Sjogren's, pilocarpine treatment and potential ocular side effects
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Wiil taking pilocarpine for advanced Sjogren's symptoms cause higher risks of ocular side effects for an older person with macular degeneration?
This person has lost the central vision in her right eye due to age related wet MD. We are obviously worried about the same thing happening to her left eye so we are on constant alert. Two years ago she lost some vision to this left eye due to a stubborn keratitis to the cornea caused by a severe dry eye that took almost 3 months to treat. She also has high risk potential for detached retina. Furthermore, she has an interocular lens in the left eye that is slightly displaced.
My mom has advanced Sjogren's and in addition to the dry eye, she can't produce enough saliva which makes it very difficult for her to swallow food, take medications, etc. There have been several instances where she's almost choked and emergency services have been called out. We give her soft food and purées as often as possible but pills often get stuck in her dry throat. She recently saw a rheumatologist who has put her on pilocarpine to try to stimulate her salivary glands, if they are not already destroyed.
The swallowing problem is very serious but with only one, very dodgy eye left, I was wondering if taking pilocarpine is going to increase the risk of her losing her vision altogether?
0 likes, 4 replies
robert93685 Augustin
Posted
Pilocarpine is derived from a shrub in the Amazon rain forest. The natives knew one of the effects was to cause salivation or slobbering. It became the main treatment for glaucoma but pilocarpine drops in the eye make the pupil very small so less light goes in and everything seems dark. The use of pilocarpine has markedly reduced because now there are more modern longer acting treatments. Rarely pilocarpine can cause retinal detachment (in eyes with existing retinal tears). I have no experience in pilocarpine taken by mouth but expect the ocular side-effects to be less than when taken as eyedrops.
Having a dry mouth causes severe swallowing difficulties. I suggest you try the oral pilocarpine during the day time. The effect on the eye is likely to last about 4 to 6 hours with a small pupil, dim vision, blurred distance vision, yet perhaps better near vision, the displaced lens may be less evident when the pupil is small. Remember dim vision can be a problem in the middle of the night when going to the bathroom. It won't have a direct effect on macular degeneration.
If the pilocarpine helps lubricate her throat that will be wonderful - if not then it can be stopped and there should not be any lasting change to her eye symptoms.
Augustin robert93685
Posted
Thanks very much for your reply. Greatly appreciated and spot on.
Just to get current, I had to take my mom off pilocarpine after 9 days due to side effects that had nothing to do with her vision.
It's a shame as her dry throat condition (xerostomia due to Sjogrean's) had improved. She wasn't salivating but her throat was more moist so she could swallow food and meds with no problem. However on the 6th day she was beginning to urinate more frequently and for an 85 year old woman with mobility problems, that was scary. Then on the 8th might she started swaeting profusely (guess her sweat glands aren't as atrophied as her lacrimal and salivary glands). She was shivering, trembing and feeling quite dizzy. She spent the 9th day in bed but the poor thing had wet herself (in bed!)
Her vision wasn't disturbed during the 9 days. She might have had less glare (esp around the issue with the displaced lens).
I must admit I am actually relieved that she's off the pilocarpine because with only one, dodgy eye, I was worried about taking any risks, no matter how small. So I am sleeping better!
Thanks again
robert93685 Augustin
Posted
Whether it is possibe to use a smaller dose I don't know (the tablets are 5 mg and may not be scored to split the dose).
You could try 1 or 2 drops of pilocarpine 2% eyedrops in a little water by mouth. Beware 5 drops would be too much being equivalent to 1 tablet.
Any sweating, dizzyness, confusion or urinary symptoms mean the dose is too great.
Otherwise stick to all the non-pharmacological methods: including so called artificial salivas. Gloopy stuff probably based on seaweed and slippery food such as avocado.
Augustin robert93685
Posted
The pilocarpine eye drops in a little water sounds very interesting. Might try it when things settle down. We will look into the artificial saliva as well.
Just to note, the normal dose is 5mg 4x per day. The tablets were scored. The Rheumatologist put her on 3 tablets so she was on 75% of the dosage. Didn't expect the toxicity... amazing!
cheers
A