Pilocarpine: Quick Guide to Uses, Dosage & Safety

If you’ve seen a prescription for pilocarpine and wonder what it actually does, you’re not alone. This short guide breaks down the basics so you can decide if it’s right for you, what to expect, and when to look for alternatives.

How Pilocarpine Works

Pilocarpine is a drug that belongs to the cholinergic class. In plain terms, it mimics a natural chemical in your body called acetylcholine. When you put pilocarpine eye drops in, the medicine makes the muscles in your eye contract. This opens up the drainage angle and lowers the pressure that can damage the optic nerve in glaucoma.

When you take it as a pill or a mouthwash, the same chemical action stimulates saliva glands. The result is more saliva, which helps people who suffer from dry mouth (xerostomia) due to radiation therapy, certain medications, or autoimmune disorders.

Typical Dosage & How to Use It

For glaucoma, the most common form is a 1% eye drop. Most doctors tell patients to put one drop in each eye two to four times a day, depending on how high the pressure is. It’s important to wash your hands before applying the drops and to avoid touching the bottle tip to your eye.

If you’re using pilocarpine tablets for dry mouth, the usual dose is 5 mg taken three times a day. Some people start with a lower dose to see how they tolerate it, then increase if needed. Always follow the exact schedule your prescriber gives you – skipping doses can cause the symptoms to flare up again.

Swallow the tablet with a full glass of water. Do not crush or chew it, because that can change how fast the drug is absorbed and increase side effects.

Common Side Effects

Eye drops can cause temporary blurred vision right after you use them. Your eyes might also feel a bit gritty or watery. These feelings usually pass within a few minutes.

Oral pilocarpine may give you sweating, nausea, or a tingling sensation in the hands and feet. Some people notice the taste becomes metallic. If you develop a rapid heartbeat, dizziness, or trouble breathing, stop the medication and call your doctor right away.

When to Talk to Your Doctor

If you notice that your eye pressure isn’t lowering after a week of regular use, or if your vision gets worse, it’s time to call the eye doctor. For dry mouth, if the increase in saliva isn’t enough or you feel overly sweaty, discuss a dose adjustment.

Pregnant or breastfeeding women should double‑check with a health professional before starting pilocarpine. The drug can cross the placenta and affect the baby’s heart rate.

Safer or Alternative Options

For glaucoma, many patients switch to newer eye drops that target different pathways, such as prostaglandin analogs (latanoprost, bimatoprost). These usually have fewer eye‑related side effects.

If dry mouth is your main issue, consider non‑drug approaches first: sipping water, chewing sugar‑free gum, or using saliva‑substituting lozenges. Over‑the‑counter saliva stimulants like pilocarpine‑free mints can help, and they avoid the systemic side effects.

In both cases, talk with a pharmacist or your doctor about the risk‑benefit balance. They can help you weigh the convenience of pilocarpine against possible side effects and suggest a plan that fits your lifestyle.

Bottom line: pilocarpine can be a useful tool for lowering eye pressure and boosting saliva, but it’s not the only option. Knowing how to use it correctly, spotting side effects early, and staying open to alternatives will keep you in control of your health.