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NDC 00998-0204-15 ISOPTO CARPINE 20 mg/mL Details
ISOPTO CARPINE 20 mg/mL
ISOPTO CARPINE is a OPHTHALMIC SOLUTION/ DROPS in the HUMAN PRESCRIPTION DRUG category. It is labeled and distributed by Alcon Laboratories, Inc.. The primary component is PILOCARPINE HYDROCHLORIDE.
MedlinePlus Drug Summary
Pilocarpine ophthalmic is used to treat glaucoma (a condition in which increased pressure in the eye can lead to gradual loss of vision) and ocular hypertension (a condition which causes increased pressure in the eye). Pilocarpine ophthalmic is also used to prevent or reduce increased pressure in the eye during and after certain types of laser eye surgery. It is also used during an eye exam to constrict (close) the pupil (the black part of the eye through which you see). Pilocarpine ophthalmic (Vuity) is used to treat presbyopia (a condition in which the lens of the eye loses its ability to focus making hard to see objects up close). Pilocarpine is in a class of medications called miotics. Pilocarpine ophthalmic treats glaucoma and ocular hypertension by allowing excess fluid to drain from the eye. Pilocarpine ophthalmic treats presbyopia by reducing the size of the pupils which helps to see objects up close.
Related Packages: 00998-0204-15Last Updated: 11/30/2022
MedLinePlus Full Drug Details: Pilocarpine Ophthalmic
Product Information
| NDC | 00998-0204 |
|---|---|
| Product ID | 0998-0204_b07b9126-1edd-4fbe-b68d-a03533346dad |
| Associated GPIs | 86501030102020 |
| GCN Sequence Number | 007824 |
| GCN Sequence Number Description | pilocarpine HCl DROPS 2 % OPHTHALMIC |
| HIC3 | Q6G |
| HIC3 Description | MIOTICS AND OTHER INTRAOCULAR PRESSURE REDUCERS |
| GCN | 32706 |
| HICL Sequence Number | 005198 |
| HICL Sequence Number Description | PILOCARPINE HCL |
| Brand/Generic | Brand |
| Proprietary Name | ISOPTO CARPINE |
| Proprietary Name Suffix | n/a |
| Non-Proprietary Name | pilocarpine hydrochloride |
| Product Type | HUMAN PRESCRIPTION DRUG |
| Dosage Form | SOLUTION/ DROPS |
| Route | OPHTHALMIC |
| Active Ingredient Strength | 20 |
| Active Ingredient Units | mg/mL |
| Substance Name | PILOCARPINE HYDROCHLORIDE |
| Labeler Name | Alcon Laboratories, Inc. |
| Pharmaceutical Class | Cholinergic Agonists [MoA], Cholinergic Muscarinic Agonists [MoA], Cholinergic Receptor Agonist [EPC] |
| DEA Schedule | n/a |
| Marketing Category | NDA |
| Application Number | NDA200890 |
| Listing Certified Through | n/a |
Package
Package Images
NDC 00998-0204-15 (00998020415)
| NDC Package Code | 0998-0204-15 |
|---|---|
| Billing NDC | 00998020415 |
| Package | 1 BOTTLE in 1 CARTON (0998-0204-15) / 15 mL in 1 BOTTLE |
| Marketing Start Date | 1974-01-01 |
| NDC Exclude Flag | N |
| Pricing Information | N/A |
Standard Product Labeling (SPL)/Prescribing Information SPL 22e4c7f4-bbd0-4e74-85da-bb56fc377568 Details
HIGHLIGHTS OF PRESCRIBING INFORMATION
ISOPTO® CARPINE (pilocarpine hydrochloride ophthalmic solution)
Initial U.S. Approval: 1974
INDICATIONS AND USAGE
Isopto Carpine is a muscarinic cholinergic agonist indicated for:
DOSAGE AND ADMINISTRATION
- Instill one drop in the eye(s) up to four times daily. (2)
DOSAGE FORMS AND STRENGTHS
- Solution containing 1% (10 mg/mL), 2% (20 mg/mL) or 4% (40 mg/mL) pilocarpine hydrochloride. (3)
CONTRAINDICATIONS
None. (4)
WARNINGS AND PRECAUTIONS
- Poor Illumination: Exercise caution in night driving and other hazardous occupations in poor illumination. (5.1)
- Preexisting Retinal Disease: Rare cases of retinal detachment have been reported; a thorough examination of the retina, including funduscopy is advised in all patients prior to the initiation of therapy. (5.2)
- Iritis: Caution is advised in patients with iritis. (5.3)
- Congenital Glaucoma: Caution is advised in pediatric patients with primary congenital glaucoma for control of IOP as cases of a paradoxical increase in IOP have been reported. (5.4)
ADVERSE REACTIONS
Most common adverse reactions are headache/browache, accommodative change, eye irritation, eye pain, blurred vision, and/or visual impairment. (6.1)
To report SUSPECTED ADVERSE REACTIONS, contact Novartis Pharmaceuticals Corporation at 1-888-669-6682 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
See 17 for PATIENT COUNSELING INFORMATION.
