Pilocarpine has side-effects, as do many drugs. One of the effects of pilocarpine given by mouth may be tearing (which is what we are looking for). With higher doses, salivating (slobbering or drooling) is the next most common effect. At still higher doses, vomiting and loose stools may occur. These signs drooling, vomiting and loose stools, are what we are trying to avoid. Unfortunately, we don't know at what level the drug will produce more tears and not cause problems for the rest of the body. Thus, we be adjusting dosage to achieve the desired effect of tearing without the unwanted effects. Pilocarpine should be applied to a small amount of food or in empty gelatin capsules and given by mouth. I find it easiest is to put pilocarpine on a small scrap of bread and give as a treat. Do not just apply drops into the mouth. It is too difficult to get an exact dose and overdoses can occur this way. Within 30 minutes of a dose, tearing should occur and the eyes will look moist if an adequate dose of pilocarpine is given. If given too much pilocarpine, a patient will usually start drooling or may have to get outside to urinate or have a loose bowel movement. AT ANY TIME, IF THE EYES LOOK MOIST TO YOU WITHIN 30 MINUTES AFTER GIVING THE PILOCARPINE, DO NOT INCREASE THE LEVEL OF PILOCARPINE BEYOND THAT LEVEL WITHOUT CONTACTING THE DOCTOR!
1) Start with 1 drop of pilocarpine by mouth 3 times daily for 3 days. Watch for tearing (what we are looking for) or drooling, uncontrolled urinating or loose stools (what we don't want). If you do not notice a change during the first 3 days, on the 4th day, increase the dosage to 2 drops 3 times a day.
2) Again, watch for the signs of tearing, drooling, loose stools, or uncontrolled urination. If no change is seen within the next 3 days, on the 7th day after beginning, again increase the dosage by 1 drop (to 3 drops).
3) Every 4th day continue to increase the dosage of pilocarpine by 1 drop 3 times a day until your pet either begins to tear within 30 minutes of giving the pilocarpine or drooling or urgent loose stools or urination occur. IF TEARING OCCURS AT ANY LEVEL, DO NOT INCREASE THE AMOUNT OF PILOCARPINE BEYOND THAT LEVEL WITHOUT CONTACTING THE DOCTOR.
4) If drooling, loose stools or vomiting is seen, STOP the pilocarpine for 24 hours and call your veterinary ophthalmologist. Begin at the last level with no side effects. For example, if you get to 6 drops 3 times a day and your pet starts drooling 15 minutes after the pilocarpine is given, STOP the pilocarpine for 24 hours and the next day begin again at 5 drops 3 times daily.
Have any questions on this subject? Contact
Dennis Hacker via E-mail:
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