Medicine & USMLE


  1. Bethanechol
  2. Carbachol
  3. Methacholine
  4. Pilocarpine
  5. Donepezil Rivastigmine and Galantamine
  6. Edrophonium
  7. Neostigmine
  8. Physostigmine
  9. Pyridostigmine


Pilocarpine is a muscarinic agonist or cholinomimetic drug that causes miosis and salivation. It is commonly used to treat glaucoma as well as dry mouth or xerostomia.

Key Points

  • Pilocarpine
    • Mechanism
      • Muscarinic agonist (cholinomimetic)
        • Acts on M3 receptors in glands to stimulate sweat, tears and saliva production
        • Relatively resistant to breakdown by acetylcholinesterases
      • Also stimulates nicotinic receptors
    • Clinical Use
      • Glaucoma (open and closed angle)
        • First-line for emergency treatment
        • Lowers intraocular pressure by increasing aqueous outflow
          • Contracts ciliary muscle of eye to treat open-angle glaucoma
          • Contracts pupillary sphincter (miosis) to treat closed-angle glaucoma
      • Xerostomia (dry mouth)
        • May be used to treat autoimmune gland diseases like Sjogren’s syndrome
    • Adverse Effects
      • Cholinergic overstimulation
        • Constellation includes diarrhea, cramps, dyspnea, sweating, miosis, etc
        • Think: parasympathetic overactivity