GENERIC NAME: pilocarpine
oral
BRAND NAME: Salagen
DRUG CLASS AND MECHANISM: Pilocarpine is a "cholinergic"
drug, that is, a drug that mimics the effects of the chemical,
acetylcholine which is produced by nerve cells. Acetylcholine serves
as a messenger between nerve cells and between nerve cells and the
organs they control. For example, acetylcholine is responsible for
causing the salivary glands to make saliva and the lacrimal glands to
make tears to lubricate the eyes.
In addition to its effects on the salivary and lacrimal glands,
acetylcholine controls the production of fluid within the eye, and
pilocarpine eye drops have been used to treat glaucoma for many
years. In 1994, an oral formulation of pilocarpine was approved by
the FDA for the treatment of dry mouth caused by radiation
therapy for head and neck cancer, a treatment that damages the
salivary glands and reduces their production of saliva. In 1998, the
oral preparation was approved for the management of Sjogren's
syndrome, an autoimmune disease that damages the salivary and
lacrimal glands. Piloca pilocarpine was first isolated from
the leaves of Pilocarpus microphyllus (also called jaborandi) in 1875.
GENERIC AVAILABLE: no
PRESCRIPTION: yes
PREPARATIONS: Tablets, 5mg; 7.5mg.
STORAGE: Tablets should be stored at room temperature,
15-30°C (59-86°F).
PRESCRIBED FOR: Oral pilocarpine is used to treat dry mouth
caused by Sjogren's syndrome and radiation therapy to the head and
neck.
DOSING: Oral pilocarpine usually is taken three or four
times
daily. The maximum effect occurs in approximately one hour but may
occur later if it is taken with food. The effects last three to five
hours.
DRUG INTERACTIONS: Medications possessing anticholinergic
effects
or side effects should not be used with pilocarpine since they will
counter pilocarpine's cholinergic effects. Such medications
include atropine, e.g., Lomotil; some antihistamines,
e.g., carbinoxamine (Cardec-DM, Rondec-D), clemastine (Tavist),
diphenhydramine (Benadryl), promethazine (Phenergan), trimeprazine (Temaril); some phenothiazines, e.g., mesoridazine
(Serentil),
promazine (Sparine), thioridazine (Mellaril), triflupromazine (Vesprin)];
clozapine (Clozaril), cyclobenzaprine (Flexeril), disopyramide Norpace); some
antidepressants, e.g., amitriptyline (Elavil), amoxapine (Asendin),
bupropion (Wellbutrin; Zyban), clomipramine (Anafranil), doxepin (Sinequan),
maprotiline (Ludiomil), and protriptyline (Vivactil).
PREGNANCY: The safety of oral pilocarpine during
pregnancy has not been evaluated. The physician and patient need to
weigh
the benefits and the unknown risk to the fetus before using
pilocarpine during pregnancy.
NURSING MOTHERS: It is not
known if pilocarpine is secreted in human breast milk in amounts large enough to affect the
nursing infant.
SIDE EFFECTS: Excessive sweating (diaphoresis) is a
frequent
side effect of pilocarpine. Other side effects include chills,
dizziness, excessive
tearing, flushing, voice change, stuffy nose, tremor, increased need
to
urinate, visual disturbances, diarrhea, difficulty swallowing,
abdominal pain,
nausea, vomiting, and slow heart rate.
Last Editorial Review: 5/6/2004
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
- Sjogren's Syndrome - Sjogren's syndrome causes symptoms that include arthritis, dry mouth, lips and eyes, leading to eye pain. Read about diagnosis, Schirmer testing, treatment and medications.
- Retinal Detachment - Learn the signs, symptoms (floaters), statistics, causes, treatment (surgery) and risk factors (severe myopia, cataract surgery) of detached retinas.
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