• Pilocarpine

    (pye'' loe kar' peen)

    WHY is this medicine prescribed?

    Pilocarpine is used to treat dry mouth caused by radiotherapy in people with head and neck cancer and to treat dry mouth in people with Sjogren's syndrome (a condition that affects the immune system and causes dryness of certain parts of the body such as the eyes and mouth). Pilocarpine is in a class of medications called cholinergic agonists.It works by increasing the amount of saliva in the mouth.

    HOW should this medicine be used?

    Pilocarpine comes as a tablet to take by mouth. When pilocarpine is used to treat dry mouth caused by radiotherapy in people who have head and neck cancer, it is usually taken three times a day. When pilocarpine is used to treat dry mouth in people who have Sjogren's syndrome, it is usually taken four times a day. Take pilocarpine at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take pilocarpine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
    Your doctor may start you on an average dose of pilocarpine and adjust your dose depending on how well your symptoms are controlled and the side effects you experience. Be sure to tell your doctor how you are feeling during your treatment with pilocarpine.
    Pilocarpine will control your symptoms but will not cure your condition. Continue to take pilocarpine even if you feel well. Do not stop taking pilocarpine without talking to your doctor.

    Are there OTHER USES for this medicine?

    This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

    What SPECIAL PRECAUTIONS should I follow?

    Before taking pilocarpine,
    • tell your doctor and pharmacist if you are allergic to pilocarpine (Pilopine HS, Salagen)or any other medications.
    • tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: ambenonium (Mytelase); antihistamines; atropine (Motofen, in Lomotil, in Lonox); beta blockers such as atenolol (Tenormin), labetalol (Normodyne), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), and propranolol (Inderal); bethanechol (Urecholine); cevimeline (Evoxac); donepezil (Aricept); galantamine (Razadyne); ipratropium (Atrovent, in Combivent, in Duoneb); medications for irritable bowel disease, motion sickness, Parkinson's disease, ulcers, or urinary problems; neostigmine (Prostigmin); physostigmine (Mestinon); rivastigmine (Exelon) and tacrine (Cognex). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
    • tell your doctor if you have asthma, acute iritis (uveitis; swelling and irritation inside the eye), or glaucoma (an eye disease).Your doctor may tell you not to take pilocarpine.
    • tell your doctor if you have or have ever had chronic bronchitis or another type of chronic obstructive pulmonary disease (COPD; a group of lung diseases that includes chronic bronchitis and emphysema); kidney stones; gallstones; mental illness; any condition that affects your ability to think; or gallbladder, heart, or liver disease.
    • tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking pilocarpine, call your doctor.
    • you should know that pilocarpine may cause decreased fertility in men and women. Talk to your doctor before you take pilocarpine if you or your partner would like to become pregnant.
    • if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking pilocarpine.
    • you should know that pilocarpine may cause changes in vision, especially at night, or when there is not enough light. Be careful when driving at night, or when performing dangerous activities in low lighting.
    • you should know that pilocarpine may cause you to sweat a great deal, which can cause dehydration.Be sure to drink plenty of water and call your doctor right away if you are having difficulty drinking enough fluid or if you think you may be dehydrated.

    What SPECIAL DIETARY instructions should I follow?

    Unless your doctor tells you otherwise, continue your normal diet.

    What should I do IF I FORGET to take a dose?

    Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

    What SIDE EFFECTS can this medicine cause?

    Pilocarpine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
    • sweating
    • nausea
    • runny nose
    • diarrhea
    • chills
    • flushing
    • frequent urination
    • dizziness
    • weakness
    • headache
    • vomiting
    • heartburn
    • stomach pain
    • swelling of the arms, hands, feet, ankles, or lower legs
    Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately:
    • changes in vision
    • fast or slow heartbeat
    Pilocarpine may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
    If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/Safety/MedWatch ] or by phone [1-800-332-1088].

    What should I know about STORAGE and DISPOSAL of this medication?

    Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

    What should I do in case of OVERDOSE?

    In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
    Symptoms of overdose may include:
    • headache
    • tearing of eyes
    • difficulty breathing
    • GI spasm
    • confusion
    • uncontrollable shaking of a part of the body

    What OTHER INFORMATION should I know?

    Keep all appointments with your doctor.
    Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.
    It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

    Brand Names

    • Salagen®

    Pilocarpine Ophthalmic

    (pye loe kar' peen)

    WHY is this medicine prescribed?

    Ophthalmic pilocarpine is used to treat glaucoma, a condition in which increased pressure in the eye can lead to gradual loss of vision. Pilocarpine is in a class of medications called miotics. It works by allowing excess fluid to drain from the eye.

