Indications

Ophthalmic: Treatment of chronic simple glaucoma, chronic angle-closure glaucoma, acute angle-closure glaucoma, pre- and postoperative management of intraocular tension, treatment of mydriasis. PO: Treatment of xerostomia in patients with malfunctioning salivary glands because of radiotherapy for cancer of head and neck, relieve dry mouth in patients with Sjogren syndrome. PO: Relief of dry mouth in patients with graft-vs-host disease.

 Contraindications Hypersensitivity; conditions in which cholinergic effects such as constriction are undesirable. Oral use also contraindicated in uncontrolled asthma, acute iritis, narrow-angle glaucoma, acute inflammatory disease of anterior segment of eye.

 Route/Dosage

Solution

Adults: Instill 1 to 2 drops of 1% or 2% solution in affected eye(s) 6 times or less/day. More concentrated solutions are sometimes used.

Gel

Adults: Apply 0.5-inch ribbon in lower conjunctival sac of affected eye(s) once daily at bedtime.

Ocular Therapeutic System

Adults: Place system into conjunctival cul-de-sac of affected eye(s) at bedtime. Replace each unit q 7 days. PO 5 mg tid; may titrate 10 mg or less tid.

PO

Adults: Titrate dosage based on therapeutic response and tolerance. To reduce the incidence and severity of side effects, use the lowest effective dose. Do not exceed a maximum of 10 mg/dose.

Radiation-induced Xerostomia

Adults: PO 5 mg tid. If no response, increase dose to 10 mg tid. Continue uninterrupted for at least 12 wk before assessing for full therapeutic benefit.

Sjogren Syndrome

Adults: PO 5 mg qid. Continue uninterrupted for at least 6 wk before assessing for full therapeutic benefit.

 Interactions

Anticholinergics: May antagonize action of pilocarpine (PO and ophthalmic). Beta-blockers: Potential for cardiac conduction disturbances with oral pilocarpine. Parasympathomimetics: Additive pharmacologic effects and increased toxicity possible.

 Lab Test Interferences None well documented.

 Adverse Reactions

CARDIOVASCULAR: Transient hypertension; tachycardia; edema; palpitations. CNS: Chills; headache; dizziness; asthenia. DERMATOLOGIC: Excessive sweating; flushing. EENT: Transient stinging and burning, tearing, ciliary spasm, conjunctival vascular congestion, temporal, peri-, or supraorbital headache, superficial keratitis-induced myopia, blurred vision, poor dark adaptation, conjunctival hyperemia, reduced visual acuity in poor illumination, lens opacity, subtle corneal granularity, conjunctival irritation, ciliary spasm, precipitation of angle closure, irritation, corneal abrasion, visual impairment (ophthalmic); rhinitis (PO). GI: Excessive salivation; nausea; vomiting; diarrhea dyspepsia; abdominal pain. GU: Urinary frequency (PO). RESPIRATORY: Bronchiolar spasm; pulmonary edema; rhinitis; sinusitis; pharyngitis; increased coughing; increases airway resistance; bronchial smooth muscle tone; bronchial secretions. SPECIAL SENSES: Lacrimation; amblyopia; conjunctivitis; abnormal vision; excessive salivation.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. CHILDREN: Safety and efficacy not established. Elderly: Elderly patients also may be at increased risk for certain adverse effects during therapy, including diarrhea, urinary frequency, and dizziness. Special risk patients: Use oral pilocarpine with caution in acute cardiac failure, bronchial asthma, peptic ulcer, hypertension, hyperthyroidism, retinal disease, GI or biliary tract spasm or obstruction, urinary tract obstruction, Parkinson disease, angina pectoris, MI, chronic bronchitis, chronic obstructive pulmonary disease, underlying psychiatric disorders.

 Administration/Storage

PO

• Administer PO.
• Administration with a high-fat meal reduces pilocarpine absorption.
• Store at room temperature.
• Give medication with food if GI distress occurs.

Optic

• To avoid contamination, do not touch tip of container to any surface. Replace cap after administration. Gently apply pressure over nasolacrimal drainage system (bridge of nose) for 1 to 2 min.
• Keep bottle tightly closed when not in use.
• Wash hands before and after using.
• Keep out of reach of children.

Solution

• Store at room temperature and protect from light.

Gel

• Refrigerate until time of dispensation. Do not freeze.
• Ocular Therapeutic System is a small device that releases pilocarpine through a membrane when placed in the cul-de-sac of the eye.
• Wash hands with soap and water before touching or manipulating system.
• Read and follow directions on package insert.
• Check for presence of system at end and beginning of each shift.
• If displaced system contacts unclean surfaces, rinse with cool tap water before replacing. Discard contaminated systems and replace with fresh unit.
• Refrigerate; do not freeze.
• Place system into eye at bedtime. If keeping unit in eye is problem, move unit from lower to upper lid by gentle lid massage. If unit slips out during night, its effects continue for period of time similar to that following instillation of eyedrops.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• During early treatment of adult glaucoma, perform hourly tonometric tests to monitor for transitory increase in IOP.
• Use health care provider- or manufacturer-recommended technique for patient application with contact lenses.
• Monitor for changes in vision, which could indicate potential retinal detachment.

