Pilocarpine 4% and 2%

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D.I.Stiller - 21 Mar 2004 15:49 GMT

A patient takes Trusopt, Tiloptic, Alphagan and Pilocarpine 4%.
Pressure : 15-18.

Pilocarpine 4% was replaced by Pilocarpine 2%.
After 2-3 days pressure increased until 24 and 37.

Could that replacement cause such sudden change?

D.I.Stiller

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Rick Cohn, M.D. - 22 Mar 2004 04:17 GMT

> A patient takes Trusopt, Tiloptic, Alphagan and Pilocarpine 4%.
> Pressure : 15-18.
[quoted text clipped - 5 lines]
>
> D.I.Stiller

yes it could.

--Rick Cohn, MD
Glaucoma specialist
Winter Park, FL

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D.I.Stiller - 22 Mar 2004 05:09 GMT

> > A patient takes Trusopt, Tiloptic, Alphagan and Pilocarpine 4%.
> > Pressure : 15-18.
[quoted text clipped - 7 lines]
>
> yes it could.

If it is possible, a bit more details.
What is the difference between Pilocarpine 4% and 2% in this context?
What exactly could cause that?

Is there any description of such situation?

> --Rick Cohn, MD
> Glaucoma specialist
> Winter Park, FL

Thanks,
D.I.Stiller

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D.I.Stiller - 08 Apr 2004 15:24 GMT

> > > A patient takes Trusopt, Tiloptic, Alphagan and Pilocarpine 4%.
> > > Pressure : 15-18.
[quoted text clipped - 13 lines]
>
> Is there any description of such situation?

[snip]

Any information would appreciated.

Thanks,
D.I.Stiller

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Rick Cohn, M.D. - 09 Apr 2004 02:28 GMT

> > > > A patient takes Trusopt, Tiloptic, Alphagan and Pilocarpine 4%.
> > > > Pressure : 15-18.
[quoted text clipped - 20 lines]
> Thanks,
> D.I.Stiller

Pilocarpine 4% is simply much stronger than 2%...I never switch anyone
from 4% to 2%...only the other way around. Often I have had patients
who I progressed rapidly from 1% to 2% and then to 4% over a 2 - 3
month period if their IOP wasn't controlled well enough. If 2% didn't
do the job, 4% often did. Not much else to say here.
--Dr. Cohn

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