Pilocarpine 2% Eye Drops

SCOPE: this is the whole of the adult posology in this SPC, and it covers this page's primary indication (miosis, and emergency treatment of acute narrow-angle glaucoma). §4.2, verbatim: 'Adults (including the elderly) Instil dropwise into the eye according to the recommended dosage. To induce miosis, one or two drops should be used. In cases of emergency treatment of acute narrow-angle glaucoma, one drop should be used every five minutes until miosis is achieved.' The strength is pinned by the product name: Minims Pilocarpine Nitrate 2% w/v. ADMINISTRATION: 'Directly after administration of any dose, the lacrimal punctum should be occluded for one minute with a finger to limit systemic exposure.' §4.4 adds: 'Systemic absorption may be reduced by compressing the lacrimal sac at the medial canthus for one minute during and following the instillation of the drops. (This blocks the passage of the drops via the naso-lacrimal duct to the wide absorptive area of the nasal and pharyngeal mucosa. It is especially advisable in children.)' NO MAXIMUM DOSE IS STATED - the SPC gives no numerical ceiling with an explicit maximum cue for adults (§4.2 refers to 'the maximum recommended adult dosage of the 2% pilocarpine eye drop solution' only when describing paediatric titration, without stating a figure). §4.4 warns that 'in the treatment of acute closed-angle glaucoma the possibility of systemic reactions must be considered because of the higher doses given.'

NO PAEDIATRIC POSOLOGY EXISTS IN THIS SPC - dosePerKg is deliberately null and there is no per-kg or per-m2 figure anywhere in the bundle; do not calculate a weight-based dose from this entry. §4.2 'Paediatric population', verbatim: 'Based on the infrequency of reports of adverse events in children, and the extensive experience of use of pilocarpine in childhood glaucoma, concentrations of up to 2% may be safely used in children. Currently available data are described in section 5.1 but no recommendation on a posology can be made. Treatment should be started with the lowest available dose and concentration in patients under 18 years of age. Depending on clinical response and tolerability, the dose may be increased up to the maximum recommended adult dosage of the 2% pilocarpine eye drop solution.' 'Directly after administration of any dose, the lacrimal punctum should be occluded for one minute with a finger to limit systemic exposure' - §4.4 notes this is 'especially advisable in children'. The SPC says only to start with the lowest available dose and concentration. Verify the paediatric dose against a children's formulary.