PO

• May cause increased sweating, resulting in dehydration.

 Patient/Family Education

• For treatment of glaucoma, emphasize need to adhere to medical regimen to prevent blindness.
• Explain that long-term therapy may be required.
• Instruct patient to wash hands thoroughly before and after using ophthalmic preparation.
• Review proper procedure for administration of ophthalmic preparations.
• Explain that ophthalmic preparations may sting upon instillation, especially with first few doses.
• Tell patient to discard solution after expiration date.
• Explain that medication may cause headache or browache and that because of blurring, altered distance vision and night vision; patient should use caution while night driving or performing hazardous tasks.
• Explain that during acute phases, a miotic (agent that causes pupil to constrict) also must be instilled into unaffected eye to prevent occurrence of angle-closure glaucoma.
• Tell patients using Ocular Therapeutic System that signs of irritation, including mild redness with or without slight increase in mucus secretion may be noticed with first use but that these symptoms tend to lessen or disappear after first wk of therapy.
• Instruct patient to check for placement of system before retiring and on arising.

PO

• Advise patients to drink additional water or noncaffeinated fluids during therapy.
• Tell patients using oral form to report the following symptoms to health care provider: sweating, nausea, nasal congestion, chills, flushing, frequent urination, dizziness, weakness, headache, indigestion, tearing, diarrhea, fluid retention.

Indications for Drugs ::

 Action Ophthalmic: Decreases IOP by constricting pupil and stimulating ciliary muscles to open trabecular meshwork spaces and facilitate outflow of aqueous humor. PO: Stimulates exocrine glands including mucous cells of respiratory tract and salivary glands in oral cavity.

 Indications

Ophthalmic: Treatment of chronic simple glaucoma, chronic angle-closure glaucoma, acute angle-closure glaucoma, pre- and postoperative management of intraocular tension, treatment of mydriasis. PO: Treatment of xerostomia in patients with malfunctioning salivary glands because of radiotherapy for cancer of head and neck, relieve dry mouth in patients with Sjogren syndrome. PO: Relief of dry mouth in patients with graft-vs-host disease.

 Contraindications Hypersensitivity; conditions in which cholinergic effects such as constriction are undesirable. Oral use also contraindicated in uncontrolled asthma, acute iritis, narrow-angle glaucoma, acute inflammatory disease of anterior segment of eye.

 Route/Dosage

Solution

Adults: Instill 1 to 2 drops of 1% or 2% solution in affected eye(s) 6 times or less/day. More concentrated solutions are sometimes used.

Gel

Adults: Apply 0.5-inch ribbon in lower conjunctival sac of affected eye(s) once daily at bedtime.

Ocular Therapeutic System

Adults: Place system into conjunctival cul-de-sac of affected eye(s) at bedtime. Replace each unit q 7 days. PO 5 mg tid; may titrate 10 mg or less tid.

PO

Adults: Titrate dosage based on therapeutic response and tolerance. To reduce the incidence and severity of side effects, use the lowest effective dose. Do not exceed a maximum of 10 mg/dose.

Radiation-induced Xerostomia

Adults: PO 5 mg tid. If no response, increase dose to 10 mg tid. Continue uninterrupted for at least 12 wk before assessing for full therapeutic benefit.

Sjogren Syndrome

Adults: PO 5 mg qid. Continue uninterrupted for at least 6 wk before assessing for full therapeutic benefit.

 Interactions

Anticholinergics: May antagonize action of pilocarpine (PO and ophthalmic). Beta-blockers: Potential for cardiac conduction disturbances with oral pilocarpine. Parasympathomimetics: Additive pharmacologic effects and increased toxicity possible.

 Lab Test Interferences None well documented.

 Adverse Reactions

CARDIOVASCULAR: Transient hypertension; tachycardia; edema; palpitations. CNS: Chills; headache; dizziness; asthenia. DERMATOLOGIC: Excessive sweating; flushing. EENT: Transient stinging and burning, tearing, ciliary spasm, conjunctival vascular congestion, temporal, peri-, or supraorbital headache, superficial keratitis-induced myopia, blurred vision, poor dark adaptation, conjunctival hyperemia, reduced visual acuity in poor illumination, lens opacity, subtle corneal granularity, conjunctival irritation, ciliary spasm, precipitation of angle closure, irritation, corneal abrasion, visual impairment (ophthalmic); rhinitis (PO). GI: Excessive salivation; nausea; vomiting; diarrhea dyspepsia; abdominal pain. GU: Urinary frequency (PO). RESPIRATORY: Bronchiolar spasm; pulmonary edema; rhinitis; sinusitis; pharyngitis; increased coughing; increases airway resistance; bronchial smooth muscle tone; bronchial secretions. SPECIAL SENSES: Lacrimation; amblyopia; conjunctivitis; abnormal vision; excessive salivation.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. CHILDREN: Safety and efficacy not established. Elderly: Elderly patients also may be at increased risk for certain adverse effects during therapy, including diarrhea, urinary frequency, and dizziness. Special risk patients: Use oral pilocarpine with caution in acute cardiac failure, bronchial asthma, peptic ulcer, hypertension, hyperthyroidism, retinal disease, GI or biliary tract spasm or obstruction, urinary tract obstruction, Parkinson disease, angina pectoris, MI, chronic bronchitis, chronic obstructive pulmonary disease, underlying psychiatric disorders.

