0.05% Pilocarpine drops - an unbelievable study!

[teddy1324]

I was recently prescribed oral Pilocarpine to help with my tear production, as I score a 2 in schirmers tests, and have been suffering since taking roaccutane 3 and a half years ago. However, there is no evidence that oral pilocarpine actually increases tear production. It seemed logical to me that Pilocarpine drops applied topically would have a much greater effect, and so I did some research. After sifting through pages of irrelevance, (it was all related to pilocarpine pills when I was searching for the effect of drops on dry eye) I finally found a study. The results are astonishing. I'll paste the most important part here:

"Result: Topical pilocarpine 0.05% significantly increased the tear production from a Schirmer’s I baseline of 4.09 mm ± 1.30 to 12.46 mm ± 9.02 after 2 months (p <0.01). Symptoms improved with noted decreased OSDI score from 33.72 ± 24.88 to 13.84 ± 8.98 (p = 0.01). There was no increase in pupil size."

That's right - it increases tear production from an average of 4mm to about 12 and a half. That's an improvement of more than 8mm. To put that in context, Cyclosporine increases tear production by an average of about 1mm at most, and usually even then takes about 6 months to take full effect. These patients met the criteria for severe dry eye with a 4mm schirmers score, but by the end of the study would be classified as being on the the lower end of the normal spectrum with tear production at 12mm. No current treatment comes even close to this. Why has this not been more widely publicised? Why is more research not being done on this? This seems on the face of it to be everything I and many of you have been searching for.

I have emailed several eye specialists whose care I am under, asking to be prescribed this immediately on a trial basis to see if it works. If/when this happens, I will keep you updated. In the mean time, I'd love to know your thoughts on this.

The study has been published here: http://paojournal.com/vol39no1/downloads/004.pdf

[nori2015]

Very interesting! Never heard of it, wonder why that is?

[waterbee]

Oh this is very interesting - what is this actual drug? Steroid? Antibiotic? Vitamin? If love to know more about it. I've not heard of it before. Keep us updated.

[unicorn]

Topical pilocarpine is used as a glaucoma medication. Teddy1324, you will notice in the article you posted it does say there is evidence that oral pilocarpine has been shown to benefit dry eye.

"In a study by Vivino using oral pilocarpine, it showed significant improvement in symptoms of dry mouth, dry eyes, and other xeroses in patients with Sjogren’s syndrome.7 Similar results were observed by Papas using a higher dose that was shown to be more beneficial.8 Oral pilocarpine was also reported to help in dry eye induced by radiation therapy.9"

[grant555]

this study involved 11 people...just saying

[Betsy]

I tried Evoxac oral a decade ago and what a disaster that was! They said less side effects with it than oral pilocarpine, which is nuts since Evo was evil haha. Anyway, if the preservative is not a harsh one or better yet comes in preservative free vials (don't I wish), then how do we get it? Is it through a regular or compounding pharmacy?

Grant, you are right, 11 people in a study is nothing. But I know if 11 people came on here to say something was great, we'd all take notice. I guess I trust us more than study results but in my desperate state, I figure it's another thing to try if there much aren't side effects.

This study below says topical pilocarpine uses phenylmercuric nitrate as the preservative and that it's a preservative that causes problems. What can we do about these bad preservatives they keep using ? Maybe as a big group we can make a change? It's getting ridiculous, if not BAK, then other harmful preservatives are used in drops that are suppose to help us; steroid drops, antibiotic drops etc...

http://www.ncbi.nlm.nih.gov/pubmed/22920012

[teddy1324]

Topical pilocarpine is used as a glaucoma medication. Teddy1324, you will notice in the article you posted it does say there is evidence that oral pilocarpine has been shown to benefit dry eye.

"In a study by Vivino using oral pilocarpine, it showed significant improvement in symptoms of dry mouth, dry eyes, and other xeroses in patients with Sjogren’s syndrome.7 Similar results were observed by Papas using a higher dose that was shown to be more beneficial.8 Oral pilocarpine was also reported to help in dry eye induced by radiation therapy.9"

Yes; there is evidence that it helps subjective symptoms and OSDI scores, but no evidence that it helps improve tear production. The drops, on the other hand, show a huge improvement in tear production at a level which is unprecedented.

[teddy1324]

Oh this is very interesting - what is this actual drug? Steroid? Antibiotic? Vitamin? If love to know more about it. I've not heard of it before. Keep us updated.

It's none of the above. It's derived from a Brazilian pilocarpus microphyllus plant. It's a parasympathomimetic agent, meaning it stimulates the parasympathetic nervous system, which is presumably why it causes the eyes to produce many more tears if applied topically. Taken orally, it causes me to salivate and sweat excessively, for the same reason.

[teddy1324]

this study involved 11 people...just saying

I share your reservations, but the enormity of the mean increase in tear production is such that for this result to be anomalous is almost an impossibility; people who have 4mm or less schirmers scores would be ever so unlikely to show an average threefold improvement, purely coincidentally, at the time this trial was being done.

[teddy1324]

I tried Evoxac oral a decade ago and what a disaster that was! They said less side effects with it than oral pilocarpine, which is nuts since Evo was evil haha. Anyway, if the preservative is not a harsh one or better yet comes in preservative free vials (don't I wish), then how do we get it? Is it through a regular or compounding pharmacy?

Grant, you are right, 11 people in a study is nothing. But I know if 11 people came on here to say something was great, we'd all take notice. I guess I trust us more than study results but in my desperate state, I figure it's another thing to try if there much aren't side effects.

This study below says topical pilocarpine uses phenylmercuric nitrate as the preservative and that it's a preservative that causes problems. What can we do about these bad preservatives they keep using ? Maybe as a big group we can make a change? It's getting ridiculous, if not BAK, then other harmful preservatives are used in drops that are suppose to help us; steroid drops, antibiotic drops etc...

http://www.ncbi.nlm.nih.gov/pubmed/22920012

To get it in the 0.05% concentration used in the study, you would need to use a compound pharmacist, which is what I intend to do. I will ask if they can give it to me preservative free, though if they can't I will try it anyway; I expect if it works and my tear production is tripled then I will be less sensitive to the stinging from preservatives anyway.

[Betsy]

To get it in the 0.05% concentration used in the study, you would need to use a compound pharmacist, which is what I intend to do. I will ask if they can give it to me preservative free, though if they can't I will try it anyway; I expect if it works and my tear production is tripled then I will be less sensitive to the stinging from preservatives anyway.

Hi Teddy, I look forward to hearing how this works out for you. I would be willing to try it with a preservative if it's a less harsh one than the common BAK. There are people who developed dry eyes from BAK alone when used long periods. There are such people on this very board. But what is a long period? And is that period shortened for people already suffering from dry eyes? We're all different, so it's scary to use BAK not knowing at what point it can cause irreversible damage. So I encourage you if you have the ability to do so, to request another preservative if it cannot be made preservative free in individual vials. Just my 2 cents, don't want anyone out there getting worse.

[grant555]

let us know how it goes. although my issue is not ATD so probably wouldnt help me. i suspect it will be hard to find a compounding pharmacy to make this if its very unusual.

[alb1967]

I asked my Dr about this study. He said he did have one patient that wanted to try it. She had underwhelming results he said. He said I can try it if I wanted but the drops would have to come from a compounded pharmacy which I am sure would be expensive and I have to pay full price until I reach my deductible so I decided against it.