II. Indications

  1. Open Angle Glaucoma second line agent (adjunctive)
    1. Pilocarpine is the most common Cholinergic Agent used in Open Angle Glaucoma
  2. Presbyopia
    1. Pilocarpine (Vuity) gained Presbyopia indication in Presbyopia in 2022

III. Contraindications

  1. Ocular inflammation

IV. Mechanism

  1. Intraocular Parasympathomimetic (Intraocular Cholinergic) results in Miosis (Pupil Constriction)
  2. Reduces resistance to aqueous outflow (decreases IOP 20 to 30%)

V. Dosing

  1. Pilocarpine, as with other Intraocular Cholinergics has a green cap
  2. Do not insert Contact Lenses within 15 minutes of applying drops
  3. Glaucoma
    1. Available in 1%, 2%, 4% solutions (15 ml bottles)
    2. Pilocarpine (Isoptocarpine, Pilopine gel, Ocusert, Pilocar) 1 drop three to four times daily
  4. Presbyopia
    1. Pilocarpine (Vuity) 1.25% apply 1 drop each eye once daily
      1. Costs $80/month for a 2.5 ml eyedropper in 2023
      2. Contrast with generic Pilocarpine 1% and 2% drops at $30/month
    2. Onset of action within 15 minutes and duration of 6 hours
    3. Improves near Vision by 3 lines on handheld Snellen Chart without loss of distance Vision

VI. Adverse Effects

  1. See Intraocular Parasympathomimetic
  2. Reduced night Vision (due to Miosis)
  3. Headache
  4. Darker Vision or blurry Vision may occur
    1. Caution when operating machinery or vehicles
  5. Retinal Detachment (rare)
    1. Retinal Exam is recommended by the manufacturer before starting medication

VII. Safety

  1. Pregnancy Category C
  2. Compatible with Lactation

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Related Studies

Cost: Medications

pilocar (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
PILOCARPINE 1% EYE DROPS Generic $3.88 per ml
PILOCARPINE 2% EYE DROPS Generic $3.55 per ml
PILOCARPINE 4% EYE DROPS Generic $3.54 per ml
PILOCARPINE HCL 5 MG TABLET Generic $0.25 each
PILOCARPINE HCL 7.5 MG TABLET Generic $0.62 each
vuity (on 6/7/2023 at Medicaid.Gov Survey of pharmacy drug pricing)
VUITY 1.25% EYE DROP $28.19 per ml