 Administration/Storage

PO

• Administer PO.
• Administration with a high-fat meal reduces pilocarpine absorption.
• Store at room temperature.
• Give medication with food if GI distress occurs.

Optic

• To avoid contamination, do not touch tip of container to any surface. Replace cap after administration. Gently apply pressure over nasolacrimal drainage system (bridge of nose) for 1 to 2 min.
• Keep bottle tightly closed when not in use.
• Wash hands before and after using.
• Keep out of reach of children.

Solution

• Store at room temperature and protect from light.

Gel

• Refrigerate until time of dispensation. Do not freeze.
• Ocular Therapeutic System is a small device that releases pilocarpine through a membrane when placed in the cul-de-sac of the eye.
• Wash hands with soap and water before touching or manipulating system.
• Read and follow directions on package insert.
• Check for presence of system at end and beginning of each shift.
• If displaced system contacts unclean surfaces, rinse with cool tap water before replacing. Discard contaminated systems and replace with fresh unit.
• Refrigerate; do not freeze.
• Place system into eye at bedtime. If keeping unit in eye is problem, move unit from lower to upper lid by gentle lid massage. If unit slips out during night, its effects continue for period of time similar to that following instillation of eyedrops.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• During early treatment of adult glaucoma, perform hourly tonometric tests to monitor for transitory increase in IOP.
• Use health care provider- or manufacturer-recommended technique for patient application with contact lenses.
• Monitor for changes in vision, which could indicate potential retinal detachment.

PO

• May cause increased sweating, resulting in dehydration.

 Patient/Family Education

• For treatment of glaucoma, emphasize need to adhere to medical regimen to prevent blindness.
• Explain that long-term therapy may be required.
• Instruct patient to wash hands thoroughly before and after using ophthalmic preparation.
• Review proper procedure for administration of ophthalmic preparations.
• Explain that ophthalmic preparations may sting upon instillation, especially with first few doses.
• Tell patient to discard solution after expiration date.
• Explain that medication may cause headache or browache and that because of blurring, altered distance vision and night vision; patient should use caution while night driving or performing hazardous tasks.
• Explain that during acute phases, a miotic (agent that causes pupil to constrict) also must be instilled into unaffected eye to prevent occurrence of angle-closure glaucoma.
• Tell patients using Ocular Therapeutic System that signs of irritation, including mild redness with or without slight increase in mucus secretion may be noticed with first use but that these symptoms tend to lessen or disappear after first wk of therapy.
• Instruct patient to check for placement of system before retiring and on arising.

PO

• Advise patients to drink additional water or noncaffeinated fluids during therapy.
• Tell patients using oral form to report the following symptoms to health care provider: sweating, nausea, nasal congestion, chills, flushing, frequent urination, dizziness, weakness, headache, indigestion, tearing, diarrhea, fluid retention.

Drug Dose ::

 Action Ophthalmic: Decreases IOP by constricting pupil and stimulating ciliary muscles to open trabecular meshwork spaces and facilitate outflow of aqueous humor. PO: Stimulates exocrine glands including mucous cells of respiratory tract and salivary glands in oral cavity.

 Indications

Ophthalmic: Treatment of chronic simple glaucoma, chronic angle-closure glaucoma, acute angle-closure glaucoma, pre- and postoperative management of intraocular tension, treatment of mydriasis. PO: Treatment of xerostomia in patients with malfunctioning salivary glands because of radiotherapy for cancer of head and neck, relieve dry mouth in patients with Sjogren syndrome. PO: Relief of dry mouth in patients with graft-vs-host disease.

 Contraindications Hypersensitivity; conditions in which cholinergic effects such as constriction are undesirable. Oral use also contraindicated in uncontrolled asthma, acute iritis, narrow-angle glaucoma, acute inflammatory disease of anterior segment of eye.

 Route/Dosage

Solution

Adults: Instill 1 to 2 drops of 1% or 2% solution in affected eye(s) 6 times or less/day. More concentrated solutions are sometimes used.

Gel

Adults: Apply 0.5-inch ribbon in lower conjunctival sac of affected eye(s) once daily at bedtime.

Ocular Therapeutic System

Adults: Place system into conjunctival cul-de-sac of affected eye(s) at bedtime. Replace each unit q 7 days. PO 5 mg tid; may titrate 10 mg or less tid.

PO

Adults: Titrate dosage based on therapeutic response and tolerance. To reduce the incidence and severity of side effects, use the lowest effective dose. Do not exceed a maximum of 10 mg/dose.

Radiation-induced Xerostomia

Adults: PO 5 mg tid. If no response, increase dose to 10 mg tid. Continue uninterrupted for at least 12 wk before assessing for full therapeutic benefit.

Sjogren Syndrome

Adults: PO 5 mg qid. Continue uninterrupted for at least 6 wk before assessing for full therapeutic benefit.

