Isopto Carpine 10% 15ml
It is used to treat glaucoma.It is used to lower high eye pressure.It may be given to you for other reasons. Talk with the doctor.
Drug Class
Miotics, Antiglaucoma agents
Pharmacologic Class
Direct-acting cholinergic agonists (muscarinic agonists)
Pregnancy Category
Category C
FDA Approved
Jun 1970
DEA Schedule
Not Controlled
Overview
What is this medicine?
Pilocarpine eye drops are used to lower high pressure inside your eye, which can damage your vision. It works by making your pupil smaller and helping fluid drain out of your eye more easily.
How to Use This Medicine
Proper Use of This Medication
To use this medication correctly, follow your doctor's instructions and read all the information provided. This medication is for use in the eyes only.
Preparation and Administration
1. Wash your hands before and after using this medication.
2. Remove contact lenses before applying the medication. You can put them back in 10 minutes after use, unless your eyes are irritated or infected.
3. Avoid touching the container tip to your eye, lid, or surrounding skin, as this can introduce bacteria and lead to severe eye problems or vision loss.
4. Tilt your head back and gently drop the medication into your eye.
5. After application, keep your eyes closed and apply gentle pressure to the inner corner of your eye for 1 to 2 minutes. This helps the medication stay in your eye.
Using Multiple Medications
If you are using more than one medication in the same eye, wait at least 5 minutes between applications.
Storage and Disposal
1. Store this medication at room temperature, away from freezing temperatures.
2. Keep all medications in a safe place, out of the reach of children and pets.
3. Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so. Consult your pharmacist for guidance on disposal, and consider participating in local drug take-back programs.
Missed Dose
If you miss a dose, use it as soon as you remember. However, if it is close to the time for your next dose, skip the missed dose and resume your regular schedule. Do not use two doses at once or take extra doses.
To use this medication correctly, follow your doctor's instructions and read all the information provided. This medication is for use in the eyes only.
Preparation and Administration
1. Wash your hands before and after using this medication.
2. Remove contact lenses before applying the medication. You can put them back in 10 minutes after use, unless your eyes are irritated or infected.
3. Avoid touching the container tip to your eye, lid, or surrounding skin, as this can introduce bacteria and lead to severe eye problems or vision loss.
4. Tilt your head back and gently drop the medication into your eye.
5. After application, keep your eyes closed and apply gentle pressure to the inner corner of your eye for 1 to 2 minutes. This helps the medication stay in your eye.
Using Multiple Medications
If you are using more than one medication in the same eye, wait at least 5 minutes between applications.
Storage and Disposal
1. Store this medication at room temperature, away from freezing temperatures.
2. Keep all medications in a safe place, out of the reach of children and pets.
3. Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so. Consult your pharmacist for guidance on disposal, and consider participating in local drug take-back programs.
Missed Dose
If you miss a dose, use it as soon as you remember. However, if it is close to the time for your next dose, skip the missed dose and resume your regular schedule. Do not use two doses at once or take extra doses.
Lifestyle & Tips
- Do not drive or operate machinery, especially at night or in dim light, until you know how this medication affects your vision (due to miosis and potential blurred vision).
- Wash hands thoroughly before and after use.
- Do not touch the dropper tip to any surface to avoid contamination.
- If using other eye drops, wait at least 5 minutes between applications.
- Remove contact lenses before applying drops and wait at least 15 minutes before reinserting them.
Available Forms & Alternatives
Dosing & Administration
Adult Dosing
Standard Dose:
1-2 drops in the affected eye(s) up to 4 times daily
Dose Range:
1 - 4 mg
Condition-Specific Dosing:
open-angle_glaucoma:
1-2 drops of 1% or 2% solution up to 4 times daily. Higher concentrations (e.g., 4%, 6%, 10%) may be used for more severe cases or less frequent dosing.
acute_angle-closure_glaucoma:
1 drop of 1% or 2% solution every 5-10 minutes for 3-6 doses, then 1 drop every 1-3 hours until pressure is controlled.
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established
Child:
Not established for routine use; limited data for specific conditions like congenital glaucoma, typically not first-line.
Adolescent:
Dosing similar to adults, but generally not first-line for glaucoma in this age group.
Dose Adjustments
Renal Impairment:
Mild:
No adjustment needed (minimal systemic absorption)
Moderate:
No adjustment needed (minimal systemic absorption)
Severe:
No adjustment needed (minimal systemic absorption)
Dialysis:
No specific considerations (minimal systemic absorption)
Hepatic Impairment:
Mild:
No adjustment needed (minimal systemic absorption)
Moderate:
No adjustment needed (minimal systemic absorption)
Severe:
No adjustment needed (minimal systemic absorption)
Pharmacology
Mechanism of Action
Pilocarpine is a direct-acting cholinergic parasympathomimetic agent. It acts by stimulating muscarinic receptors (M3) in the eye, primarily on the sphincter muscle of the iris and the ciliary muscle. Stimulation of the iris sphincter muscle causes miosis (pupil constriction). Contraction of the ciliary muscle causes tension on the scleral spur, opening the trabecular meshwork, which facilitates the outflow of aqueous humor and thereby reduces intraocular pressure (IOP).
