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Isopto Carpine

pilocarpine
Used for Glaucoma, Eye Pressure
Used for Glaucoma, Eye Pressure

Generic pilocarpine eye drops, formerly known by the brand name Isopto Carpine, are used to treat and prevent high eye pressure. They're also used to shrink the pupil (the black part of your eye), typically before certain eye procedures. This medication belongs to the drug class called cholinergic agonists. The usual dosage is 1 drop in the eye(s) up to 4 times a day. Side effects can include headache, temporary blurry vision, and eye irritation.

Last reviewed on September 3, 2024
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What is Pilocarpine eye drops?

What is Pilocarpine eye drops used for?

  • High pressure in the eye

  • Glaucoma (open-angle or acute angle-closure)

  • Prevention of high eye pressure due to laser eye surgery

  • Shrinking the size of the pupils (miosis)

How Pilocarpine eye drops works

Pilocarpine eye drops is a cholinergic agonist. It drains fluid out of the eye, which lessens the amount of fluid in the eye. When there's less fluid inside the eye, the eye pressure goes down. This medication also makes the pupils smaller, which helps lower eye pressure in certain types of glaucoma.

Drug Facts

Common BrandsIsopto Carpine (brand name no longer available)
Drug ClassCholinergic agonist
Controlled Substance ClassificationNot a controlled medication
Generic StatusLower-cost generic available
AvailabilityPrescription only
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What are the side effects of Pilocarpine eye drops?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

Side effects occurring in 5% or more of people:
  • Headache or eyebrow ache
  • Difficulty focusing when looking at objects at different distances
  • Blurry vision
  • Eye irritation
  • Worse vision
  • Eye pain
Note: Side effects listed were reported by people who used the 2% strength of pilocarpine eye drops with Betoptic-S (betaxolol) 0.25% eye drops.

Source: DailyMed

The following side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

Symptoms of too much medicine being absorbed into the body

Increased sweating

muscle tremors

nausea, vomiting, or diarrhea

troubled breathing or wheezing

watering of mouth

Less common or rare

Eye pain

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Blurred vision or change in near or far vision

decrease in night vision

Less common

Eye irritation

headache or browache

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

pros-and-cons

Pros and cons of Pilocarpine eye drops

thumbs-up

Pros

Lowers eye pressure to prevent long-term damage, such as blindness

Can use for adults and children

Available as a lower-cost generic

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Cons

Not a first-choice medication for treating glaucoma long term

Sometimes need to use up to 4 times a day

Can make it hard to see clearly at night or to focus on objects at different distances, so might not be safe for you to drive after you use the eye drops

pharmacist-tips

Pharmacist tips for Pilocarpine eye drops

pharmacist
  • Wash your hands before you put pilocarpine eye drops in your eye(s). Don't let the dropper tip touch your eye or any other surface, and don't touch the tip with your hands. This will help prevent germs and bacteria from spreading into the medication, which will help lower the risk for eye infections.

    • Take out your contact lenses before each time you use pilocarpine eye drops. Then, wait 10 minutes after you place the drop(s) in your eye(s) to put your contacts back in. This medication contains a preservative that can damage contact lenses.

      • Avoid driving and doing important tasks at night or in low light conditions. Pilocarpine eye drops can make your vision worse when it's dark.

        • Pilocarpine eye drops can make it harder for you to clearly see objects that are at different distances. For example, it'll take your eyes longer to focus when you're looking at something far away and then at something else that's right in front of you. Don't drive or use heavy machinery if you notice this side effect.

          • It's not easy to tell whether your eye pressure is improving at home. Make sure to use pilocarpine eye drops as prescribed, even if you don't notice any difference in your symptoms or vision right away. Follow up with your eye specialist to check how the medication is improving your eye pressure.

            How to use pilocarpine eye drops:

            • Hold the pilocarpine eye drop bottle just above the pocket and squeeze a drop of medication into it.