 Interactions

Anticholinergics: May antagonize action of pilocarpine (PO and ophthalmic). Beta-blockers: Potential for cardiac conduction disturbances with oral pilocarpine. Parasympathomimetics: Additive pharmacologic effects and increased toxicity possible.

 Lab Test Interferences None well documented.

 Adverse Reactions

CARDIOVASCULAR: Transient hypertension; tachycardia; edema; palpitations. CNS: Chills; headache; dizziness; asthenia. DERMATOLOGIC: Excessive sweating; flushing. EENT: Transient stinging and burning, tearing, ciliary spasm, conjunctival vascular congestion, temporal, peri-, or supraorbital headache, superficial keratitis-induced myopia, blurred vision, poor dark adaptation, conjunctival hyperemia, reduced visual acuity in poor illumination, lens opacity, subtle corneal granularity, conjunctival irritation, ciliary spasm, precipitation of angle closure, irritation, corneal abrasion, visual impairment (ophthalmic); rhinitis (PO). GI: Excessive salivation; nausea; vomiting; diarrhea dyspepsia; abdominal pain. GU: Urinary frequency (PO). RESPIRATORY: Bronchiolar spasm; pulmonary edema; rhinitis; sinusitis; pharyngitis; increased coughing; increases airway resistance; bronchial smooth muscle tone; bronchial secretions. SPECIAL SENSES: Lacrimation; amblyopia; conjunctivitis; abnormal vision; excessive salivation.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. CHILDREN: Safety and efficacy not established. Elderly: Elderly patients also may be at increased risk for certain adverse effects during therapy, including diarrhea, urinary frequency, and dizziness. Special risk patients: Use oral pilocarpine with caution in acute cardiac failure, bronchial asthma, peptic ulcer, hypertension, hyperthyroidism, retinal disease, GI or biliary tract spasm or obstruction, urinary tract obstruction, Parkinson disease, angina pectoris, MI, chronic bronchitis, chronic obstructive pulmonary disease, underlying psychiatric disorders.

 Administration/Storage

PO

• Administer PO.
• Administration with a high-fat meal reduces pilocarpine absorption.
• Store at room temperature.
• Give medication with food if GI distress occurs.

Optic

• To avoid contamination, do not touch tip of container to any surface. Replace cap after administration. Gently apply pressure over nasolacrimal drainage system (bridge of nose) for 1 to 2 min.
• Keep bottle tightly closed when not in use.
• Wash hands before and after using.
• Keep out of reach of children.

Solution

• Store at room temperature and protect from light.

Gel

• Refrigerate until time of dispensation. Do not freeze.
• Ocular Therapeutic System is a small device that releases pilocarpine through a membrane when placed in the cul-de-sac of the eye.
• Wash hands with soap and water before touching or manipulating system.
• Read and follow directions on package insert.
• Check for presence of system at end and beginning of each shift.
• If displaced system contacts unclean surfaces, rinse with cool tap water before replacing. Discard contaminated systems and replace with fresh unit.
• Refrigerate; do not freeze.
• Place system into eye at bedtime. If keeping unit in eye is problem, move unit from lower to upper lid by gentle lid massage. If unit slips out during night, its effects continue for period of time similar to that following instillation of eyedrops.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• During early treatment of adult glaucoma, perform hourly tonometric tests to monitor for transitory increase in IOP.
• Use health care provider- or manufacturer-recommended technique for patient application with contact lenses.
• Monitor for changes in vision, which could indicate potential retinal detachment.

PO

• May cause increased sweating, resulting in dehydration.

 Patient/Family Education

• For treatment of glaucoma, emphasize need to adhere to medical regimen to prevent blindness.
• Explain that long-term therapy may be required.
• Instruct patient to wash hands thoroughly before and after using ophthalmic preparation.
• Review proper procedure for administration of ophthalmic preparations.
• Explain that ophthalmic preparations may sting upon instillation, especially with first few doses.
• Tell patient to discard solution after expiration date.
• Explain that medication may cause headache or browache and that because of blurring, altered distance vision and night vision; patient should use caution while night driving or performing hazardous tasks.
• Explain that during acute phases, a miotic (agent that causes pupil to constrict) also must be instilled into unaffected eye to prevent occurrence of angle-closure glaucoma.
• Tell patients using Ocular Therapeutic System that signs of irritation, including mild redness with or without slight increase in mucus secretion may be noticed with first use but that these symptoms tend to lessen or disappear after first wk of therapy.
• Instruct patient to check for placement of system before retiring and on arising.

PO

• Advise patients to drink additional water or noncaffeinated fluids during therapy.
• Tell patients using oral form to report the following symptoms to health care provider: sweating, nausea, nasal congestion, chills, flushing, frequent urination, dizziness, weakness, headache, indigestion, tearing, diarrhea, fluid retention.

Contraindication ::

 Action Ophthalmic: Decreases IOP by constricting pupil and stimulating ciliary muscles to open trabecular meshwork spaces and facilitate outflow of aqueous humor. PO: Stimulates exocrine glands including mucous cells of respiratory tract and salivary glands in oral cavity.

