Pilocar 2% Eye Drops
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Indications & Clinical Uses
- Pilocar 2% is listed here as pilocarpine hydrochloride ophthalmic solution 2%; no product currently marketed under the exact name “Pilocar” could be located on DailyMed, Drugs@FDA or the EMA registers, so this information is based on the generic pilocarpine hydrochloride ophthalmic solution label (Akorn, USA).
- Pilocarpine is a direct-acting cholinergic (parasympathomimetic) miotic that contracts the pupil and ciliary muscle, opening the eye's drainage angle.
- It is used to lower elevated pressure inside the eye in open-angle glaucoma and ocular hypertension, to break an attack of acute angle-closure glaucoma before surgery, to control pressure spikes after laser iridotomy or other laser eye surgery, and to produce miosis for diagnostic or surgical purposes.
- It is available in strengths from 1% to 4%; treatment usually starts at the lowest strength needed to control pressure.
- It is used in adults and is given as eye drops only, never by mouth or injection.
Side Effects
- The most commonly reported reactions with pilocarpine eye drops are headache or brow-ache, a temporary change in near or distance focusing (accommodative spasm), stinging or burning on instillation, eye pain, blurred vision and general visual disturbance, all related to the drug's effect on the eye's focusing muscle.
- Vision, especially in dim light, may be reduced because the pupil stays small; this usually eases as the eye adjusts.
- Rarely, retinal detachment has been reported, more often in short-sighted (myopic) patients or those with existing retinal disease, and requires urgent eye assessment if new flashes, floaters or a curtain-like loss of vision appear.
- Sweating, salivation, nausea, and a slowed heartbeat can occur if enough drug is absorbed into the body; seek urgent care for chest tightness, wheeze, or fainting.
- Because vision can blur temporarily after each dose, avoid driving or hazardous tasks in poor light until you can see clearly.
Precautions & Warnings
- Pilocarpine drops should be used with caution in anyone with a history of retinal detachment, retinal tears or other retinal disease, since the drug can theoretically increase that risk, and any new flashes or floaters need same-day eye review.
- It is not recommended when the eye has active inflammation of the iris (iritis) because pupil constriction can worsen adhesions.
- Because pilocarpine can cause temporary blurred or dim vision, particularly at night, patients should not drive or use machinery until vision has stabilised after each dose.
- Use cautiously in people with asthma, cardiovascular disease, gastrointestinal spasm, urinary tract obstruction, Parkinson's disease, or recent myocardial infarction, since absorbed pilocarpine can affect heart rate, airway tone, and gut and bladder muscle.
- Safety in pregnancy and breastfeeding has not been established for this route; use only if the potential benefit outweighs any risk to the fetus or infant.
- Contact lenses should generally be removed before instillation, and the bottle tip should not touch the eye.
Avoid Interactions
- Pilocarpine's miotic and pressure-lowering effect can be combined with other glaucoma medicines, including topical beta-blockers, carbonic anhydrase inhibitors and sympathomimetic or hyperosmotic agents, but eye drops should be given at least five minutes apart to prevent one drop washing out another.
- Using pilocarpine with other cholinergic (parasympathomimetic) drugs or cholinesterase inhibitors can increase systemic cholinergic side effects such as sweating, salivation, slow heart rate and gut cramping, and the combination should be used cautiously.
- Anticholinergic medicines can reduce pilocarpine's effect on the pupil and eye pressure.
- Because absorbed pilocarpine can affect heart rhythm and blood pressure, tell the prescriber about any heart medicines, asthma or COPD treatments, and drugs for Parkinson's disease or urinary retention.
- Always tell the healthcare provider and pharmacist about every medicine, herbal remedy and other eye drop being used, and never mix eye drops together in the same bottle.
References
Frequently Asked Questions
Pilocar is listed here as pilocarpine 2% eye drops. No product called “Pilocar” was found on DailyMed, Drugs@FDA or the EMA, so this answer uses the generic pilocarpine hydrochloride label. It lowers eye pressure in open-angle glaucoma and ocular hypertension, and is used in acute angle-closure glaucoma.
Instill one drop of pilocarpine into the affected eye up to four times daily, as directed. Press gently on the inner corner of the eye for a minute after each drop to limit absorption. Wait at least 5 minutes before any other eye drop.
Headache, brow-ache, stinging, blurred vision and difficulty focusing are common with pilocarpine drops. Vision may be dim, especially at night. Rarely, retinal detachment occurs, more often in short-sighted people — seek urgent same-day eye review for new flashes, floaters or vision loss.
Avoid driving or hazardous tasks in poor light until your vision clears after each dose of Pilocar. Use other cholinergic drugs cautiously, since combined effects can cause sweating, slow heartbeat or cramping. Tell your prescriber about any heart, asthma or Parkinson's medicines you take.
Yes, pilocarpine is often combined with beta-blocker, carbonic anhydrase inhibitor or hyperosmotic eye drops, but each drop should be given at least 5 minutes apart. Remove contact lenses before using the drops, and avoid touching the bottle tip to your eye.
Safety of pilocarpine eye drops in pregnancy and breastfeeding has not been established, so it should be used only if the potential benefit outweighs any risk to the baby. Discuss glaucoma treatment options with your eye doctor if you are pregnant or breastfeeding.

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