Pilocarpine and Dipivefrin Ophthalmic: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Pilocarpine
Dipivefrin Ophthalmic
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Increased myopia
Interaction Deep Dive
An interaction between dipivefrin, a prodrug of epinephrine, and a pilocarpine Ocusert(R) system that caused a transient increase in myopia has been reported. Neither dipivefrin alone nor the combination of dipivefrin and timolol had this effect in a patient with chronic open-angle glaucoma1.
Why it happens (mechanism)
Increased sympathetic tone
Literature reports
1 report — tap to read
a) An interaction between dipivefrin and a pilocarpine Ocusert(R) system that caused a transient increase in myopia has been documented. The case involved a 34-year-old man with chronic open angle glaucoma who utilized the pilocarpine Ocusert(R)-40 as initial therapy. New refraction improved his visual acuity to 20/20 in both eyes following institution of pilocarpine therapy. Timolol maleate 0.5% was added to the regimen without further refractive change, but progressive cupping led to the addition of 0.1% dipivefrin in both eyes. The following visit, the patient complained of blurred distant vision for two hours after instillation of dipivefrin. Further testing via manifest refraction revealed that both dipivefrin and 2% epinephrine, but not artificial tears, increased myopia from baseline. Neither dipivefrin alone nor the combination of dipivefrin and timolol had this same effect 1.
Common questions
Can I take Pilocarpine and Dipivefrin Ophthalmic together?
Increased myopia Always confirm with your pharmacist or prescriber before making any change.
How serious is the Pilocarpine and Dipivefrin Ophthalmic interaction?
It is rated minor. Usually limited clinical impact.
How quickly could this interaction happen?
The documented onset is "rapid". Effects can appear quickly, often within about 24 hours of combining the drugs.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Pilocarpine or Dipivefrin Ophthalmic need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there anything you'd monitor while I'm on both?
References (1)
- Duffey RJ & Ferguson JG: Interaction of dipivefrin and epinephrine with the pilocarpine ocular therapeutic system (Ocusert). Arch Ophthalmol 1986; 104:1135-1136. PubMed
Keep reading about Pilocarpine
Keep reading about Dipivefrin Ophthalmic
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