PILOCARPINE IS USED IN THE TREATMENT OF OPEN-ANGLE GLAUCOMA AND IS COMMONLY GIVEN WITH TOPICAL BETA BLOCKERS OR SYMPATHOMIMETICS. IT IS USED AS THE HYDROCHLORIDE OR THE NITRATE, USUALLY AS 0.5 TO 4% EYE DROPS GIVEN UP TO 4 TIMES DAILY, ADJUSTED ACCORDING TO RESPONSE. SOLUTIONS CONTAINING 0.25 TO 10% OF THE HYDROCHLORIDE MAY ALSO BE AVAILABLE AND THE HIGHER STRENGTHS MAY SOMETIMES BE REQUIRED IN PATIENTS WITH HEAVILY PIGMENTED IRIDES. A MODIFIED-RELEASE SYSTEM INSERTED INTO THE CONJUNCTIVAL SAC AND RELEASING 20 OR 40 MICROGRAMS OF PILOCARPINE PER HOUR FOR 7 DAYS, AND A 4% OPHTHALMIC GEL HAVE ALSO BEEN USED. PILOCARPINE MAY BE USED BEFORE SURGERY AS PART OF THE EMERGENCY TREATMENT OF ACUTE ATTACKS OF ANGLE-CLOSURE GLAUCOMA.
THE MIOTIC ACTION OF PILOCARPINE HAS BEEN USED TO ANTAGONISE THE EFFECTS OF SYMPATHOMIMETIC MYDRIATICS ON THE EYE AND IN SURGICAL PROCEDURES ON THE EYE. PILOCARPINE BORATE HAS BEEN USED SIMILARLY IN OPHTHALMOLOGY TO THE HYDROCHLORIDE AND NITRATE.
PILOCARPINE HYDROCHLORIDE IS USED IN THE TREATMENT OF DRY MOUTH FOLLOWING RADIOTHERAPY FOR MALIGNANT NEOPLASMS OF THE HEAD AND NECK. IT INCREASES SALIVARY FLOW ONLY IN PATIENTS WITH RESIDUAL SALIVARY GLAND FUNCTION. THE INITIAL ORAL DOSE IS 5 MG THREE TIMES DAILY WITH OR IMMEDIATELY AFTER MEALS, INCREASED GRADUALLY IF NECESSARY AFTER 4 WEEKS UNTIL AN ADEQUATE RESPONSE IS OBTAINED, UP TO A MAXIMUM OF 10 MG THREE TIMES DAILY. DOSES OF 5 MG BY MOUTH FOUR TIMES DAILY ARE USED TO TREAT DRY EYE OR MOUTH IN PATIENTS WITH SJΓGREN'S SYNDROME; THIS DOSE MAY BE INCREASED TO A MAXIMUM OF 30 MG DAILY. TREATMENT SHOULD BE STOPPED IF NO IMPROVEMENT OCCURS AFTER 3 MONTHS OF USE. FOR DOSES IN PATIENTS WITH HEPATIC IMPAIRMENT.