Adult Dosing

Pilopine HS

Elevated IOP

• Apply 1/2 inch ribbon in the lower conjunctival sac of the affected eye(s) qhs

Isopto Carpine

Elevated IOP in Open-Angle Glaucoma or Ocular Hypertension

• Instill 1 gtt (1%, 2% or 4%) in the eye(s) qid
• Start with 1% concentration

Management of Acute Angle-Closure Glaucoma

• Instill 1 gtt (1-2%) in the eye(s) q10 minutes x 3 doses
• Before Laser iridoplasty or iridomy: Instill 1 gtt (4%) prior to procedure
• Following laser iridoplasty: Instill 1 gtt (1%) qid until iridotomy performed

Prevention of postoperative elevated IOP associated with Laser surgery

• Instill 1 gtt (1-4%) in the eye(s) 15-60 minutes prior to surgery

Induction of Miosis

• Instill 1-2 gtt 5 minutes apart (1-4%) in the eye(s)

Pediatric Dosing

Isopto Carpine

Elevated IOP

• Children <2 yrs: Instill 1 gtt (1%) tid
• Children >2 yrs: Instill 1 gtt (1%, 2% or 4%) in the eye(s) qid

Induction of Miosis prior to goniotomy or trabeculotomy

• Instill 1 gtt (1-2%) in the eye(s) 15-60 minutes prior to surgery

Pilopine HS

• Safety and effectiveness in pediatric patients have not been established

• Isopto Carpine
• Reduction of elevated Intraocular Pressure (IOP) in open-angle glaucoma or ocular hypertension
• Management of Acute Angle-Closure Glaucoma
• Prevention of postoperative elevated IOP associated with laser surgery
• Induction of miosis

• Pilopine HS
• Control of intraocular pressure in combination with miotics, beta-blockers, carbonic anhydrase inhibitors, sympathomimetics or hyperosmotic agents

• Hypersensitivity to any of the ingredients of the product

• N/A

Renal Dose Adjustment

• Renal impairment: Dose adjustments not defined

Hepatic Dose Adjustment

• Hepatic adjustment: Dose adjustments not defined

See Supplemental Patient Information

• Miosis induced by pilocarpine causes difficulty in dark adaptation. Hence advise patient to exercise caution in night driving and other hazardous occupations in poor illumination
• Retinal detachment has been reported with pilocarpine therapy. Examine retina through fundoscopy in all the patients, prior to the initiation of therapy, as pilocarpine therapy can cause retinal detachment in certain susceptible individuals and those with pre-existing retinal disease
• Do not use pilocarpine in the presence of iritis
• Cases of a paradoxical increase in IOP have been reported in pediatric patients with primary congenital glaucoma, hence use cautiously in this patient group. Do not use in pediatric patients diagnosed with glaucoma secondary to anterior segment dysgenesis or uveitis

Cautions: Use cautiously in

• Pre-existing retinal disease
• Primary congenital glaucoma

Supplemental Patient Information

• Advise patients to exercise caution when driving at night and performing hazardous occupations in poor light, as pilocarpine can cause visual disturbances
• Patients should be advised to remove contact lenses prior to the instillation of pilocarpine, and after 10 minutes of dosing, reinsert the contact lenses

Pregnancy Category:C

Breastfeeding: Limited information indicates that maternal use of ophthalmic pilocarpine is unlikely to affect the breastfed infant. Monitor the infants for signs of cholinergic excess (diarrhea, lacrimation, and excessive salivation or urination), especially in younger, exclusively breastfed infants when pilocarpine used during breastfeeding. This information is based on LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 14 April 2011). Manufacturer advises caution.

• CNS: Supraorbital or temporal headache
• EENT: Accommodative change, retinal detachment, blurred vision, eye irritation, visual impairment, eye pain, lacrimation, burning or discomfort, ciliary spasm, conjunctival vascular congestion, superficial keratitis, induced myopia, corneal granularity, lens opacity

• Cholinergic parasympathomimetic agent; stimulates muscarinic receptors and smooth muscle such as the iris and secretory glands, produces miosis through contraction of the iris sphincter muscle and opens the trabecular meshwork spaces to facilitate outflow of aqueous humor
• Metabolized at neuronal synapses at neuronal synapses
• Renally excreted
• Half-life: 0.76-1.35 hrs

US Trade Name(s)

• Isopto Carpine
• Pilopine HS

US Availability

Isopto Carpine

• OPTH SOLN: 1%, 2%, 4%

Pilopine HS

• OPTH GEL: 4%

Canadian Trade Name(s)

• Akarpine
• Diocarpine
• Isopto Carpin
• Pilopine HS

Canadian Availability

pilocarpine (generic)

• OPTH SOLN: 1%, 2%, 4%, 6%

pilocarpine nitrate (generic)

• DROPS: 2%

Akarpin, Diocarpine

• OPTH SOLN: 1%, 2%, 4%

Isopto Carpine

• OPTH LIQ: 1%, 2%, 4%

Pilopine HS

• OPTH GEL: 4%

UK Trade Name(s)

• Piogel

UK Availability

pilocarpine (generic)

• DROPS: 1%, 2%, 4%

pilocarpine nitrate (generic)

• DROPS: 2%

Piogel

• OPTH GEL: 4%

Australian Trade Name(s)

• Isopto Carpine

Australian Availability

pilocarpine nitrate (generic)

• DROPS: 1%, 2%, 4%

Isopto Carpine

• DROPS: 1%, 2%, 3%, 4%

Ophthalmic

Ophthalmic Glaucoma Agents

Pricing data from www.DrugStore.com in U.S.A.

• Pilocarpine HCl 4 % SOLN [Bottle] (SANDOZ)
  15 % = $56.99
  45 % = $155.96
• Isopto Carpine 1 % SOLN [Bottle] (ALCON VISION)
  15 % = $44.36
  45 % = $121.1
• Pilopine HS 4 % GEL [Tube] (ALCON VISION)
  4 % = $94.99
  12 % = $275.82
• Isopto Carpine 2 % SOLN [Bottle] (ALCON VISION)
  15 % = $44.37
  45 % = $124.71
• Pilocarpine HCl 1 % SOLN [Bottle] (SANDOZ)
  15 % = $53.99
  30 % = $95.97

Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.