Pilocarpine is indicated for chronic open-angle glaucoma, acute or chronic narrow-angle glaucoma, suspected glaucoma, and ocular hypertension.

Pilocarpine Hydrochloride directly stimulates cholinergic receptors. It causes contraction of the iris sphincter muscle leading to pupil constriction (miosis), and contraction of the ciliary muscle resulting in increased accommodation. It also reduces intraocular pressure by increasing the outflow and decreasing the inflow of aqueous humor. In chronic open-angle glaucoma, the exact mechanism of pressure reduction is not fully understood, but contraction of the ciliary muscle is believed to open intertrabecular spaces and enhance aqueous humor drainage. It also reduces aqueous humor production. In angle-closure glaucoma, pupil constriction pulls the iris away from the trabecular meshwork, thereby relieving obstruction and improving fluid outflow.

Instill 1 drop 2-4 times daily. To minimize systemic absorption of the active ingredient of the eye drops, pressure should be applied for one minute on the tear duct after application.

Belladonna alkaloids or cyclopentolate used in ophthalmic preparations may reduce the miotic effect of pilocarpine and may counteract its action by producing mydriasis. In some cases, this effect may be used for therapeutic benefit.

• Hypersensitivity to pilocarpine or any of its ingredients, including excipients.
• It should not be used in conditions where pupil constriction is not desirable, such as acute iritis.
• It is also contraindicated in retinal detachment, previous history of retinal detachment, or conditions that increase the risk of retinal detachment.

Common: Temporary blurred vision, eye burning, stinging, redness, watering, reduced night vision, eye irritation, and headache.
Rare: Eye pain, increased sweating, muscle tremors, nausea, vomiting, diarrhea, excessive salivation, breathing difficulty, or wheezing.

Safety during pregnancy has not been fully established. No clear evidence of harm in human pregnancy has been reported. However, ophthalmic pilocarpine can be systemically absorbed, so caution is advised.

If blurred vision or difficulty in near or distant vision occurs, especially at night, caution should be taken during driving or operating machinery in low light. Regular monitoring of intraocular pressure is recommended during treatment.

In case of accidental or intentional overdose, dilution with water or other fluids is the usual management.

Drugs affecting exocrine secretions

Store at room temperature, protected from light. Once opened, the bottle should preferably be used within 4 weeks.