 Indications

Ophthalmic: Treatment of chronic simple glaucoma, chronic angle-closure glaucoma, acute angle-closure glaucoma, pre- and postoperative management of intraocular tension, treatment of mydriasis. PO: Treatment of xerostomia in patients with malfunctioning salivary glands because of radiotherapy for cancer of head and neck, relieve dry mouth in patients with Sjogren syndrome. PO: Relief of dry mouth in patients with graft-vs-host disease.

 Contraindications Hypersensitivity; conditions in which cholinergic effects such as constriction are undesirable. Oral use also contraindicated in uncontrolled asthma, acute iritis, narrow-angle glaucoma, acute inflammatory disease of anterior segment of eye.

 Route/Dosage

Solution

Adults: Instill 1 to 2 drops of 1% or 2% solution in affected eye(s) 6 times or less/day. More concentrated solutions are sometimes used.

Gel

Adults: Apply 0.5-inch ribbon in lower conjunctival sac of affected eye(s) once daily at bedtime.

Ocular Therapeutic System

Adults: Place system into conjunctival cul-de-sac of affected eye(s) at bedtime. Replace each unit q 7 days. PO 5 mg tid; may titrate 10 mg or less tid.

PO

Adults: Titrate dosage based on therapeutic response and tolerance. To reduce the incidence and severity of side effects, use the lowest effective dose. Do not exceed a maximum of 10 mg/dose.

Radiation-induced Xerostomia

Adults: PO 5 mg tid. If no response, increase dose to 10 mg tid. Continue uninterrupted for at least 12 wk before assessing for full therapeutic benefit.

Sjogren Syndrome

Adults: PO 5 mg qid. Continue uninterrupted for at least 6 wk before assessing for full therapeutic benefit.

 Interactions

Anticholinergics: May antagonize action of pilocarpine (PO and ophthalmic). Beta-blockers: Potential for cardiac conduction disturbances with oral pilocarpine. Parasympathomimetics: Additive pharmacologic effects and increased toxicity possible.

 Lab Test Interferences None well documented.

 Adverse Reactions

CARDIOVASCULAR: Transient hypertension; tachycardia; edema; palpitations. CNS: Chills; headache; dizziness; asthenia. DERMATOLOGIC: Excessive sweating; flushing. EENT: Transient stinging and burning, tearing, ciliary spasm, conjunctival vascular congestion, temporal, peri-, or supraorbital headache, superficial keratitis-induced myopia, blurred vision, poor dark adaptation, conjunctival hyperemia, reduced visual acuity in poor illumination, lens opacity, subtle corneal granularity, conjunctival irritation, ciliary spasm, precipitation of angle closure, irritation, corneal abrasion, visual impairment (ophthalmic); rhinitis (PO). GI: Excessive salivation; nausea; vomiting; diarrhea dyspepsia; abdominal pain. GU: Urinary frequency (PO). RESPIRATORY: Bronchiolar spasm; pulmonary edema; rhinitis; sinusitis; pharyngitis; increased coughing; increases airway resistance; bronchial smooth muscle tone; bronchial secretions. SPECIAL SENSES: Lacrimation; amblyopia; conjunctivitis; abnormal vision; excessive salivation.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. CHILDREN: Safety and efficacy not established. Elderly: Elderly patients also may be at increased risk for certain adverse effects during therapy, including diarrhea, urinary frequency, and dizziness. Special risk patients: Use oral pilocarpine with caution in acute cardiac failure, bronchial asthma, peptic ulcer, hypertension, hyperthyroidism, retinal disease, GI or biliary tract spasm or obstruction, urinary tract obstruction, Parkinson disease, angina pectoris, MI, chronic bronchitis, chronic obstructive pulmonary disease, underlying psychiatric disorders.

 Administration/Storage

PO

• Administer PO.
• Administration with a high-fat meal reduces pilocarpine absorption.
• Store at room temperature.
• Give medication with food if GI distress occurs.

Optic

• To avoid contamination, do not touch tip of container to any surface. Replace cap after administration. Gently apply pressure over nasolacrimal drainage system (bridge of nose) for 1 to 2 min.
• Keep bottle tightly closed when not in use.
• Wash hands before and after using.
• Keep out of reach of children.

Solution

• Store at room temperature and protect from light.

Gel

• Refrigerate until time of dispensation. Do not freeze.
• Ocular Therapeutic System is a small device that releases pilocarpine through a membrane when placed in the cul-de-sac of the eye.
• Wash hands with soap and water before touching or manipulating system.
• Read and follow directions on package insert.
• Check for presence of system at end and beginning of each shift.
• If displaced system contacts unclean surfaces, rinse with cool tap water before replacing. Discard contaminated systems and replace with fresh unit.
• Refrigerate; do not freeze.
• Place system into eye at bedtime. If keeping unit in eye is problem, move unit from lower to upper lid by gentle lid massage. If unit slips out during night, its effects continue for period of time similar to that following instillation of eyedrops.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• During early treatment of adult glaucoma, perform hourly tonometric tests to monitor for transitory increase in IOP.
• Use health care provider- or manufacturer-recommended technique for patient application with contact lenses.
• Monitor for changes in vision, which could indicate potential retinal detachment.

