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[Guanethidine/dipivefrin and pilocarpine in the treatment of increased intraocular pressure].

Thirty patients with ocular hypertension or open-angle glaucoma were tested to see if, and to what extent, guanethidine/dipivefrin and pilocarpine produced a supplementary reduction in intraocular pressure. An equally marked additional lowering of pressure was achieved when patients who had been given guanethidine/dipivefrin over an extended period of time were additionally treated with one dose of pilocarpine 2%. The reduction in intraocular pressure was much more pronounced in patients who had been treated with pilocarpine 2% alone over an extended period of time, followed by a single dose of guanethidine/dipivefrin, than in those who had been treated first with guanethidine/dipivefrin and subsequently with pilocarpine.

Drug Therapy, Combination↗

The treatment of Sjögren's syndrome patients with pilocarpine-tablets.

Therapeutic progress in Sjögren's syndrome has lagged behind our recognition and understanding of clinical manifestations and disease pathogenesis. Past treatment of sicca symptoms with immunosuppressives has been unsuccessful. The use of secretagogues (e.g. pilocarpine-HCl) to stimulate flow from exocrine glands represents a novel approach that has dramatically altered our management strategy for Sjögren's syndrome. Clinical studies with pilocarpine (Salagen) tablets in the United States have demonstrated significant subjective and objective benefit for xerostomia and related oral symptoms at doses of 20 mg/day or more. Symptomatic relief of xerophthalmia and other xeroses due to Sjögren's syndrome may also occur. Data from human and animal models suggest that regular use of pilocarpine may not only improve patient quality of life but potentially prevent complications as well. Better methods of patient selection for therapy are needed since clinical response to pilocarpine cannot be predicted based on the duration of patient symptoms.

Administration, Oral↗

Ophthalmic epinephrine, phenylephrine, and pilocarpine affect the systemic absorption of ocularly applied timolol.

Ocularly applied timolol eyedrops may cause serious systemic side-effects in some patients. In this study we evaluated the effects of pretreatment with epinephrine and pilocarpine eyedrops on systemic absorption of ophthalmic timolol. Epinephrine decreased the systemic absorption of timolol, while pilocarpine increased the peak concentrations of timolol in plasma. When applied in the same solution with timolol, pilocarpine had no effect and phenylephrine decreased the systemic absorption of timolol. The observed effects were due to the conjunctival and nasal vasoconstricting effects of epinephrine and phenylephrine and to the vasodilating effects of pilocarpine. These pharmacokinetic interactions demonstrate the importance of the conjunctival and nasal blood flow in the systemic absorption of timolol.

Absorption↗

Anterior chamber angles shallowing and intraocular pressure after topical pilocarpine.

Pilocarpine has been well recognized as the drug of choice for acute angle-closure glaucoma. The purpose of this study is to clarify quantitatively the change of anterior chamber angle and depth with the passage of time after pilocarpine drop administration. Chamber angles of the four quadrants and chamber depths were measured in 18 normal subjects by Scheimpflug Video Image prior to and 30, 60, and 180 minutes after administration of one drop of 4% pilocarpine in one eye, while the opposite eye served as control. The anterior chamber angle and depth showed a significant shallowing at 30, 60 and 180 minutes after 4% pilocarpine administration with a maximal effect of -3.61 degrees and -0.15 mm at 30 minutes, respectively, while the reduction of intraocular pressure reached its maximal effect at 180 minutes. These facts should be well understood in the treatment of angle-closure glaucoma.

Adult↗

Intraoperative bradycardia and hypotension associated with timolol and pilocarpine eye drops.

A 69-yr-old man, who was concurrently being treated with pilocarpine nitrate and timolol maleate eye drops, developed a bradycardia and became hypotensive during halothane anaesthesia. Both timolol and pilocarpine were subsequently identified in a 24-h collection of urine. Timolol (but not pilocarpine) was detected in a sample of plasma removed during surgery; the plasma concentration of timolol (2.6 ng ml-1) was consistent with partial beta-adrenoceptor blockade. It is postulated that this action may have been enhanced during halothane anaesthesia with resultant bradycardia and hypotension. Pilocarpine may have had a contributory effect.