              • After you place a drop in the eye, close your eye and press a finger to the inner corner of your eye by the nose for at least a minute. This helps make sure that your eye absorbs the drop and that the medication doesn't drain into your nose instead.

                • If you're using pilocarpine eye drops at the same time as other eye medications, wait at least 5 minutes between each medication to give your eyes time to absorb each medication.

                  faqs

                  Frequently asked questions about Pilocarpine eye drops

                  Is pilocarpine eye drops anticholinergic?
                  No, pilocarpine is a cholinergic agonist. It mimics the actions of acetylcholine, a natural chemical found in the body, to make the pupil smaller and lower eye pressure. Anticholinergic medications do the opposite; they block the actions of acetylcholine.
                  Do pilocarpine eye drops side effects go away?
                  Yes, most side effects from pilocarpine eye drops are temporary and go away with time. For example, you might experience blurry vision for 2 to 3 hours after you place pilocarpine eye drops into your eye. Other temporary side effects can include pain around the eyebrows and eye irritation. Contact your prescriber if any side effects seem severe or if they don't seem to get better after several hours.
                  Can pilocarpine eye drops cause retinal detachment?
                  Pilocarpine eye drops can rarely cause retinal detachment, but the risk might be higher in people who already have problems with their retina. Your eye specialist will carefully examine your retina to make sure pilocarpine eye drops are safe for you to use. Contact your eye specialist or go to the emergency room right away if you notice more floaters (small spots or lines in your vision), flashes of light, or a shadow in your vision. These can be signs of retinal detachment.
                  Do pilocarpine eye drops help dry eyes?
                  There isn't enough information to know how well pilocarpine eye drops help with dry eyes, and they aren't FDA approved for this use. Talk to a healthcare professional about treatment options if you have dry eye.
                  How long does it take for the pilocarpine eye drops to work?
                  It takes about 10 to 30 minutes for the pilocarpine eye drops to start making your pupil smaller. The pressure in your eye should drop within 60 minutes after you place the eye drop into your eye.
                  How long do pilocarpine eye drops last?
                  The effects of pilocarpine eye drops can last for around 4 to 8 hours. In some rare situations, effects can last for up to 20 hours. This can depend on which strength of the pilocarpine eye drops you're using.
                  Does pilocarpine eye drops constrict or dilate pupils?
                  Pilocarpine eye drops constrict your pupils. It makes your pupils look smaller but only temporarily. Your pupils will go back to its normal size within several hours after you use the eye drops.
                  Can you just stop taking pilocarpine eye drops?
                  Don't stop taking pilocarpine eye drops without talking to your prescriber first. This medication helps to lower eye pressure. So when you stop taking pilocarpine eye drops earlier than instructed, your eye pressure might climb up again. Very high eye pressure can sometimes lead to permanent damage to your vision. Speak with your eye specialist about when your eye pressure is stable enough to stop using pilocarpine eye drops.
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                  What are the risks and warnings for Pilocarpine eye drops?

                  Pilocarpine eye drops can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

                  risk-warning

                  Worse vision

                  Using pilocarpine eye drops can make it harder to see clearly, especially when it's dark. Be careful driving, using machinery, or performing tasks at night or in low light conditions. Tell your prescriber if this side effect is too bothersome and if it affects your daily lifestyle.

                  risk-warning

                  Retinal detachment

                  • Risk factors: History of retinal problems

                    Although rare, pilocarpine eye drops can cause retinal detachment, a serious injury in the eye that could potentially lead to blindness. Let your prescriber know about any of your past or current eye conditions. Depending on your medical history, you might need to visit an eye specialist for a retinal exam before you start pilocarpine eye drops. Call your prescriber right away if you start seeing "floaters," flashes of light, or shadows in your vision. Also contact your prescriber if your vision dims or if you have any other changes in your vision.

                    risk-warning

                    Not recommended for people with inflamed iris

                    Pilocarpine eye drops aren't recommended for use if you have iritis, which is inflammation of the colored part of your eye (the iris).

