Isopto Carpine
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.
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
What are the side effects of Pilocarpine eye drops?
Common Side Effects
- Headache or eyebrow ache
- Difficulty focusing when looking at objects at different distances
- Blurry vision
- Eye irritation
- Worse vision
- Eye pain
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
troubled breathing or wheezing
watering of mouth
Less common or rare
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
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 of Pilocarpine eye drops
Pros
Lowers eye pressure to prevent long-term damage, such as blindness
Can use for adults and children
Available as a lower-cost generic
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 for Pilocarpine eye drops
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:
Tilt your head back and pull your lower eyelid down to make a pocket.
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.
Frequently asked questions about 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.
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.
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.
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).
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.
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).
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 between Pilocarpine eye drops and other drugs
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
What are alternatives to Pilocarpine eye drops?
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)
What is the latest news about Pilocarpine eye drops?
Pilocarpine eye drops images
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References
Best studies we foundAhn, 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.
National Eye Institute. (2021). How to put in eye drops.
Novartis Pharma AG. (2013). Isopto® Carpine 2% sterile ophthalmic solution; Isopto® Carpine 4% sterile ophthalmic solution (pilocarpine hydrochloride).
Park, K. S., et al. (2021). Effects of miosis on anterior chamber structure in glaucoma implant surgery. Journal of Clinical Medicine.
Somerset Therapeutics, LLC. (2023). Pilocarpine hydrochloride- pilocarpine hydrochloride ophthalmic solution solution/ drops [package insert]. DailyMed.
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