Pilocarpine

Introduction

Written by Patricia Weiser, PharmD
Medically reviewed by Brittany Duke, PharmD RPh
Updated on October 3, 2023

Pilocarpine (pye loe KAR peen) is a generic medication prescribed for certain causes of dry mouth. It’s also prescribed for various eye conditions, including glaucoma. Pilocarpine belongs to a group of drugs called cholinergic agonists or miotics.

The Food and Drug Administration (FDA) has approved pilocarpine for:

• treating dry mouth caused by radiation therapy for head and neck cancer in adults
• treating dry mouth caused by Sjögren’s syndrome in adults
• lowering the pressure in the eyes in adults and children with glaucoma or ocular hypertension
• preventing increased eye pressure after laser eye surgery in adults and children
• constricting (shrinking) the pupil before certain eye procedures in adults and children

These approved uses differ based on the form of pilocarpine your doctor prescribes.

This article doesn’t provide coupons for all forms of pilocarpine. To find coupons for pilocarpine oral tablet, see this article. 

Side effects of pilocarpine

Pilocarpine may cause mild or serious side effects. More common mild side effects of pilocarpine and its serious side effects are listed below. This article doesn’t include all possible side effects of the drug. Side effects can vary based on your age, overall health, and any other medications you take.

To learn more about pilocarpine’s side effects, ask your doctor or pharmacist. You can also refer to the prescribing information for pilocarpine listed in the “Resources” section.

Mild side effects

More common mild side effects reported with some forms of pilocarpine are listed below. These side effects may differ based on the form of pilocarpine you take or use. 

This article doesn’t include all possible mild side effects of the drug. To learn more about pilocarpine’s side effects based on the form, refer to the prescribing information for pilocarpine listed in the “Resources” section.

With many drugs, mild side effects may go away within a few days or a couple of weeks. If the side effects are bothersome, tell your doctor or pharmacist. They may be able to suggest ways to manage them.

Pilocarpine eye drop’s mild side effects may include:

• headache
• problems seeing clearly when you look at something nearby after looking at something far away (or vice versa)
• blurred vision
• eye irritation
• mild allergic reaction*

Pilocarpine oral tablet’s mild side effects include:

• sweating
• urinating more than usual
• chills
• nausea
• mild allergic reaction*

* For details about this side effect, see the “Interactions and warnings for pilocarpine” section.

Serious side effects

Serious side effects of pilocarpine are listed below. These side effects may differ based on the form of pilocarpine you take or use. 

This article doesn’t include all possible serious side effects of the drug. To learn more about pilocarpine’s side effects based on the form, refer to the prescribing information for pilocarpine listed in the “Resources” section.

With many drugs, serious side effects are possible but not common. If you have serious side effects from this drug, call your doctor right away. If you’re having severe symptoms or a medical emergency, call 911 or a local emergency number. 

In general, pilocarpine’s serious side effects include:

• confusion
• changes in blood pressure and heart rate
• heart problems, such as irregular heart rhythm
• severe allergic reaction*

For pilocarpine eye drops, the following serious side effects may also occur:

• trouble seeing in dim lighting, which may make it dangerous to drive when it’s dark outside 

* For details about this side effect, see the “Interactions and warnings for pilocarpine” section.

Uses of pilocarpine

The Food and Drug Administration (FDA) approves prescription drugs such as pilocarpine for certain conditions. Approved uses for pilocarpine are described below. These uses differ based on the form of pilocarpine prescribed.

Use for dry mouth

Doctors may prescribe pilocarpine oral tablet for treating dry mouth caused by radiation therapy for head and neck cancer. It’s also used to treat dry mouth caused by Sjögren’s syndrome. The drug is used for these purposes in adults. It’s usually prescribed as a long-term treatment.

Dry mouth occurs when the salivary glands in your mouth don’t make enough saliva. Dry mouth is a common side effect of radiation therapy in people who get treatment for cancer of the head or neck. Dry mouth can also be caused by chronic (long-term) medical conditions, such as Sjögren’s syndrome.

Use for some eye conditions

Doctors may prescribe pilocarpine eye drops for:

• lowering the pressure in the eye in people with glaucoma or ocular hypertension
• preventing increased pressure in the eye after laser eye surgery
• constricting (shrinking) the pupil before certain eye procedures

Pilocarpine is used for these purposes in adults and children of any age. It may be prescribed as a long-term or short-term treatment.

Pilocarpine may be prescribed together with other eye drops for glaucoma, such as dorzolamide/timolol (Cosopt). If your doctor prescribes more than one eye drop medication, you should administer them at least 5 minutes apart. Doing so helps eye drops work more effectively.

Common questions about pilocarpine

Below you’ll find answers to a few commonly asked questions about pilocarpine.

Do side effects of pilocarpine go away?

You may experience side effects at any time during pilocarpine treatment, whether you’ve just taken your first dose or have taken the drug for a while.

Side effects of pilocarpine should go away shortly after your last dose. You shouldn’t stop pilocarpine treatment without first talking with your doctor. If you’re experiencing bothersome side effects, they may recommend a different treatment option for you.