Pharmacokinetics
Absorption:
Bioavailability:
Minimal systemic bioavailability from ophthalmic administration (<1%)
Tmax:
Not applicable for systemic Tmax; local ocular effects within minutes.
FoodEffect:
Not applicable for ophthalmic use.
Distribution:
Vd:
Not applicable for systemic Vd; primarily local distribution within ocular tissues.
ProteinBinding:
Not applicable for systemic protein binding; minimal systemic absorption.
CnssPenetration:
Limited (minimal systemic absorption)
Elimination:
HalfLife:
Systemic half-life is short (approx. 0.76 hours); ocular effects last longer.
Clearance:
Rapid systemic clearance by hydrolysis.
ExcretionRoute:
Primarily renal excretion of metabolites and unchanged drug (if systemically absorbed).
Unchanged:
Not available (minimal systemic absorption)
Pharmacodynamics
OnsetOfAction:
Miosis: 10-30 minutes; IOP reduction: 1 hour
PeakEffect:
Miosis: 30 minutes to 1 hour; IOP reduction: 1-2 hours
DurationOfAction:
Miosis: 4-8 hours; IOP reduction: 4-8 hours (depending on concentration)
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Attention Immediately
Although rare, this medication can cause severe and potentially life-threatening side effects. If you experience any of the following symptoms, contact your doctor or seek medical help right away:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Changes in eyesight, eye pain, or severe eye irritation
Severe eye problems, including:
+ Retinal tear or detachment (especially in people with pre-existing retinal disease)
+ Sudden symptoms such as:
- Flashing lights
- Floaters
- A curtain-like shadow coming across your eye
- Sudden eyesight loss
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other unusual symptoms, contact your doctor for advice:
Headache
Eye irritation
Blurred eyesight
Eye redness
Temporary dim or dark eyesight
Reporting Side Effects
This list is not exhaustive, and you may experience other side effects. If you have questions or concerns, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, this medication can cause severe and potentially life-threatening side effects. If you experience any of the following symptoms, contact your doctor or seek medical help right away:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Changes in eyesight, eye pain, or severe eye irritation
Severe eye problems, including:
+ Retinal tear or detachment (especially in people with pre-existing retinal disease)
+ Sudden symptoms such as:
- Flashing lights
- Floaters
- A curtain-like shadow coming across your eye
- Sudden eyesight loss
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other unusual symptoms, contact your doctor for advice:
Headache
Eye irritation
Blurred eyesight
Eye redness
Temporary dim or dark eyesight
Reporting Side Effects
This list is not exhaustive, and you may experience other side effects. If you have questions or concerns, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Severe eye pain or discomfort that worsens
- Sudden changes in vision (e.g., flashes, floaters, vision loss)
- Signs of allergic reaction (e.g., rash, itching, swelling of face/tongue/throat, severe dizziness, trouble breathing)
- Persistent headache or brow ache
- Excessive tearing or discharge from the eye
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
If you have a specific eye condition called iritis.
This list is not exhaustive, and it is crucial to discuss all your medications, health conditions, and concerns with your doctor. Please provide your doctor and pharmacist with a comprehensive list of:
All prescription and over-the-counter (OTC) medications you are taking
Any natural products or vitamins you are using
* Your health problems, including any pre-existing conditions
Before starting, stopping, or changing the dose of any medication, including this one, consult with your doctor to ensure your safety. It is vital to verify that it is safe to take this medication with all your other medications and health conditions.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
If you have a specific eye condition called iritis.
This list is not exhaustive, and it is crucial to discuss all your medications, health conditions, and concerns with your doctor. Please provide your doctor and pharmacist with a comprehensive list of:
All prescription and over-the-counter (OTC) medications you are taking
Any natural products or vitamins you are using
* Your health problems, including any pre-existing conditions
Before starting, stopping, or changing the dose of any medication, including this one, consult with your doctor to ensure your safety. It is vital to verify that it is safe to take this medication with all your other medications and health conditions.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. When taking this drug, exercise caution when driving or performing tasks that require clear vision, as it may affect your eyesight. Additionally, be careful when driving at night or engaging in activities in low-light environments. Regularly schedule appointments with your doctor to monitor your eye pressure and vision, as advised. If you are pregnant, planning to become pregnant, or breastfeeding, notify your doctor promptly. You and your doctor will need to discuss the potential benefits and risks of this medication to both you and your baby.
Overdose Information
Overdose Symptoms:
- Systemic overdose from ophthalmic use is rare but could cause cholinergic symptoms:
- Nausea, vomiting, diarrhea
- Bradycardia (slow heart rate)
- Hypotension (low blood pressure)
- Bronchospasm (difficulty breathing)
- Increased salivation, sweating, lacrimation
- Muscle weakness or tremors
What to Do:
If systemic overdose is suspected, seek immediate medical attention. Call 911 or Poison Control at 1-800-222-1222. Treatment is supportive and may involve atropine for severe cholinergic symptoms.
