Pilocarpine

Summary

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