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Pilocarpine

(pye'' loe kar' peen)

Brand Name(s): Salagen®; also available generically

WHY is this medicine prescribed?

Pilocarpine is used to treat dry mouth caused by radiotherapy in people with head and neck cancer and to treat dry mouth in people with Sjogren's syndrome (a condition that affects the immune system and causes dryness of certain parts of the body such as the eyes and mouth). Pilocarpine is in a class of medications called cholinergic agonists. It works by increasing the amount of saliva in the mouth.

Are there OTHER USES for this medicine?

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

HOW should this medicine be used?

Pilocarpine comes as a tablet to take by mouth. When pilocarpine is used to treat dry mouth caused by radiotherapy in people who have head and neck cancer, it is usually taken three times a day. When pilocarpine is used to treat dry mouth in people who have Sjogren's syndrome, it is usually taken four times a day. Take pilocarpine at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take pilocarpine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Your doctor may start you on an average dose of pilocarpine and adjust your dose depending on how well your symptoms are controlled and the side effects you experience. Be sure to tell your doctor how you are feeling during your treatment with pilocarpine.

Pilocarpine will control your symptoms but will not cure your condition. Continue to take pilocarpine even if you feel well. Do not stop taking pilocarpine without talking to your doctor.

What SPECIAL PRECAUTIONS should I follow?

Before taking pilocarpine,

  • tell your doctor and pharmacist if you are allergic to pilocarpine (Pilopine HS, Salagen)or any other medications.

  • tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: ambenonium (Mytelase); antihistamines; atropine (Motofen, in Lomotil, in Lonox); beta blockers such as atenolol (Tenormin), labetalol (Normodyne), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), and propranolol (Inderal); bethanechol (Urecholine); cevimeline (Evoxac); donepezil (Aricept); galantamine (Razadyne); ipratropium (Atrovent, in Combivent, in Duoneb); medications for irritable bowel disease, motion sickness, Parkinson's disease, ulcers, or urinary problems; neostigmine (Prostigmin); physostigmine (Mestinon); rivastigmine (Exelon) and tacrine (Cognex). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

  • tell your doctor if you have asthma, acute iritis (uveitis; swelling and irritation inside the eye), or glaucoma (an eye disease).Your doctor may tell you not to take pilocarpine.

  • tell your doctor if you have or have ever had chronic bronchitis or another type of chronic obstructive pulmonary disease (COPD; a group of lung diseases that includes chronic bronchitis and emphysema); kidney stones; gallstones; mental illness; any condition that affects your ability to think; or gallbladder, heart, or liver disease.

  • tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking pilocarpine, call your doctor.

  • you should know that pilocarpine may cause decreased fertility in men and women. Talk to your doctor before you take pilocarpine if you or your partner would like to become pregnant.

  • you should know that pilocarpine may cause changes in vision, especially at night, or when there is not enough light. Be careful when driving at night, or when performing dangerous activities in low lighting.

  • you should know that pilocarpine may cause you to sweat a great deal, which can cause dehydration.Be sure to drink plenty of water and call your doctor right away if you are having difficulty drinking enough fluid or if you think you may be dehydrated.

What SPECIAL DIETARY instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do IF I FORGET to take a dose?

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What SIDE EFFECTS can this medicine cause?

Pilocarpine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • sweating
  • nausea
  • runny nose
  • diarrhea
  • chills
  • flushing
  • frequent urination
  • dizziness
  • weakness
  • headache
  • vomiting
  • heartburn
  • stomach pain
  • swelling of the arms, hands, feet, ankles, or lower legs

Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately:

  • changes in vision
  • fast or slow heartbeat

Pilocarpine may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

What should I know about STORAGE and DISPOSAL of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

What should I do in case of OVERDOSE?

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include:

  • headache
  • tearing of eyes
  • difficulty breathing
  • GI spasm
  • confusion
  • uncontrollable shaking of a part of the body

What OTHER INFORMATION should I know?

Keep all appointments with your doctor.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

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