Drug Interactions
Moderate Interactions
- Anticholinergic ophthalmic agents (e.g., atropine, cyclopentolate): May antagonize the miotic and IOP-lowering effects of pilocarpine.
- Beta-blockers (ophthalmic): Additive IOP-lowering effect, generally beneficial but monitor for excessive bradycardia if systemic absorption occurs (rare).
Monitoring
Baseline Monitoring
Intraocular Pressure (IOP)
Rationale: To establish baseline and assess treatment efficacy.
Timing: Prior to initiation of therapy
Visual Acuity
Rationale: To establish baseline and monitor for changes, especially due to miosis or accommodative spasm.
Timing: Prior to initiation of therapy
Ophthalmic Examination (e.g., slit lamp, fundus)
Rationale: To assess ocular health and rule out contraindications.
Timing: Prior to initiation of therapy
Routine Monitoring
Intraocular Pressure (IOP)
Frequency: Regularly, as determined by ophthalmologist (e.g., 1-4 weeks after initiation, then every 3-6 months)
Target: Individualized, typically <21 mmHg or target pressure to prevent progression
Action Threshold: IOP not adequately controlled, or signs of progression
Visual Acuity
Frequency: Periodically, as determined by ophthalmologist
Target: Stable or improved
Action Threshold: Significant decrease in vision, especially if not explained by miosis
Ocular discomfort/pain
Frequency: At each visit and patient self-monitoring
Target: Minimal to none
Action Threshold: Persistent or severe eye pain, headache, or redness
Symptom Monitoring
- Blurred vision (especially at night or in dim light)
- Headache (especially brow ache)
- Eye pain or discomfort
- Redness or irritation of the eye
- Difficulty with night vision
- Increased tearing
- Nausea, vomiting, diarrhea (rare, systemic effects)
Special Patient Groups
Pregnancy
Pilocarpine is Pregnancy Category C. Use only if the potential benefit justifies the potential risk to the fetus. Minimal systemic absorption is expected with ophthalmic use, but animal studies have shown adverse effects at high systemic doses.
Trimester-Specific Risks:
First Trimester:
Potential risk cannot be ruled out; minimal systemic exposure is expected to limit risk.
Second Trimester:
Potential risk cannot be ruled out; minimal systemic exposure is expected to limit risk.
Third Trimester:
Potential risk cannot be ruled out; minimal systemic exposure is expected to limit risk.
Lactation
Pilocarpine is considered L3 (Moderately Safe) for lactation. Due to minimal systemic absorption from ophthalmic administration, the amount excreted into breast milk is expected to be very low and unlikely to cause adverse effects in a breastfed infant.
Infant Risk:
Low risk of adverse effects to the infant.
Pediatric Use
Safety and efficacy in pediatric patients have not been established for routine use. Use with caution and only if clearly indicated, as children may be more susceptible to systemic side effects.
Geriatric Use
No specific dose adjustments are typically required for geriatric patients. However, older patients may be more susceptible to side effects such as blurred vision, accommodative spasm, and headache. Monitor closely.
Clinical Information
Clinical Pearls
- Pilocarpine is a classic miotic agent, often used for acute angle-closure glaucoma or as an adjunctive therapy in open-angle glaucoma, especially when other agents are insufficient or contraindicated.
- The primary side effects are ocular: miosis (leading to dim vision, especially at night), accommodative spasm (brow ache, blurred distance vision), and headache.
- Patients should be advised about the potential for reduced night vision and difficulty with activities requiring clear distance vision.
- Higher concentrations (e.g., 10%) are typically reserved for severe cases or for less frequent dosing regimens.
- Proper instillation technique is crucial to minimize systemic absorption and maximize local effect (e.g., nasolacrimal occlusion).
Alternative Therapies
- Prostaglandin analogs (e.g., latanoprost, travoprost, bimatoprost) - first-line for open-angle glaucoma.
- Beta-blockers (e.g., timolol, betaxolol) - common first-line or adjunctive.
- Alpha-adrenergic agonists (e.g., brimonidine, apraclonidine)
- Carbonic anhydrase inhibitors (e.g., dorzolamide, brinzolamide)
- Rho kinase inhibitors (e.g., netarsudil)
- Combination products (e.g., timolol/dorzolamide, timolol/brimonidine)
Cost & Coverage
Average Cost:
Varies widely, typically $20-$100 per 15ml bottle of 1-4% solution
Generic Available:
Yes
Insurance Coverage:
Tier 1 or Tier 2 (preferred generic)
General Drug Facts
If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about this medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek medical attention. When seeking help, be prepared to provide details about the overdose, including the medication taken, the amount, and the time it occurred.