pilocarpine nitrate: clinical use

Prescribing considerations

• Emergency glaucoma use should form part of urgent ophthalmic management and should not delay hospital assessment or definitive treatment.
• Examine the fundus before starting treatment because retinal detachment has occurred in susceptible people and those with pre-existing retinal disease.
• Reduce systemic exposure with lacrimal punctum occlusion, particularly in children, older people and others at increased risk.
• Use caution with acute heart failure, bronchial asthma, peptic ulceration, hypertension, urinary obstruction, Parkinson's disease or corneal abrasion.
• Counsel about accommodation spasm, blurred vision and impaired dark adaptation.

Contraindications and cautions

• Hypersensitivity to pilocarpine nitrate or an excipient
• Conditions where pupillary constriction is undesirable, including acute iritis, anterior uveitis and some secondary glaucomas
• Use of this preparation with soft contact lenses

Monitoring

• For long-term glaucoma treatment, monitor intraocular pressure and visual fields regularly.
• Assess promptly for new flashes, floaters, field loss or other symptoms suggesting retinal detachment or vitreous haemorrhage.
• Watch for systemic cholinergic effects when exposure may be increased.

Clinical pharmacology

Pilocarpine is a direct-acting parasympathomimetic that reproduces the muscarinic, but not nicotinic, actions of acetylcholine. Ocular bioavailability is limited by pre-corneal loss and corneal penetration; binding to ocular pigment may provide gradual release to the muscles.

Formulation and product differences

• The selected Minims formulation is a clear, sterile, preservative-free solution supplied in individually wrapped single-use units.
• Each opened unit must be used immediately and discarded; the only listed excipient is purified water.
• The single-use presentation remains contraindicated for patients wearing soft contact lenses.

Eye drops

Route: Ophthalmic

Strengths: 2% w/v