PO

• May cause increased sweating, resulting in dehydration.

 Patient/Family Education

• For treatment of glaucoma, emphasize need to adhere to medical regimen to prevent blindness.
• Explain that long-term therapy may be required.
• Instruct patient to wash hands thoroughly before and after using ophthalmic preparation.
• Review proper procedure for administration of ophthalmic preparations.
• Explain that ophthalmic preparations may sting upon instillation, especially with first few doses.
• Tell patient to discard solution after expiration date.
• Explain that medication may cause headache or browache and that because of blurring, altered distance vision and night vision; patient should use caution while night driving or performing hazardous tasks.
• Explain that during acute phases, a miotic (agent that causes pupil to constrict) also must be instilled into unaffected eye to prevent occurrence of angle-closure glaucoma.
• Tell patients using Ocular Therapeutic System that signs of irritation, including mild redness with or without slight increase in mucus secretion may be noticed with first use but that these symptoms tend to lessen or disappear after first wk of therapy.
• Instruct patient to check for placement of system before retiring and on arising.

PO

• Advise patients to drink additional water or noncaffeinated fluids during therapy.
• Tell patients using oral form to report the following symptoms to health care provider: sweating, nausea, nasal congestion, chills, flushing, frequent urination, dizziness, weakness, headache, indigestion, tearing, diarrhea, fluid retention.

Drug Precautions ::

 Action Ophthalmic: Decreases IOP by constricting pupil and stimulating ciliary muscles to open trabecular meshwork spaces and facilitate outflow of aqueous humor. PO: Stimulates exocrine glands including mucous cells of respiratory tract and salivary glands in oral cavity.

 Indications

Ophthalmic: Treatment of chronic simple glaucoma, chronic angle-closure glaucoma, acute angle-closure glaucoma, pre- and postoperative management of intraocular tension, treatment of mydriasis. PO: Treatment of xerostomia in patients with malfunctioning salivary glands because of radiotherapy for cancer of head and neck, relieve dry mouth in patients with Sjogren syndrome. PO: Relief of dry mouth in patients with graft-vs-host disease.

 Contraindications Hypersensitivity; conditions in which cholinergic effects such as constriction are undesirable. Oral use also contraindicated in uncontrolled asthma, acute iritis, narrow-angle glaucoma, acute inflammatory disease of anterior segment of eye.

 Route/Dosage

Solution

Adults: Instill 1 to 2 drops of 1% or 2% solution in affected eye(s) 6 times or less/day. More concentrated solutions are sometimes used.

Gel

Adults: Apply 0.5-inch ribbon in lower conjunctival sac of affected eye(s) once daily at bedtime.

Ocular Therapeutic System

Adults: Place system into conjunctival cul-de-sac of affected eye(s) at bedtime. Replace each unit q 7 days. PO 5 mg tid; may titrate 10 mg or less tid.

PO

Adults: Titrate dosage based on therapeutic response and tolerance. To reduce the incidence and severity of side effects, use the lowest effective dose. Do not exceed a maximum of 10 mg/dose.

Radiation-induced Xerostomia

Adults: PO 5 mg tid. If no response, increase dose to 10 mg tid. Continue uninterrupted for at least 12 wk before assessing for full therapeutic benefit.

Sjogren Syndrome

Adults: PO 5 mg qid. Continue uninterrupted for at least 6 wk before assessing for full therapeutic benefit.

 Interactions

Anticholinergics: May antagonize action of pilocarpine (PO and ophthalmic). Beta-blockers: Potential for cardiac conduction disturbances with oral pilocarpine. Parasympathomimetics: Additive pharmacologic effects and increased toxicity possible.

 Lab Test Interferences None well documented.

 Adverse Reactions

CARDIOVASCULAR: Transient hypertension; tachycardia; edema; palpitations. CNS: Chills; headache; dizziness; asthenia. DERMATOLOGIC: Excessive sweating; flushing. EENT: Transient stinging and burning, tearing, ciliary spasm, conjunctival vascular congestion, temporal, peri-, or supraorbital headache, superficial keratitis-induced myopia, blurred vision, poor dark adaptation, conjunctival hyperemia, reduced visual acuity in poor illumination, lens opacity, subtle corneal granularity, conjunctival irritation, ciliary spasm, precipitation of angle closure, irritation, corneal abrasion, visual impairment (ophthalmic); rhinitis (PO). GI: Excessive salivation; nausea; vomiting; diarrhea dyspepsia; abdominal pain. GU: Urinary frequency (PO). RESPIRATORY: Bronchiolar spasm; pulmonary edema; rhinitis; sinusitis; pharyngitis; increased coughing; increases airway resistance; bronchial smooth muscle tone; bronchial secretions. SPECIAL SENSES: Lacrimation; amblyopia; conjunctivitis; abnormal vision; excessive salivation.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. CHILDREN: Safety and efficacy not established. Elderly: Elderly patients also may be at increased risk for certain adverse effects during therapy, including diarrhea, urinary frequency, and dizziness. Special risk patients: Use oral pilocarpine with caution in acute cardiac failure, bronchial asthma, peptic ulcer, hypertension, hyperthyroidism, retinal disease, GI or biliary tract spasm or obstruction, urinary tract obstruction, Parkinson disease, angina pectoris, MI, chronic bronchitis, chronic obstructive pulmonary disease, underlying psychiatric disorders.

