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pilocarpine (oral)†(pye-loe-kar-peen) ,
Pregnancy Category: C
ClassificationTherapeutic: none assigned
†For ophthalmic use of pilocarpine, see
Management of xerostomia, which may occur as a consequence of radiation therapy for cancer of the head and neck.Treatment of dry mouth in patients with Sjögren’s syndrome.
Stimulates cholinergic receptors, resulting in primarily muscarinic action, including stimulation of exocrine glands.
Other effects include:
- Increased sweating, gastric secretions,
- Increased bronchial secretions,
- Increased tone and motility of the urinary tract, gallbladder, and biliary duct smooth muscle.
Increased salivary gland secretion.
Absorption: Well absorbed after oral administration.
Metabolism and Excretion: Inactivated at neuronal synapses and in plasma. Some unchanged pilocarpine and metabolites are excreted in urine.
Half-life: After 5-mg dose for 2 days—0.8 hr; after 10-mg dose for 2 days—1.3 hr.
|PO||20 min||1 hr||3–5 hr|
Contraindicated in: Hypersensitivity;Uncontrolled asthma;Angle-closure glaucoma;Iritis.
Use Cautiously in: History of pulmonary disease (asthma, bronchitis, or chronic obstructive pulmonary disease);Biliary tract disease or cholelithiasis;Cardiovascular disease;Retinal disease;Nephrolithiasis;History of psychiatric or cognitive disorders; Obstetric / Lactation / Pediatric: Safety not established.
Adverse Reactions/Side Effects
Central nervous system
Ear, Eye, Nose, Throat
- nausea (most frequent)
- vomiting (most frequent)
- urinary frequency
- flushing (most frequent)
- sweating (most frequent)
- voice change
Drug-Drug interactionConcurrent use of anticholinergics will ↓ the effectiveness of pilocarpine.Concurrent use of bethanechol or ophthalmiccholinergics may result in ↑ cholinergic effects.Concurrent use with beta blockers may ↑ the risk of adverse cardiovascular reactions (conduction disturbances).
Route/DosageHead and Neck Cancer Patients
Oral (Adults) 5 mg three times daily initially, then titrated to need/response, usual range 15–30 mg/day (no single should exceed 10 mg).Patients with Sjögren’s Syndrome
Oral (Adults) 5 mg four times daily.
Tablets: 5 mg, 7.5 mg
- Assess oral mucosa for dryness and ulceration periodically during therapy.
Potential Nursing DiagnosesImpairedoral mucous membrane (Indications)
- Do not confuse Salagen (pilocarpine) with selegiline.
- Oral: Use lowest dose that is tolerated and effective for maintenance.
- Instruct patient to take medication as directed.
- Caution patient that pilocarpine may cause visual changes, especially at night; avoid driving or other activities requiring alertness until effects of medication are known.
- Advise patient to drink adequate daily fluids (1500–2000 mL/day), especially if sweating occurs. Less than adequate fluid intake may lead to dehydration.
- Increased salivary gland secretion in patients with xerostomia.
- Decrease in dry mouth in patients with Sjögren’s syndrome. Full effects in cancer patients may not be seen for up to 12 wk or 6 wk in patients with Sjögren’s syndrome.