Aged↗

MK-801 sensitizes rats to pilocarpine induced limbic seizures and status epilepticus.

High doses of pilocarpine are known to produce prolonged seizure activity in rats. Previous studies show that pretreatment with LiCl will sensitize rats to the convulsant effects of pilocarpine. Here we report that the anti-epileptogenic and anticonvulsant drug MK-801 (dizocilpine) paradoxically also sensitizes rats to pilocarpine induced limbic seizures and limbic status epilipticus (LSE). If rats were pretreated with MK-801, normally subconvulsive doses of pilocarpine rapidly produced LSE. LSE could be prevented by co-administration of either atropine or diazepam with MK-801.

Animals↗

The Ocusert pilocarpine system: advantages and disadvantages.

Thirty-four patients with glaucoma were treated with the Ocusert pilocarpine system, a unique method of providing round-the-clock delivery of pilocarpine in the eye for seven-day periods. Advantages of the device include therapeutic effectiveness and continuous release rate, less effect on accommodation, less miosis, convenience for the patient, and reliability in patients who must rely on others for treatment (eg, children and the elderly). Some disadvantages encountered were need for instruction and encouragement of patients; retention difficulties, with some patients unaware when the device was lost; occasional side effects of a cutting sensation (as when the Ocusert sometimes doubles over), movement in the eye, and transient blurring of vision and miosis; and high cost. Overall, when compared to pilocarpine eyedrops, the Ocusert pilocarpine system presents many definite advantages and is a highly desirable method of therapy in selected cases of glaucoma.

Drug Evaluation↗

Healing effect of Pilocarpine gel 4% on skin lesions of pemphigus vulgaris.

BACKGROUND: The high rate of morbidity and mortality resulting from long-term use of corticosteroids in pemphigus vulgaris (PV) warrants discovery of a new treatment strategy. Based on a new theory on the pathophysiology of PV, cholinomimetics can block the process of blister formation. AIMS: This study was conducted to evaluate the clinical effectiveness of Pilocarpine gel in the treatment of skin lesions of PV. METHODS: In a double-blind, placebo-controlled study, three PV patients with a total of 64 skin lesions were treated by either Pilocarpine or placebo gel. After 15 days of treatment an epithelialization index of the two groups was compared. RESULTS: The mean of the epithelialization index in skin lesions that received Pilocarpine was significantly higher than that of the placebo group (40.3 +/- 1.7 vs. 24.4 +/- 3.3, P < 0.001). CONCLUSIONS: Pilocarpine gel effectively treats PV.

Cholinergic Agents↗

Antagonism of the effect of isoprenaline on heart rate by pilocarpine.

1 The interaction of pilocarpine and isoprenaline on heart rate was investigated in the spontaneously beating, right isolated atrium of the rat.2 The log dose-effect curve of isoprenaline, measured in the presence of various concentrations of pilocarpine, was not modified when the concentration of the latter did not exceed 10(-6)M even though significant slowing of the heart had occurred. At concentrations higher than 10(-6)M a rapid but graded shift to the right of isoprenaline response curves occurred so that at pilocarpine 10(-5)M the pD(2) of isoprenaline was reduced from 11 to 3.3; cocaine slightly reduced this antagonism.3 It is concluded that pilocarpine antagonizes isoprenaline by some mechanism which is not of the simple competitive type.

Animals↗

The inhibition of CYP enzymes in mouse and human liver by pilocarpine.