How does pilocarpine work? And how long does it take to start working?

Pilocarpine eye drops work by making certain eye muscles contract. This creates more space in your eye for fluid to flow out, which lowers the pressure inside your eye. It also causes the pupil of your eye to constrict (shrink).

Pilocarpine oral tablet works by stimulating certain nerves in your body. These nerves signal your glands to make and release more fluids, such as saliva and sweat.  

After putting the drops in your eye for the first time, pilocarpine eye drops usually start working within 15 minutes to an hour. Pilocarpine oral tablet usually starts working within 20 minutes to an hour after taking it.

If you’d like to know more about how pilocarpine works, talk with your doctor or pharmacist. 

If I wear contact lenses, should I take them out before using pilocarpine eye drops?

Yes, if you wear contact lenses, make sure you remove them before using pilocarpine eye drops. Then, after using the eye drops, wait at least 10 minutes before putting your contact lenses back into your eyes.

Interactions and warnings for pilocarpine

Below, you’ll find information about pilocarpine’s possible interactions and warnings. 

Interactions of pilocarpine

Certain things may affect how a drug works. These include getting vaccines, consuming alcohol or certain foods, or taking the drug with other medications. This effect is called a drug interaction.

Some forms of pilocarpine have interactions, so ask your doctor to check for possible interactions before you start pilocarpine. Be sure to tell them about any of the following you take or use:

• prescription or over-the-counter drugs 
• vitamins, herbs, or supplements

Other forms of pilocarpine don’t have any known interactions. But this doesn’t mean drug interactions with pilocarpine can’t happen. For instance, medications created at a later time could interact with these forms of pilocarpine.

To learn about drug-condition interactions, see the “Warnings for pilocarpine” section below.

Warnings for pilocarpine

Pilocarpine oral tablet should not be taken by certain people. And others should use pilocarpine eye drops cautiously. 

Pilocarpine could cause harm to people with certain health conditions. This effect is called a drug-condition interaction. Other factors can also affect whether pilocarpine is a safe option for you. These warnings may differ based on the form of pilocarpine you take or use.

Ask your doctor about specific warnings for pilocarpine, and be sure to tell your doctor about your:

• current health, including any allergies to medications
• past health conditions or surgeries

Allergic reaction

Pilocarpine can cause an allergic reaction in some people. Severe allergic reactions are rare but possible.

If you’ve had an allergic reaction to pilocarpine or any of its ingredients, your doctor will likely not prescribe pilocarpine. They can tell you about medications that are safer options for you.

A mild allergic reaction may cause the following symptoms:

• skin rash
• itchiness
• flushing (temporary warmth, redness, or deepening of skin color)

A severe allergic reaction may cause the following symptoms:

• swelling under your skin, usually in your hands, feet, eyelids, or lips
• swelling of your mouth, throat, or tongue, which can cause breathing problems 

If you have an allergic reaction to pilocarpine, call your doctor right away. If you have severe symptoms, call 911 or a local emergency number.

Overdose of pilocarpine

If you take pilocarpine oral tablet by mouth or apply pilocarpine eye drops, you should not take or use more pilocarpine than your doctor prescribes. For some drugs, doing so may lead to harmful effects or overdose.

If you think you’ve taken or used too much pilocarpine, call your doctor or pharmacist right away. Or you could call 800-222-1222 to speak with someone at America’s Poison Centers. You can also use its online resource. If you have concerning symptoms, call 911 or a local emergency number immediately. You can also go to the closest emergency room.

Pregnancy or breastfeeding and pilocarpine

Information about pilocarpine and pregnancy and breastfeeding is described below.

Pilocarpine and pregnancy

It’s not known whether pilocarpine should be taken or used during pregnancy. If you’re planning a pregnancy or can become pregnant, talk with your doctor before starting this medication. 

Pilocarpine and breastfeeding

It’s not known whether pilocarpine should be taken or used while breastfeeding. If you’re currently breastfeeding or planning to do so, talk with your doctor before starting this medication. 

What to ask your doctor

Let your doctor know if you have questions about pilocarpine or would like more details about it.

Here’s a list of some possible questions you may want to ask your doctor:

• Do any of my other medications interact with pilocarpine oral tablet?
• Do any of my health conditions put me at a higher risk of having side effects from pilocarpine?
• How long will I need to use pilocarpine eye drops?
• Is there anything I should avoid while using pilocarpine eye drops or oral tablet?

Resources

• Food and Drug Administration. (2023). Orange Book: Approved drug products with therapeutic equivalence evaluations. https://www.accessdata.fda.gov/scripts/cder/ob/index.cfm
• Pilocarpine hydrochloride ophthalmic solution. (2023). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/84428e9a-f486-44d9-ad93-4ea9069a6787/spl-doc
• Pilocarpine hydrochloride tablet. (2023). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/06c054af-62b4-4373-813a-9bb2e5c92316/spl-doc

Disclaimer: Optum Perks has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.