypotension
- Severe dehydration from excessive sweating
- Confusion, agitation or hallucinations
- Sudden symptoms suggesting retinal detachment
- Severe allergic reaction
pilocarpine hydrochloride in pregnancy
Human pregnancy safety data are inadequate. Oral pilocarpine is not recommended during pregnancy; eye drops should be used only when considered essential. Discuss pregnancy or plans to conceive with the prescriber before treatment.
pilocarpine hydrochloride while breastfeeding
It is unknown whether pilocarpine enters human breast milk, and systemic absorption can occur even from eye drops. The prescriber should assess the need for treatment against the benefits of breastfeeding; do not stop either without advice.
pilocarpine hydrochloride interactions
Interaction relevance depends on whether pilocarpine is taken orally or used in the eye and how much is absorbed systemically.
Beta-blockers
Oral pilocarpine may increase the risk of cardiac conduction disturbances.
Other parasympathomimetics or anticholinesterases
Cholinergic effects, such as sweating, salivation, gastrointestinal effects or slow heart rate, may be increased.
Anticholinergics, including atropine and inhaled ipratropium
Pilocarpine and these medicines may oppose each other’s effects.
Common questions about pilocarpine hydrochloride
Answers are fully visible for fast scanning and source review.
Why is pilocarpine hydrochloride prescribed after head and neck radiotherapy?
Radiotherapy can reduce salivary-gland function. Oral pilocarpine stimulates remaining glandular tissue to increase saliva and relieve severe dry-mouth symptoms.
How does pilocarpine hydrochloride help glaucoma?
It constricts the pupil and contracts the ciliary muscle, helping fluid drain through the trabecular pathway and lowering pressure inside the eye.
Why does pilocarpine hydrochloride cause sweating?
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.