II. Indication

  1. Open Angle Glaucoma second line agent (adjunctive)

III. Mechanism

  1. Reduces resistance to aqueous outflow

IV. Medications

  1. Cholinergic Agonists
    1. Pilocarpine (Isoptocarpine, Pilopine gel, Ocusert, Pilocar) 1 drop four times daily
    2. Carbachol (Isopto Carbachol)
  2. Anticholinesterases
    1. Echothiophate (Phospholine Iodide)
    2. Demacarium (Humorsol)

V. Adverse Effects

  1. Generally well tolerated
  2. Pupil Constriction (primary expected effect)
  3. Systemic effects (if absorbed)
    1. Nausea or Vomiting
    2. Diarrhea
    3. Sweating
    4. Tremor
    5. Hypotension
    6. Sinus Bradycardia
    7. Atrioventricular Block

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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