1. Pilocarpine is a cholinomimetic natural alkaloid. Its interactions with testosterone hydroxylations, coumarin 7-hydroxylase (COH), dimethylnitrosamine N-demethylase (DMNA), pentoxyresorufin O-dealkylase (PROD) and 7-ethoxyresorufin O-deethylase (EROD), which are indicative of the activities of cytochrome P4502A5 (CYP2A5) or 6, 2E1, 2B, 1A, were examined in mouse and human liver microsomes. 2. In mouse liver microsomes the IC50 values of pilocarpine were 6 microM for COH and testosterone 15 alpha-hydroxylase (T15 alpha OH) activities, 4 microM for PROD, approximately 100 microM for DMNA and testosterone 6 beta-hydroxylase (T6 beta OH) activities and > 1 mM for EROD activity. 3. In human liver microsomes, the IC50 value for COH was 6 microM and for DMNA 10 microM; T15 alpha OH and PROD activities were not detectable but T6 beta OH and testosterone 16 beta/2 beta-hydroxylase activities were moderately inhibited (IC50 70 microM). 4. These results suggest that pilocarpine has (i) a high affinity towards phenobarbitone-inducible CYP2A4/5 and CYP2B activities in mouse liver, (ii) a high affinity towards CYP2A6 in human liver microsomes and (iii) a moderate affinity towards CYP3A enzyme(s) in both microsomal preparations. 5. The low IC50 concentrations in vitro indicate potential metabolic interactions between pilocarpine and several P450 enzymes.

Aged↗

Cognitive functions after pilocarpine-induced status epilepticus: changes during silent period precede appearance of spontaneous recurrent seizures.

PURPOSE: To study the possible relation between spontaneous recurrent seizures (SRS) and the derangement of cognitive memory. METHODS: Status epilepticus (SE) was induced in adult Long-Evans rats by pilocarpine (320 mg/kg, i.p.) and interrupted after 2 h by clonazepam (CZPs mg/kg, i.p.). In addition to the animals that were given pilocarpine and CZP (group P), two groups received ketamine (100 mg/kg, i.p.): the first group 15 minutes after SE onset (group K15), and the second immediately after the CZP (group K120). Control groups were formed from animals not treated with pilocarpine as well as animals that received pilocarpine but did not develop motor seizures. Spatial cognitive memory was tested in the Morris water maze. RESULTS: Testing was impossible for more than 6 days after SE in group P. Ketamine shortened this period for the two groups that received it. During the silent period, deteriorated cognitive memory progressively improved, but the performance of group P started to worsen before the appearance of SRS. Group K120 only expressed a tendency toward declining performance, whereas group K15 never developed SRS, and the behavior of these animals did not differ from that of the controls after the postseizure period was over. Histologically, massive hippocampal cell loss was seen in group P. Ketamine protected hippocampal cells in a time-dependent manner; group K15 did not exhibit any obvious necrosis in the hippocampus. CONCLUSIONS: There is no close relation between cognitive functions and the appearance of SRS, because ketamine, administered 120 min after the beginning of SE, prevented the derangment of cognitive functions but not the appearance of SRSs.

Animals↗

Plastic changes and disease-modifying effects of scopolamine in the pilocarpine model of epilepsy in rats.

PURPOSE: We describe the use of a clinically relevant pharmacological intervention that alters the clinical history of status epilepticus (SE)-induced spontaneous recurrent seizures (SRS) in the pilocarpine model and the possible plastic changes underlying such an effect. METHODS: Two hours after pilocarpine-induced SE (320-350 mg/kg, i.p.), rats received scopolamine 1-2 mg/kg i.p. or saline, every 6 h for 3 days. After that, osmotic minipumps were implanted for continuous delivery of scopolamine or saline for an additional 14 days. Animals were video-monitored for 12 h/week during the following 3-month period for the occurrence of SRS and, thereafter, were perfused, processed, and coronal brain sections were stained for acetylcholinesterase (AChE) and for the presence of supragranular mossy fibers (Timm). RESULTS: Treatment with scopolamine led to significantly fewer SRS. Staining for AChE in the dentate gyrus was significantly more intense in naïve animals. The scopolamine group had the least intense AChE staining of all groups. However, regression analysis of the AChE staining for this group did not correlate with the presence or absence of SRS, or the latency or frequency of SRS. Supragranular mossy fiber sprouting developed in all animals experiencing pilocarpine-induced SE, irrespective of whether or not they were treated with scopolamine. CONCLUSIONS: Pilocarpine-induced SE in the presence of scopolamine might produce animals that, despite mossy fiber sprouting, were not seen to exhibit spontaneous seizures. In addition, our data suggest that the encountered changes in the AChE staining in the dentate gyrus that followed treatment with scopolamine do not help to explain its disease-modifying effects.

