Beta Blockers
Severe
Database
Additive bradycardia/conduction effects
Monitor heart rate; caution
Source: Kimi deep-research + Cla
Drug reference
Pilocarpine
Cholinergic (muscarinic) agonist · Miotics, Sialagogues, Glaucoma agents
Also known as Pilocarpine Hydrochloride, Pilocarpine Nitrate, Salagen, Isopto Carpine, Pilocar
START
Ophthalmic 1–2% 1 drop up to QID; oral xerostomia 5 mg PO 3–4×/day
TYPICAL MAX
Oral ~30 mg/day; ophthalmic per regimen
STOP IF
Bronchospasm, severe bradycardia/hypotension, cholinergic crisis, retinal detachment
WATCH
Respiratory (asthma/COPD), heart rate, sweating/cholinergic symptoms, vision/retina in at-risk eyes
CDSCO approvedSchedule HATC S01EB01
KDIGO 2024 + manufacturer label
- ONSET
- 20min · effect onset
- PEAK
- 1h · peak effect
- t½
- 1h · plasma t½
- DURATION
- 4h · effect duration
EXCRETION
Esterase inactivation; renal
route + CYP
INTERACTIONS
2 major
SEVERE in our sources
PREGNANCY
Use only if clearly needed — limited data
FDA category + note
Top interactionssee all 5 →
- Beta BlockersSevereDatabaseKimi deep-research + Cla
- SiponimodSevereDatabaseDDInter
Available in India
15 branded formulations and 2 fixed-dose combinations. Look up specific brands in the Drugs workspace.
Mechanism
Directly stimulates muscarinic receptors — ocular: ciliary muscle contraction (accommodation) and pupillary sphincter contraction (miosis) opening the trabecular meshwork (lowers IOP); systemic (oral): stimulates exocrine glands (saliva).
Indications
Open-angle glaucoma; acute angle-closure glaucoma (emergency miosis)Reversal of mydriasis; presbyopia (low-dose ophthalmic)Xerostomia (Sjögren syndrome, post head-and-neck radiation — oral)
Dosing
- Adult
- Ophthalmic 1–2% : 1 drop up to 4×/day (acute angle-closure more frequent initially). Oral xerostomia: 5 mg PO 3–4×/day (radiation); Sjögren 5 mg QID; presbyopia drop once daily.
- Pediatric
- Ophthalmic per specialist.
- Renal adjustment
- No specific adjustment.
- Hepatic adjustment
- Moderate hepatic impairment: reduce oral dose (e.g. 5 mg BID).
- Geriatric
- Cautious; cardiac/respiratory comorbidity.
- Max dose
- Oral ~30 mg/day (xerostomia); ophthalmic per regimen
Pharmacokinetics
Onset
Ocular miosis 10–30 min; salivary effect ~20 min (oral)
Peak effect
Ocular IOP ~75 min; oral ~1 h
Duration
Ocular 4–8 h; oral ~3–5 h
Half-life
Oral ~0.8–1.3 h (dose-dependent)
Bioavailability
Oral well absorbed; ocular topical
Protein binding
Low
Metabolism
Inactivation at neuronal synapses/plasma (esterase); hepatic
Excretion
Renal
Contraindications
- Acute iritis/anterior uveitis (ocular)
- Uncontrolled asthma/COPD (bronchospasm)
- Acute heart failure / significant bradyarrhythmia
- Narrow-angle where pupillary block would worsen (specific scenarios)
- Hypersensitivity to pilocarpine
Side effects
Common
Sweating (oral — prominent)Ocular: brow ache, blurred/dim vision, miosisIncreased salivation, nauseaRhinitis, urinary frequency
Serious
- Bronchospasm/pulmonary oedema (asthma/COPD)
- Severe bradycardia/AV block, hypotension
- Retinal detachment (predisposed eyes, ocular)
- Cholinergic crisis (overdose)
Pregnancy & lactation
Pregnancy
Use only if clearly needed — limited data
Lactation
Unknown excretion; caution (oral); ophthalmic minimal systemic
Drug interactions
Siponimod
Severe
Database
Clinical effect not specified
Source: DDInter
Anticholinergics
Moderate
Database
Mutual antagonism — reduced efficacy of both
Avoid concurrent; counsel
Source: Kimi deep-research + Cla
Drugs Causing Bronchospasm
Moderate
Database
Additive airway effects
Avoid in uncontrolled asthma/COPD
Source: Kimi deep-research + Cla
Other Cholinergics
Moderate
Database
Additive cholinergic toxicity
Avoid combination; monitor
Source: Kimi deep-research + Cla
7 additional low-confidence interactions hidden — those rows lack a documented mechanism or management plan in our sources.
Related guidelines
Ask House about Pilocarpine
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Katzung, BNF·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19