 Administration/Storage

PO

• Administer PO.
• Administration with a high-fat meal reduces pilocarpine absorption.
• Store at room temperature.
• Give medication with food if GI distress occurs.

Optic

• To avoid contamination, do not touch tip of container to any surface. Replace cap after administration. Gently apply pressure over nasolacrimal drainage system (bridge of nose) for 1 to 2 min.
• Keep bottle tightly closed when not in use.
• Wash hands before and after using.
• Keep out of reach of children.

Solution

• Store at room temperature and protect from light.

Gel

• Refrigerate until time of dispensation. Do not freeze.
• Ocular Therapeutic System is a small device that releases pilocarpine through a membrane when placed in the cul-de-sac of the eye.
• Wash hands with soap and water before touching or manipulating system.
• Read and follow directions on package insert.
• Check for presence of system at end and beginning of each shift.
• If displaced system contacts unclean surfaces, rinse with cool tap water before replacing. Discard contaminated systems and replace with fresh unit.
• Refrigerate; do not freeze.
• Place system into eye at bedtime. If keeping unit in eye is problem, move unit from lower to upper lid by gentle lid massage. If unit slips out during night, its effects continue for period of time similar to that following instillation of eyedrops.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• During early treatment of adult glaucoma, perform hourly tonometric tests to monitor for transitory increase in IOP.
• Use health care provider- or manufacturer-recommended technique for patient application with contact lenses.
• Monitor for changes in vision, which could indicate potential retinal detachment.

PO

• May cause increased sweating, resulting in dehydration.

 Patient/Family Education

• For treatment of glaucoma, emphasize need to adhere to medical regimen to prevent blindness.
• Explain that long-term therapy may be required.
• Instruct patient to wash hands thoroughly before and after using ophthalmic preparation.
• Review proper procedure for administration of ophthalmic preparations.
• Explain that ophthalmic preparations may sting upon instillation, especially with first few doses.
• Tell patient to discard solution after expiration date.
• Explain that medication may cause headache or browache and that because of blurring, altered distance vision and night vision; patient should use caution while night driving or performing hazardous tasks.
• Explain that during acute phases, a miotic (agent that causes pupil to constrict) also must be instilled into unaffected eye to prevent occurrence of angle-closure glaucoma.
• Tell patients using Ocular Therapeutic System that signs of irritation, including mild redness with or without slight increase in mucus secretion may be noticed with first use but that these symptoms tend to lessen or disappear after first wk of therapy.
• Instruct patient to check for placement of system before retiring and on arising.

PO

• Advise patients to drink additional water or noncaffeinated fluids during therapy.
• Tell patients using oral form to report the following symptoms to health care provider: sweating, nausea, nasal congestion, chills, flushing, frequent urination, dizziness, weakness, headache, indigestion, tearing, diarrhea, fluid retention.

Drug Side Effects ::

 Action Ophthalmic: Decreases IOP by constricting pupil and stimulating ciliary muscles to open trabecular meshwork spaces and facilitate outflow of aqueous humor. PO: Stimulates exocrine glands including mucous cells of respiratory tract and salivary glands in oral cavity.

 Indications

Ophthalmic: Treatment of chronic simple glaucoma, chronic angle-closure glaucoma, acute angle-closure glaucoma, pre- and postoperative management of intraocular tension, treatment of mydriasis. PO: Treatment of xerostomia in patients with malfunctioning salivary glands because of radiotherapy for cancer of head and neck, relieve dry mouth in patients with Sjogren syndrome. PO: Relief of dry mouth in patients with graft-vs-host disease.

 Contraindications Hypersensitivity; conditions in which cholinergic effects such as constriction are undesirable. Oral use also contraindicated in uncontrolled asthma, acute iritis, narrow-angle glaucoma, acute inflammatory disease of anterior segment of eye.

 Route/Dosage

Solution

Adults: Instill 1 to 2 drops of 1% or 2% solution in affected eye(s) 6 times or less/day. More concentrated solutions are sometimes used.

Gel

Adults: Apply 0.5-inch ribbon in lower conjunctival sac of affected eye(s) once daily at bedtime.

Ocular Therapeutic System

Adults: Place system into conjunctival cul-de-sac of affected eye(s) at bedtime. Replace each unit q 7 days. PO 5 mg tid; may titrate 10 mg or less tid.

PO

Adults: Titrate dosage based on therapeutic response and tolerance. To reduce the incidence and severity of side effects, use the lowest effective dose. Do not exceed a maximum of 10 mg/dose.

Radiation-induced Xerostomia

Adults: PO 5 mg tid. If no response, increase dose to 10 mg tid. Continue uninterrupted for at least 12 wk before assessing for full therapeutic benefit.

Sjogren Syndrome

Adults: PO 5 mg qid. Continue uninterrupted for at least 6 wk before assessing for full therapeutic benefit.

