How does this medication work? What will it do for me?

Pilocarpine belongs to the class of medications called cholinomimetic agents.

It is used to treat symptoms of dry mouth that occur when radiation therapy to the head and neck causes reduced function of the salivary glands. It is also used to treat dry mouth and dry eyes that are symptoms of Sjogren's syndrome. Sjogren's syndrome is a condition where the body's defenses attack and damage the glands that produce saliva and tears.

Pilocarpine works by stimulating the glands that produce tears and saliva, as well as other body fluids. It may take up to 12 weeks to see an improvement in dry mouth and dry eyes.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

Each round, white film-coated, ¼ inch (6.35 mm) biconvex bevelled-edged tablet, debossed with "54 647" on one side and plain on the other contains pilocarpine 5 mg. Nonmedicinal ingredients: microcrystalline cellulose, stearic acid, and coating (titanium dioxide, polydextrose, hypromellose, macrogol and triacetin).

How should I use this medication?

The usual starting dose for adults is 5 mg taken 3 or 4 times a day. Depending on how well it works for you, your doctor may increase your dose to 10 mg (2 tablets) up to 3 times a day. It is not recommended that more than 30 mg (6 tablets) be taken per day.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

Pilocarpine may be taken with or without food. Take the tablets whole. Do not chew or bite on the tablet.

It is important that this medication be taken exactly as prescribed by your doctor. If you miss a dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take pilocarpine if you:

  • are allergic to pilocarpine or any ingredients of the medication
  • have uncontrolled asthma
  • have an inflamed iris (the coloured part of the eye)
  • have narrow angle glaucoma

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • chills
  • diarrhea
  • flushing
  • headache
  • more frequent urination
  • nausea
  • runny eyes
  • runny nose
  • sweating
  • vomiting

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

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

  • agitation
  • difficulty breathing
  • confusion
  • dizziness
  • fainting
  • rapid heart beat
  • severe stomach pain
  • signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
  • vision changes
  • weakness

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
  • chest pain

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Asthma and Chronic Obstructive Airway Disease (COPD): This medication may cause the muscles in to tighten, in the walls of the small air passages in the lung, narrowing the air passages and making it more difficult to breathe. If you have breathing problems such as asthma or COPD, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Behaviour Changes: People taking this medication may be at an increased risk of feeling agitated (restless, anxious, aggressive, emotional, and feeling not like themselves), especially people who are taking medications for mental health conditions like depression. If you experience a change in your moods, or notice them in a family member who is taking this medication, contact your doctor immediately.

Heart Disease: Pilocarpine may cause worsening symptoms of heart disease. If you have heart disease or are at risk of heart failure, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. If you experience difficulty breathing, fainting or are easily tired, contact your doctor as soon as possible.

Kidney function: Kidney disease or reduced kidney function may cause this medication to build up in the body, causing side effects. If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking this medication.

Vision: This medication may cause blurred vision, particularly at night. Avoid driving, operating machinery, or performing other hazardous tasks until you have determined how this medication affects you.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is not known if pilocarpine passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children less than 18 years old.

What other drugs could interact with this medication?

There may be an interaction between pilocarpine and any of the following:

  • aripiprazole
  • beta-adrenergic blockers (e.g., atenolol, propranolol, sotalol)
  • donepezil
  • galantamine
  • pimozide
  • rivastigmine

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.