Acetylcholinesterase↗

Modulation of seizures and synaptic plasticity by adenosinergic receptors in an experimental model of temporal lobe epilepsy induced by pilocarpine in rats.

PURPOSE: Adenosine is a major negative neuromodulator of synaptic activity in the central nervous system and can exert anticonvulsant and neuroprotective effects in many experimental models of epilepsy. Extracellular adenosine can be formed by a membrane-anchored enzyme ecto-5'-nucleotidase. The purposes of this study were to characterize the role of adenosine receptors in modulating status epilepticus (SE) induced by pilocarpine and evaluate its neuroprotective action. Ecto-5'-nucleotidase activity was studied during the different phases of pilocarpine-induced epilepsy in rats. METHODS: Adult rats were pretreated with different adenosinergic agents to evaluate the latency and incidence of SE induced by pilocarpine in rats. The neuroprotective effect also was evaluated. RESULTS: A proconvulsant effect was observed with DPCPX and DMPX that reduced the latency of SE in almost all rats. Pretreatment with the MRS 1220 did not alter the incidence of SE but reduced the latency to develop SE. An anticonvulsant and neuroprotective effect was detected with R-PIA. Rats pretreated with R-PIA had a decreased number of apoptotic cells in the hippocampus, whereas pretreatment with DPCPX did not modify the hippocampal damage. An intensification of neuronal death was observed in the dentate gyrus and CA3 when rats were pretreated with DMPX. MRS-1220 did not modify the number of apoptotic cells in the hippocampus. An increase in the ecto-5 -nucleotidase staining was detected in the hippocampus during silent and chronic phases. CONCLUSIONS: The present data show that adenosine released during pilocarpine-induced SE via A1-receptor stimulation can exhibit neuroprotective and anticonvulsant roles. Similar effects could also be inferred with A2a and A3 adenosinergic agents, but further experiments are necessary to confirm their roles. Ecto-5 -nucleotidase activity during silent and chronic phases might have a role in blocking spontaneous seizures by production of inhibitory neuromodulator adenosine, besides taking part in the mechanism that controls sprouting.

5'-Nucleotidase↗

Inhibition of prolactin secretion and synthesis by dopamine, noradrenaline and pilocarpine in cultured rat pituitary tumour cells.

Clonal strains of rat pituitary tumour cells (GH3-cells) synthesize and secrete prolactin into a chemically defined culture medium. Short time treatment (0.5-2 hrs) of cell cultures with noradrenaline (10(-3) M) and dopamine (10(-3 M) reduced the spontaneous secretion of prolactin by 50% and 30%, respectively, while pilocarpine (10(-3) M) had no effect. Long-term treatment (20 hrs) with noradrenaline (10(-3)M) or with pilocarpine (10(-3) M) inhibited prolactin synthesis by 45% and 65% of control cultures, respectively. Neither compounds affected cell growth. The inhibitory effect of noradrenaline, but not that of pilocarpine, was completely reversed 4 hrs after cessation of treatment. Adrenaline, dopamine and acetylcholine in concentrations up to 10(-3) M did not change prolactin synthesis. In contrast thyroliberin treatment (2 X 10(-8)M) caused a 45% increase in prolactin secretion, and resulted in a 40% increase in hormone synthesis after treatment for 20 hrs. It is concluded that both noradrenaline and dopamine are able to inhibit prolactin section. Prolactin synthesis could be inhibited by noradrenaline and pilocarpine. How, only the effect of noradrenaline is easily reversible on cessation of treatment.