 Interactions

Anticholinergics: May antagonize action of pilocarpine (PO and ophthalmic). Beta-blockers: Potential for cardiac conduction disturbances with oral pilocarpine. Parasympathomimetics: Additive pharmacologic effects and increased toxicity possible.

 Lab Test Interferences None well documented.

 Adverse Reactions

CARDIOVASCULAR: Transient hypertension; tachycardia; edema; palpitations. CNS: Chills; headache; dizziness; asthenia. DERMATOLOGIC: Excessive sweating; flushing. EENT: Transient stinging and burning, tearing, ciliary spasm, conjunctival vascular congestion, temporal, peri-, or supraorbital headache, superficial keratitis-induced myopia, blurred vision, poor dark adaptation, conjunctival hyperemia, reduced visual acuity in poor illumination, lens opacity, subtle corneal granularity, conjunctival irritation, ciliary spasm, precipitation of angle closure, irritation, corneal abrasion, visual impairment (ophthalmic); rhinitis (PO). GI: Excessive salivation; nausea; vomiting; diarrhea dyspepsia; abdominal pain. GU: Urinary frequency (PO). RESPIRATORY: Bronchiolar spasm; pulmonary edema; rhinitis; sinusitis; pharyngitis; increased coughing; increases airway resistance; bronchial smooth muscle tone; bronchial secretions. SPECIAL SENSES: Lacrimation; amblyopia; conjunctivitis; abnormal vision; excessive salivation.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. CHILDREN: Safety and efficacy not established. Elderly: Elderly patients also may be at increased risk for certain adverse effects during therapy, including diarrhea, urinary frequency, and dizziness. Special risk patients: Use oral pilocarpine with caution in acute cardiac failure, bronchial asthma, peptic ulcer, hypertension, hyperthyroidism, retinal disease, GI or biliary tract spasm or obstruction, urinary tract obstruction, Parkinson disease, angina pectoris, MI, chronic bronchitis, chronic obstructive pulmonary disease, underlying psychiatric disorders.

 Administration/Storage

PO

• Administer PO.
• Administration with a high-fat meal reduces pilocarpine absorption.
• Store at room temperature.
• Give medication with food if GI distress occurs.

Optic

• To avoid contamination, do not touch tip of container to any surface. Replace cap after administration. Gently apply pressure over nasolacrimal drainage system (bridge of nose) for 1 to 2 min.
• Keep bottle tightly closed when not in use.
• Wash hands before and after using.
• Keep out of reach of children.

Solution

• Store at room temperature and protect from light.

Gel

• Refrigerate until time of dispensation. Do not freeze.
• Ocular Therapeutic System is a small device that releases pilocarpine through a membrane when placed in the cul-de-sac of the eye.
• Wash hands with soap and water before touching or manipulating system.
• Read and follow directions on package insert.
• Check for presence of system at end and beginning of each shift.
• If displaced system contacts unclean surfaces, rinse with cool tap water before replacing. Discard contaminated systems and replace with fresh unit.
• Refrigerate; do not freeze.
• Place system into eye at bedtime. If keeping unit in eye is problem, move unit from lower to upper lid by gentle lid massage. If unit slips out during night, its effects continue for period of time similar to that following instillation of eyedrops.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• During early treatment of adult glaucoma, perform hourly tonometric tests to monitor for transitory increase in IOP.
• Use health care provider- or manufacturer-recommended technique for patient application with contact lenses.
• Monitor for changes in vision, which could indicate potential retinal detachment.

PO

• May cause increased sweating, resulting in dehydration.

 Patient/Family Education

• For treatment of glaucoma, emphasize need to adhere to medical regimen to prevent blindness.
• Explain that long-term therapy may be required.
• Instruct patient to wash hands thoroughly before and after using ophthalmic preparation.
• Review proper procedure for administration of ophthalmic preparations.
• Explain that ophthalmic preparations may sting upon instillation, especially with first few doses.
• Tell patient to discard solution after expiration date.
• Explain that medication may cause headache or browache and that because of blurring, altered distance vision and night vision; patient should use caution while night driving or performing hazardous tasks.
• Explain that during acute phases, a miotic (agent that causes pupil to constrict) also must be instilled into unaffected eye to prevent occurrence of angle-closure glaucoma.
• Tell patients using Ocular Therapeutic System that signs of irritation, including mild redness with or without slight increase in mucus secretion may be noticed with first use but that these symptoms tend to lessen or disappear after first wk of therapy.
• Instruct patient to check for placement of system before retiring and on arising.

PO

• Advise patients to drink additional water or noncaffeinated fluids during therapy.
• Tell patients using oral form to report the following symptoms to health care provider: sweating, nausea, nasal congestion, chills, flushing, frequent urination, dizziness, weakness, headache, indigestion, tearing, diarrhea, fluid retention.

Drug Mode of Action ::  

 Action Ophthalmic: Decreases IOP by constricting pupil and stimulating ciliary muscles to open trabecular meshwork spaces and facilitate outflow of aqueous humor. PO: Stimulates exocrine glands including mucous cells of respiratory tract and salivary glands in oral cavity.