Pilocarpine Disease Interactions

The use of cholinergic agonists is contraindicated in patients with uncontrolled reactive airway disease. Cholinergic agonists inhibits the hydrolysis of acetylcholine. The enhanced effect of acetylcholine produces constriction of the bronchi, increased bronchial secretions, and bronchospasm.

The use of cholinergic agonists, such as bethanechol and pilocarpine, is contraindicated in patients with pronounced bradycardia, hypotension/hypertension, coronary artery disease or conduction disorders.

The use of cholinergic agonists is contraindicated in patients with peptic ulcers, mechanical GI obstruction, acute GI inflammatory conditions, or urinary obstruction. Cholinergic activity may result in an increase in gastric acid secretion, GI motility, and gastric contractions. In patients with urinary retention, urinary reflux may occur if the sphincter fails to relax when the bladder is contracted by cholinergic stimulation. The reflux of urine from the bladder can cause infection in the kidneys and upper urinary tract if bacteriuria is present.

The use of cholinergic agents may be contraindicated in patients with hyperthyroidism. Atrial fibrillation has occurred in hyperthyroid patients administered a cholinergic agonist.

The use of cholinergic agonists may be contraindicated in patients with parkinsonism. Cholinergic agonists directly stimulates the parasympathetic nervous system inducing acetylcholinergic effects. Symptoms of Parkinson's disease may be exacerbated.

The use of cholinergic agonists may be contraindicated in patients with seizure disorders. Cholinomimetics have been associated with convulsions.

The use of pilocarpine is contraindicated in conditions where miosis is undesirable, such as acute iritis and in narrow-angle (angle closure) glaucoma.

Pilocarpine should be administered with caution to patients with known or suspected cholelithiasis or biliary tract disease. Contractions of the gallbladder or biliary smooth muscle could precipitate complications including cholecystitis, cholangitis, and biliary obstruction.

Pilocarpine may increase ureteral smooth muscle tone and could theoretically precipitate renal colic (or ureteral reflux), particularly in patients with nephrolithiasis. Caution is advised when used on these patients.