Animals↗

Modified beta-cyclodextrin (SBE7-beta-CyD) with viscous vehicle improves the ocular delivery and tolerability of pilocarpine prodrug in rabbits.

The complexation of pilocarpine prodrug, O,O'-dipropionyl-(1,4-xylylene) bispilocarpate, with various beta-cyclodextrin (beta-CyD) derivatives was studied by the phase solubility method. The effects of coadministered sulphobutyl ether beta-CyD (SBE7-beta-CyD) with and without poly(vinyl alcohol) (PVA) on the miotic response and eye irritation of the prodrug were investigated in pigmented rabbits. The pilocarpine prodrug formed 1:1 inclusion complexes with variably substituted sulphobutyl ether derivatives of beta-CyD (SBE4-beta-CyD and SBE7-beta-CyD), and 1:1 and 1:2 complexes with hydroxypropyl-beta-CyD (HP-beta-CyD) at pH 7-4. Coadministered SBE7-beta-CyD eliminated the eye irritation due to the pilocarpine prodrug, but also decreased the miotic response. Ocular absorption of the prodrug was improved by increasing the viscosity of prodrug/SBE7-beta-CyD solution with PVA without inducing any eye irritation. Eye irritation due to viscous prodrug/SBE7-beta-CyD solutions was comparable with isotonic NaCl solution. We conclude that administration of pilocarpine prodrug in viscous SBE7-beta-CyD solution decreases substantially eye irritation while ocular absorption is not affected.

Animals↗

Pilocarpine dispensation for the soft hydrophilic contact lens.

The use of hydrophilic soft contact lenses for dispensation of pilocarpine is described. The release rate of pilocarpine from three materials of different water content was estimated and from this the surface concentrations were calculated. It is estimated that PolyHEMA can after 15 hours provide a 1 per cent surface concentration of pilocarpine, whereas higher water content materials (70 and 85 per cent) halve this, although they provide a much higher concentration in the first few hours of use. These results are based upon pre-soaking in 4 per cent pilocarpine solution. Because contact lenses present a management problem, this method of dispensation will be used only for selected cases. Some clinical examples treated successfully over a 20 month period are discussed.

Contact Lenses, Hydrophilic↗

Effect of pilocarpine on visual acuity and on the dimensions of the cornea and anterior chamber.

The effect of pilocarpine on visual acuity and on the dimensions of the cornea, anterior chamber, and lens were studied in two groups of subjects. Significant changes in ocular tension, corneal curvature, anterior chamber depth, and lens anterior radius were found in a group of 55 glaucomatous eyes as a result of pilocarpine treatment, but there was no change in corneal thickness. Out of 102 glaucomatous eyes 78 became relatively myopic, and this appears to be due to changes in the dimensions of the lens of the eye similar to those occurring in accommodation, as a result of the effect of the drug on the ciliary muscle. The effect of pilocarpine on anterior chamber depth, area, and volume was studied in 125 eyes using a photographic method, and a significant reduction in the dimensions of the anterior chamber was observed as a result of the administration of pilocarpine. A significant correlation between depth and volume was also noted and the implications of this are discussed.

Adult↗

Effects of pilocarpine on the morphology of the human outflow apparatus.

The morphology of the outflow apparatus in human eyes which had been treated topically with either 2 or 4% pilocarpine on 4 occasions at 6-hourly intervals before enucleation was compared with an untreated control series of eyes from patients in a similar age range. In the pilocarpine-treated group the scleral spur was pulled posteriorly and internally, so that the angle formed by the scleral spur and the scleral sulcus was significantly greater in the treated than the untreated series. The change in attitude of the scleral spur produced widening of the spaces between the corneoscleral trabeculae and distension of the endothelial meshwork. It was shown from counts of giant vacuoles in the endothelium of Schlemm's canal that the incidence of giant vacuoles in the pilocarpine-treated group was greater than twice that in the controls. It would appear that pilocarpine produces alterations in the configuration of the outflow apparatus which would promote the drainage of aqueous humour.

Adult↗