Cholinergics for Glaucoma

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Cholinergics for Glaucoma


Generic NameBrand Name
pilocarpine Isopto Carpine, Pilopine

Cholinergic medicines are also called miotics. Most of these medicines are given in eyedrop form. Pilocarpine comes as a gel form (Pilopine).

The eyedrops have green bottle caps. If you need to use more than one type of eyedrop, you may need to take each medicine in a certain order. You can use the color of the bottle cap to help you keep track of each type of eyedrop.

If you are using more than one type of eyedrop, wait 5 minutes between the different eyedrop medicines.

How It Works

These medicines reduce pressure in the eyes by increasing the drainage of fluid (aqueous humor) out of the eye through the trabecular meshwork.

Why It Is Used

Cholinergics can be used to treat glaucoma.

Like beta-blockers, cholinergics can be used alone or combined with other glaucoma medicines. A combination of medicines can help control how much fluid is produced in the eye and increase the amount of fluid that drains out of the eye.

Cholinergic medicines may be used during an episode of closed-angle glaucoma after the pressure inside the eye has been reduced.

How Well It Works

These medicines lower eye pressure by 20% to 30%.1 They have the strongest effect on the pressure in the eye during the 2 to 4 hours after medicine is applied. The medicine continues to work for 4 to 8 hours after use.

Side Effects

All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

Here are some important things to think about:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • Side effects may go away after you take the medicine for a while.
  • If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Call 911 or other emergency services right away if you have:

  • Trouble breathing.
  • Swelling of your face, lips, tongue, or throat.

Call your doctor if you have:

  • Hives.

Common side effects of this medicine include:

  • Blurred vision or a change in near or far vision.
  • Trouble seeing at night or in dim light.
  • Stinging or burning of the eye.
  • Headache, aching in the brow, or eye pain.
  • Eyelid twitching.
  • Watery eyes.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

Cholinergics are one of the oldest types of medicines used to treat glaucoma. But because they can cause significant side effects and because there are other effective medicines to treat glaucoma, cholinergics are not used as frequently as in the past.

What To Think About

If you are going to take any of these medicines, tell your eye doctor about all of the prescription and over-the-counter medicines, vitamins, herbs, and supplements you take. This is especially important if your doctor suggests echothiophate for you. This medicine is known to interact badly with quite a few other medicines.

Echothiophate needs to be stopped several weeks before surgery if a certain general anesthetic (succinylcholine) is going to be used. Using echothiophate while receiving this anesthetic could increase the risk of breathing problems (respiratory paralysis).

If you take echothiophate, avoid breathing in even small amounts of poisons that kill insects and pests. Breathing in these products may increase the effects of your medicine and could be harmful.

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

Advice for women

Do not use echothiophate if you are pregnant, breast-feeding, or planning to get pregnant. If you need to use this medicine, talk to your doctor about how you can prevent pregnancy.

If you are pregnant, breast-feeding, or planning to get pregnant, do not use any of the other medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breast-feeding, or planning to get pregnant.


Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.



  1. Gross RL (2009). Current medical management of glaucoma. In M Yanoff, JS Duker, eds., Ophthalmology, 3rd ed., pp. 1220–1226. Edinburgh: Mosby Elsevier.


ByHealthwise Staff
Primary Medical ReviewerAdam Husney, MD - Family Medicine
Specialist Medical ReviewerChristopher J. Rudnisky, MD, MPH, FRCSC - Ophthalmology
Last RevisedMay 14, 2012

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