                    risk-warning

                    Higher eye pressure in children

                    Pilocarpine eye drops aren't recommended for children with certain types of glaucoma, since the medication can sometimes raise eye pressure rather than lower it. Let your child's prescriber know about any past or current eye conditions that your child has.

                    risk-warning

                    Don't wear soft contact lenses when you use pilocarpine eye drops

                    The preservative in pilocarpine eye drops, benzalkonium chloride, can get absorbed by soft contact lenses and damage the lenses. Remove soft contact lenses from your eye(s) before you put the pilocarpine eye drops into your eye(s). Wait at least 10 minutes after you put the eye drop(s) in before putting your contacts back onto your eye(s).

                    dosage

                    Pilocarpine eye drops dosage forms

                    Typical dosing for Pilocarpine eye drops

                    People 2 years of age and older

                    • Open-angle glaucoma or high pressure in the eye: The typical dose is 1 drop in the affected eye(s) up to 4 times daily. It's best to start with the 1% strength (the lowest strength) of pilocarpine eye drops to avoid side effects. Your prescriber might adjust the number of drops or the strength of pilocarpine eye drops you need depending on your eye pressure.

                    • Acute angle-closure glaucoma: This condition is usually treated with pilocarpine eye drops and other medications in a clinic or hospital. In most cases, the typical starting dose is 1 drop of the 1% or 2% strength in the affected eye(s) up to 3 times within a 30-minute period. Your eye specialist might tell you to continue using the 1% strength as 1 drop in the affected eye(s) 4 times a day while you wait for laser treatment.

                    • To prepare for laser eye surgery or to make the pupils smaller: Pilocarpine eye drops are usually given by an eye specialist before your eye procedure at a clinic or hospital. Your eye specialist will place 1 or 2 drops into the affected eye(s), 15 to 60 minutes before the surgery or procedure.

                    Children younger than 2 years old should use the 1% strength of pilocarpine eye drops as 1 drop in the affected eye(s) no more than 3 times a day. Ask your child's eye specialist for more information about dosing for specific situations.

                    interactions

                    Interactions between Pilocarpine eye drops and other drugs

                    Pilocarpine eye drops may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Pilocarpine eye drops. Please note that only the generic name of each medication is listed below.

                    Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

                    • Tegafur
                    alternatives

                    What are alternatives to Pilocarpine eye drops?

                    There are a number of medications that your doctor can prescribe in place of Pilocarpine eye drops. Compare a few possible alternatives below.
                    Pilocarpine eye drops
                    Used for:
                    • High pressure in the eye

                    • Glaucoma (open-angle or acute angle-closure)

                    • Prevention of high eye pressure due to laser eye surgery

                    • Shrinking the size of the pupils (miosis)

                    images

                    Pilocarpine eye drops images

                    Pilocarpine Coupon - Pilocarpine 15ml of 1% eye dropper
                    eye dropper (15ml) 1% of pilocarpinePilocarpine Coupon - Pilocarpine 15ml of 1% eye dropper
                    Pilocarpine Coupon - Pilocarpine 15ml of 2% eye dropper
                    eye dropper (15ml) 2% of pilocarpinePilocarpine Coupon - Pilocarpine 15ml of 2% eye dropper
                    Pilocarpine Coupon - Pilocarpine 15ml of 4% eye dropper
                    eye dropper (15ml) 4% of pilocarpinePilocarpine Coupon - Pilocarpine 15ml of 4% eye dropper

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                    References

                    Best studies we found

                    Ahn, J., et al. (2021). Binding affinity of benzalkonium chloride on contact lens surfaces and the effects on their physical properties. Colloids and Surfaces B: Biointerfaces.

                    American Academy of Ophthalmology. (2016). Primary open-angle glaucoma.

                    Emina, M. O. (2010). Aging and topical pilocarpine concentrations effects on pupil size and tear flow rate. Journal of Optometry.

                    GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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