II. Indication

  1. Open Angle Glaucoma second line agent (adjunctive)

III. Mechanism

  1. Reduces resistance to aqueous outflow

IV. Preparations

  1. Pilocarpine (Isoptocarpine, Pilopine gel, Ocusert, Pilocar) 1 drop four times daily
  2. Carbachol (Isopto Carbachol)
  3. Echothiophate (Phospholine Iodide)

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 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
PILOCARPINE 1% EYE DROPS Generic $4.79 per ml
PILOCARPINE 2% EYE DROPS Generic $4.69 per ml
PILOCARPINE 4% EYE DROPS Generic $5.00 per ml
PILOCARPINE HCL 5 MG TABLET Generic $1.04 each
PILOCARPINE HCL 7.5 MG TABLET Generic $1.26 each

Ontology: Carbachol (C0006945)

Definition (NCI) A synthetic choline ester and a positively charged quaternary ammonium compound. Carbachol is a parasympathomimetic that mimics the effect of acetylcholine on both the muscarinic and nicotinic receptors. This drug is administered ocularly to induce miosis to reduce intraocular pressure in the treatment of glaucoma. Carbachol is also used to stimulate micturition by contraction of detrusor muscle. This drug may cause hypotension, bradycardia, nausea, vomiting, bronchospasm, and abdominal cramps.
Definition (MSH) A slowly hydrolyzed cholinergic agonist that acts at both muscarinic and nicotinic receptors.
Definition (CSP) slowly hydrolyzed cholinergic agonist that acts at both muscarinic and nicotinic receptors.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D002217
SnomedCT 326500009, 33675006, 387183001
English Carbachol, Carbacholine, Carbocholine, Ethanaminium, 2-((aminocarbonyl)oxy)-N,N,N-trimethyl-, chloride, Carbachol [urine retention], 2-((Aminocarbonyl)oxy)-N,N,N-trimethylethanaminium Chloride, carbachol (medication), Carbachol [Chemical/Ingredient], carbacholine, CARBACHOL, carbachol, Carbachol [urine retention] (product), Carbamoylcholine chloride, Carbamylcholine chloride, Carbachol (product), Carbachol (substance), Carbachol [urine retention] (substance), Bioniche Brand of Carbachol, NutraMax Brand of Carbachol
Swedish Karbakol
Czech karbachol
Finnish Karbakoliini
Italian Carbacolina, Carbacolo
Russian KARBAKHOLIN, KARBAMILKHOLIN, КАРБАМИЛХОЛИН, КАРБАХОЛИН
Japanese カルバミルコリン, カルバコール
Croatian KARBAHOL
Polish Karbachol, Karbamylocholina
Spanish carbacol [retención urinaria] (producto), carbacol [retención urinaria], carbacol (producto), carbacol (sustancia), carbacolina, carbacol, cloruro de carbamilcolina, Carbacol
French Carbachol, Carbacholine, Carbaminoylcholine
German Carbachol
Portuguese Carbacol

Ontology: Miotics (C0026207)

Definition (MSH) Agents causing contraction of the pupil of the eye. Some sources use the term miotics only for the parasympathomimetics but any drug used to induce miosis is included here.
Definition (CSP) agent that causes the pupil of the eye to contract.
Concepts Pharmacologic Substance (T121)
MSH D008916
SnomedCT 372822009, 69242008
English Miotics, pupillary constrictor, miotic, miotics, Miotic, Miotic (product), Miotic (substance), Miotic, NOS, Miotics, Ophthalmic
French Agents myotiques, Médicaments myotiques, Miotiques, Myotiques
Swedish Pupillsammandragande medel
Czech miotika
Finnish Miootit
Russian ANTIKHOLINESTERAZNYE SREDSTVA, M-KHOLINOMIMETICHESKIE SREDSTVA, MIOTIKI, MIOTICHESKIE SREDSTVA, M-ХОЛИНОМИМЕТИЧЕСКИЕ СРЕДСТВА, АНТИХОЛИНЭСТЕРАЗНЫЕ СРЕДСТВА, МИОТИКИ, МИОТИЧЕСКИЕ СРЕДСТВА
Croatian MIOTICI
Polish Miotica, Leki zwężające źrenice
Spanish Efecto Miótico, miótico (producto), miótico (sustancia), miótico, Mióticos
Portuguese Efeito Miótico, Mióticos
German Miotika
Italian Preparati miotici

Ontology: Parasympathomimetic Agents (C0030512)

Definition (MSH) Drugs that mimic the effects of parasympathetic nervous system activity. Included here are drugs that directly stimulate muscarinic receptors and drugs that potentiate cholinergic activity, usually by slowing the breakdown of acetylcholine (CHOLINESTERASE INHIBITORS). Drugs that stimulate both sympathetic and parasympathetic postganglionic neurons (GANGLIONIC STIMULANTS) are not included here.
Concepts Pharmacologic Substance (T121)
MSH D010277
SnomedCT 19581007, 372668005
English Parasympathomimetics, Agents, Parasympathomimetic, Drugs, Parasympathomimetic, Parasympathomimetic Agents, Parasympathomimetic Drugs, parasympathomimetic agent, parasympathomimetics, parasympathomimetics (medication), parasympathomimetic drugs, parasympathomimetic drug, parasympathomimetic agents, parasympathomimetic, PARASYMPATHOMIMETICS, Parasympathomimetic agents, Parasympathomimetic, Parasympathomimetic agent (product), Parasympathomimetic agent (substance), Parasympathomimetic agent, Parasympathomimetic agent, NOS
Swedish Parasympatomimetika
Czech parasympatomimetika, cholinomimetika
Finnish Parasympatomimeetit
French Médicaments parasympathomimétiques, Agents parasympathomimétiques, Parasympathomimétiques
Russian PARASIMPATOMIMETIKI, ПАРАСИМПАТОМИМЕТИКИ
Croatian PARASIMPATOMIMETICI
Polish Leki parasympatykomimetyczne
Japanese 副交感神経興奮薬, 副交感神経作動剤, 副交感神経作動薬, 副交感神経様作動物質, 副交感神経様作動薬, 副交感神経様作用薬物
Spanish Efecto Parasimpaticomimético, agente parasimpaticomimético (producto), agente parasimpaticomimético (sustancia), agente parasimpaticomimético, Parasimpaticomiméticos
Portuguese Efeito Parassimpatomimético, Parassimpatomiméticos
German Parasympathikomimetika
Italian Parasimpatomimetici

Ontology: Echothiophate (C0301366)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
SnomedCT 387339003, 60682004
English echothiophate, ecothiopate, ECHOTHIOPHATE, Echothiophate, Ecothiopate, Echothiophate (product), Echothiophate (substance)
Spanish ecotiofato (producto), ecotiofato (sustancia), ecotiofato

Ontology: Ophthalmic form pilocarpine (C1720108)

Concepts Organic Chemical (T109) , Pharmacologic Substance (T121)
SnomedCT 420727003
English Ophthalmic form pilocarpine (product), Ophthalmic form pilocarpine
Spanish pilocarpina, forma oftálmica (producto), pilocarpina, forma oftálmica