Revised: 5/2020
Table Of Contents
FULL PRESCRIBING INFORMATION: CONTENTS*
1 INDICATIONS AND USAGE
1.1 Reduction of Elevated Intraocular Pressure (IOP) in Patients With Open-Angle Glaucoma or Ocular Hypertension
1.2 Management of Acute Angle-Closure Glaucoma
1.3 Prevention of Postoperative Elevated IOP Associated With Laser Surgery
1.4 Induction of Miosis
2 DOSAGE AND ADMINISTRATION
2.1 Reduction of Elevated IOP in Patients With Open-Angle Glaucoma or Ocular Hypertension
2.2 Management of Acute Angle-Closure Glaucoma
2.3 Prevention of Postoperative Elevated IOP Associated With Laser Surgery
2.4 Induction of Miosis
2.5 Use With Other Topical Ophthalmic Medications
2.6 Use in Pediatric Patients
3 DOSAGE FORMS AND STRENGTHS
4 CONTRAINDICATIONS
5 WARNINGS AND PRECAUTIONS
5.1 Poor Illumination
5.2 Preexisting Retinal Disease
5.3 Iritis
5.4 Primary Congenital Glaucoma
5.5 Contact Lens Wear
6 ADVERSE REACTIONS
6.1 Clinical Trials Experience
8 USE IN SPECIFIC POPULATIONS
8.1 Pregnancy
8.3 Nursing Mothers
8.4 Pediatric Use
8.5 Geriatric Use
10 OVERDOSAGE
11 DESCRIPTION
12 CLINICAL PHARMACOLOGY
12.1 Mechanism of Action
12.3 Pharmacokinetics
13 NONCLINICAL TOXICOLOGY
13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility
14 CLINICAL STUDIES
16 HOW SUPPLIED/STORAGE AND HANDLING
17 PATIENT COUNSELING INFORMATION
- *
- Sections or subsections omitted from the full prescribing information are not listed.
1 INDICATIONS AND USAGE
2 DOSAGE AND ADMINISTRATION
2.1 Reduction of Elevated IOP in Patients With Open-Angle Glaucoma or Ocular Hypertension
One drop of Isopto® Carpine 1%, 2%, or 4% should be applied topically in the eye(s) up to four times daily. Pilocarpine-naïve patients should be started on the 1% concentration as higher concentrations are often not tolerated initially. The frequency of instillation and concentration of Isopto® Carpine are determined by the severity of the elevated intraocular pressure and miotic response of the patient.
To limit systemic exposure to pilocarpine, patients may be instructed to perform punctal occlusion for 2 minutes after instillation of Isopto® Carpine ophthalmic solution.
2.2 Management of Acute Angle-Closure Glaucoma
Prior to Isopto® Carpine use, treatment with secretory suppressants and hyperosmotic agents may be needed to lower IOP below 50 mmHg and relieve iris ischemia. For initial management of acute angle-closure glaucoma, one drop of Isopto® Carpine 1% or 2% may be applied topically in the eye(s) up to three times over a 30-minute period.
If laser iridoplasty or iridomy is used to break the attack, one drop of Isopto® Carpine 4% should be administered prior to the procedure. Following laser iridoplasty, one drop of Isopto® Carpine 1% should be administered four times daily until an iridotomy can be performed.
2.3 Prevention of Postoperative Elevated IOP Associated With Laser Surgery
One drop of Isopto® Carpine 1%, 2%, or 4% (or two drops administered five minutes apart) should be applied topically in the eye(s) 15 to 60 minutes prior to surgery.
2.4 Induction of Miosis
One drop of Isopto® Carpine 1%, 2%, or 4% (or two drops administered five minutes apart) should be applied topically in the eye(s).
2.5 Use With Other Topical Ophthalmic Medications
Isopto® Carpine may be used in combination with beta-blockers, carbonic anhydrase inhibitors, sympathomimetics or hyperosmotic agents. If more than one topical ophthalmic drug is being used, the drugs should be administered at least five minutes apart.