    HOW should this medicine be used?

    Ophthalmic pilocarpine comes as a solution (liquid) to instill in the eyes and as an eye gel to apply to the eyes. The eye drops are usually instilled two to four times daily. The gel is usually applied once daily at bedtime. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use pilocarpine eye drops and eye gel exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.
    Pilocarpine eye drops and eye gel control glaucoma but do not cure it. Continue to use pilocarpine eye drops or eye gel even if you feel well. Do not stop using pilocarpine eye drops or eye gel without talking to your doctor.
    To instill the eye drops, follow these steps:
    1. Wash your hands thoroughly with soap and water.
    2. Check the dropper tip to make sure that it is not chipped or cracked.
    3. Avoid touching the dropper tip against your eye or anything else; eye drops and droppers must be kept clean.
    4. While tilting your head back, pull down the lower lid of your eye with your index finger to form a pocket.
    5. Hold the dropper (tip down) with the other hand, as close to the eye as possible without touching it.
    6. Brace the remaining fingers of that hand against your face.
    7. While looking up, gently squeeze the dropper so that a single drop falls into the pocket made by the lower eyelid. Remove your index finger from the lower eyelid.
    8. Close your eye for 2 to 3 minutes and tip your head down as though looking at the floor. Try not to blink or squeeze your eyelids.
    9. Place a finger on the tear duct and apply gentle pressure.
    10. Wipe any excess liquid from your face with a tissue.
    11. If you are to use more than one drop in the same eye, wait at least 5 minutes before instilling the next drop.
    12. Replace and tighten the cap on the dropper bottle. Do not wipe or rinse the dropper tip.
    13. Wash your hands to remove any medication.
    To apply the eye gel, follow these instructions:
    1. Wash your hands thoroughly with soap and water.
    2. Use a mirror or have someone else apply the gel.
    3. Remove the protective cap. Avoid touching the tip of the tube against your eye or anything else. The gel must be kept clean.
    4. Tilt your head forward slightly.
    5. Holding the tube between your thumb and index finger, place the tube as near as possible to your eyelid without touching it.
    6. Brace the remaining fingers of that hand against your cheek or nose.
    7. With the index finger of your other hand, pull the lower lid of your eye down to form a pocket.
    8. Place a small amount of gel into the pocket made by the lower lid and the eye. A 1/2-inch (1.25-centimeter) strip of gel usually is enough unless otherwise directed by your doctor.
    9. Hold your lower eyelid below the lashes and gently pull it outward. As you are pulling, look down and close your eye.
    10. Keep your eye closed for 1 to 2 minutes to allow the medication to be absorbed.
    11. Replace and tighten the cap right away.
    12. Wipe off any excess gel from your eyelids and lashes with a clean tissue. Wash your hands again.

    What SPECIAL PRECAUTIONS should I follow?

    Before using pilocarpine eye drops or eye gel,
    • tell your doctor and pharmacist if you are allergic to pilocarpine or any other drugs.
    • tell your doctor and pharmacist what prescription and nonprescription medications you are taking, including vitamins.
    • tell your doctor if you have or have ever had asthma, intestinal disease, ulcers, high blood pressure, heart disease, an overactive thyroid gland, seizures, Parkinson's disease, or an obstruction in the urinary tract.
    • tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using pilocarpine eye drops or eye gel, call your doctor immediately.
    • if you are having surgery, including dental surgery, tell the doctor or dentist that you are using pilocarpine eye drops or eye gel.
    • if you are using another topical eye medication, instill it at least 10 minutes before or after you instill pilocarpine eye drops.

    What should I do IF I FORGET to take a dose?

    Instill or apply the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not instill or apply a double dose to make up for a missed one.

    What SIDE EFFECTS can this medicine cause?

    Pilocarpine eye drops or eye gel may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
    • blurred or dim vision
    • stinging, burning, or discomfort in the eye
    • itching or redness of the eye
    • tearing or swelling of the eye
    • redness of the eyelids
    • headache
    Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:
    • sweating
    • muscle tremors
    • upset stomach
    • vomiting
    • diarrhea
    • difficulty breathing
    • watering of the mouth
    • dizziness
    • weakness
    If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/Safety/MedWatch ] or by phone [1-800-332-1088].

    What should I know about STORAGE and DISPOSAL of this medication?

    Keep the medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

    What OTHER INFORMATION should I know?

    Keep all appointments with your doctor. Your doctor will order certain eye tests to check your response to pilocarpine eye drops or eye gel.
    Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription.
    It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

    Brand Names

    • Carpine®
    • Pilopine® HS
    • Also available generically
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