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Reduced muscle narrowing the pupil (miosis) leads to a shift in the root of the iris of the anterior chamber angle of the eye that helps the opening of Schlemm’s canal and fontanovyh spaces with angle-closure glaucoma. The reduction of the ciliary muscle (accommodation spasm) leads to the discovery of Schlemm’s canal and trabecular slots with open-angle winstrol steroid glaucoma.Through these processes, increases the outflow of aqueous humor from the anterior chamber of the eye with a further reduction in intraocular pressure. The antihypertensive effect of pilocarpine begins after 10-30 minutes. The duration of the hypotensive effect after a single instillation of pilocarpine solution varies individually and averages 4-6 hours. Intraocular pressure is lowered to 4.8 mm Hg (17-20% of baseline).
In primary open angle glaucoma instillation of 1% solution causes a reduction of intraocular pressure by 25-26%. Start effect – after 30-40 minutes, reaching a peak after 1.5-2 hours and lasts for 4-14 hours.

Pharmacokinetics
pilocarpine well penetrates through the cornea, it is well absorbed through the conjunctiva. Practically not absorbed in the conjunctival sac. When applied topically, the concentration in the aqueous humor of the eye reaches a maximum (T cmax ) after 30 minutes of installation. Delays in the eye tissues, which increases the half-life of the tissues of the eye (the T 1/2 ), which is 1.5-2.5 hours.
Pilocarpine is not metabolized in the eye tissues and excreted unchanged in the intraocular fluid. Pilocarpine is converted into an inactive form by hydrolysis in blood serum and liver. Plasma half-life is approximately 30 minutes.

Indications

 

  • acute attack of angle-closure glaucoma;
  • secondary glaucoma (vascular, traumatic (burns));
  • Primary open angle glaucoma (in combination with β-blockers or other agents that reduce intraocular pressure);
  • need pupil constriction after mydriatics installation.

Contraindications

Iritis, iridocyclitis, and other conditions that are not recommended constriction of the pupil (for example, after surgery on the eye, except when it is necessary to narrow the pupil immediately after surgery to prevent the formation of adhesions), hypersensitivity to pilocarpine, children up to 18 years , retinal detachment (including history), as well as conditions predisposing to retinal detachment. If you have one of these diseases, you should consult with your doctor before taking the drug.

The caution
in young patients with high myopia. If  winstrol steroidyou have one of these diseases, before taking the drug should consult a doctor.

Application of pregnancy and during breastfeeding

Perhaps the use of pilocarpine for the treatment of pregnant and lactating mothers prescribed by a doctor, if the expected benefit to the mother outweighs the potential risk to the fetus and child.

Dosing and Administration

Buried in the conjunctival sac 1-2 drops. The number of installations can vary depending on the indication and individual sensitivity of the patient.
The acute glaucoma attack closed: during the first hour is dug pilocarpine solution every 15 minutes, 3.2 hours – every 30 minutes, 6.4 hours – every 60 minutes and then 3- 6 times a day until relief attack.
Secondary glaucoma (vascular, traumatic (burns)): 1-2 drops 2-4 times daily;
primary open-angle glaucoma: 1-2 drops 2-4 times daily in conjunction with β-blockers or other drugs that reduce intraocular pressure,
to narrow the pupil after installation mydriatics: 1-2 drops once.

Side effect

Headache (in the temporal and periorbital), short-term pain in the eyes; myopia; decreased vision, especially in the twilight time of day, due to the development of resistant miosis and spasm of accommodation; watery eyes, runny nose, superficial keratitis; allergic reactions.
Prolonged use may develop follicular conjunctivitis, contact dermatitis of eyelids and reversible clouding of the lens.
Systemic side effects are rare. Pilocarpine as m-choline-mimetic can cause bronchospasm, slow heart beat, increased salivation, runny nose.
If any of these instructions side effects are compounded, or if you notice any other side effects not mentioned in the instructions, inform your doctor.

Overdose

In case of overdose possible excessive salivation, sweating, bradycardia, bronchoconstriction, decreased blood pressure.
When ingestion possible poisoning, manifested by a significant increase in m-cholinomimetic effects, including with the development of severe heart failure and bronchoconstriction.
Treatment: gastric lavage; monitoring of heart rate (HR), blood pressure (BP), respiratory function; atropine (0.5-1.0 mg subcutaneously or intravenously), epinephrine (0.3-1.0 mg subcutaneously or intravenously).

Interaction with other drugs

Antagonists of pilocarpine are atropine and other m-holinoblokatory.
While the use of agonists may occur antagonistic action (in the diameter of the pupil).
Timolol and phenylephrine winstrol steroid increase the reduction of intraocular pressure by reducing the production of intraocular fluid.
Perhaps the use of pilocarpine in combination with sympathomimetics, .beta.-blockers, . carbonic anhydrase inhibitors
M-cholinomimetic activity of pilocarpine is reduced tricyclic antidepressants, phenothiazine derivatives, hlorprotiksenom, clozapine; enhanced cholinesterase inhibitors.
Perhaps the development of bradycardia and fall in blood pressure during general anesthesia with halothane (in patients who use pilocarpine in eye drops).

special instructions

Treatment should be carried out at regular monitoring of intraocular pressure.
To reduce the intake is recommended after installation pinch ocular channel for 1-2 minutes, pressing his finger at the inner corner of the eye.
As a result of the development of resistant myositis, as well as myopic effect related to the change of accommodation, possible alleviation view, therefore, use of the drug is not recommended for drivers of vehicles in the twilight and at night, you must be careful when activities potentially hazardous activities that require high concentration and psychomotor speed reactions.
The use of pilocarpine is not recommended while wearing soft contact lenses.

Product form.

1% eye drops.
1.5 ml, 2 ml or 5 ml plastic dropper tube. 1, 2, 4, 5, or 10-tube drippers with instructions for use of the drug is placed in a pile of cardboard.
Text for use dropper tube attached instructions on the pack.
5 mL or 10 mL in plastic dropper bottle. 1 or 2 bottle-dropper with the instructions for use of the drug is placed in a pile of cardboard.
The text on the use of bottle-dropper instructions applied to the stack.
5 ml vials of glass.
1 bottle complete with a sterile cover-dropper and instruction for use of the drug is placed in a a pile of cardboard.
5 vials in blisters.
1 contour cell package complete with 5 sterile lids, droppers and the instructions for use of the drug is placed in the pack.

Storage conditions

In the dark place at tempera-round, no higher than 15 ° C for the drug in tube-looks and bottle-droppers, in a dark place at a temperature no winstrol steroid higher than 25 ° C for the drug in vials of glass. Keep out of the reach of children. online anabolic steroids pharmacy

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