2.6 Use in Pediatric Patients
In children under 2 years of age, one drop of Isopto® Carpine 1% should be applied topically in the eye(s) three times daily. Children 2 years of age and over should be dosed as for adults. For the induction of miosis prior to goniotomy or trabeculotomy in children, one drop of Isopto® Carpine 1% or 2% should be applied topically in the eye 15 to 60 minutes prior to surgery.
3 DOSAGE FORMS AND STRENGTHS
5 WARNINGS AND PRECAUTIONS
5.1 Poor Illumination
Patients should be advised to exercise caution in night driving and other hazardous occupations in poor illumination. In addition, miotics may cause accommodative spasm. Patients should be advised not to drive or use machinery if vision is not clear.
5.2 Preexisting Retinal Disease
As with all miotics, rare cases of retinal detachment have been reported when used in certain susceptible individuals and those with preexisting retinal disease; therefore, a thorough examination of the retina including funduscopy is advised in all patients prior to the initiation of therapy.
5.4 Primary Congenital Glaucoma
Caution is advised when using Isopto® Carpine in pediatric patients with primary congenital glaucoma for control of IOP as cases of a paradoxical increase in IOP have been reported. In addition, the use of Isopto® Carpine is not recommended in pediatric patients diagnosed with glaucoma secondary to anterior segment dysgenesis or uveitis (especially if uveitis is active).
6 ADVERSE REACTIONS
6.1 Clinical Trials Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
The safety data described below reflect exposure in four controlled clinical trials of 90 days to 2 years duration in 317 patients diagnosed with open-angle glaucoma or ocular hypertension. In the four clinical trials, patients were treated with Isopto® Carpine 2%, two to four times daily or with pilocarpine 1%, 1.75%, or 2% in fixed combination with betaxolol 0.25%, two or three times daily. The most frequently reported adverse reactions occurring in ≥ 5% of patients in the pilocarpine 2% populations were: headache/brow ache, accommodative change, blurred vision, eye irritation, visual impairment (dim, dark, or “jumping” vision), and eye pain.
The adverse reaction profile reported for the use of Isopto® Carpine in pediatric patients is comparable to that seen in adult patients.
8 USE IN SPECIFIC POPULATIONS
8.1 Pregnancy
Pregnancy. Category C. Animal reproduction studies have not been conducted with pilocarpine hydrochloride. It is also not known whether pilocarpine hydrochloride can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Isopto® Carpine should be given to a pregnant woman only if clearly needed.
8.3 Nursing Mothers
It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Isopto® Carpine is administered to a nursing woman.
10 OVERDOSAGE
Systemic toxicity following topical ocular administration of pilocarpine is rare, but occasionally patients who are sensitive may develop sweating and gastrointestinal overactivity following the suggested dosage and administration. Overdosage can produce sweating, salivation, nausea, tremors and slowing of the pulse and a decrease in blood pressure. In moderate overdosage, spontaneous recovery is to be expected and is aided by intravenous fluids to compensate for dehydration. For patients demonstrating severe poisoning, atropine, the pharmacologic antagonist to pilocarpine, should be used.
11 DESCRIPTION
Isopto® Carpine (pilocarpine hydrochloride ophthalmic solution) is a cholinergic agonist prepared as a sterile topical ophthalmic solution. The active ingredient is represented by the chemical structure:
Established name: pilocarpine hydrochloride
Chemical name: 2(3H)-furanone, 3-ethyldihydro-4-[(1-methyl-1H-imidazol-5-yl)-methyl]-monohydrochloride, (3S-cis)-. Molecular Formula: C11H16N2O2 • HCl; Molecular Weight: 244.72 g/mol.
Each mL of Isopto® Carpine (pilocarpine hydrochloride ophthalmic solution) contains:
Active: pilocarpine hydrochloride 1% (10 mg/mL), 2% (20 mg/mL), or 4% (40 mg/mL).
Preservative: benzalkonium chloride 0.01%.
Inactives: hypromellose 2910, boric acid, sodium citrate, sodium chloride (present in 1% only); hydrochloric acid and/or sodium hydroxide (to adjust pH); purified water. Isopto® Carpine has a pH of 3.5 to 5.5 and an osmolality of 290 to 350 mOsm/kg (1% and 2% products) and 550 to 600 mOsm/kg (4% product).
12 CLINICAL PHARMACOLOGY
12.1 Mechanism of Action
Pilocarpine hydrochloride is a direct acting cholinergic parasympathomimetic agent which acts through direct stimulation of muscarinic receptors and smooth muscle such as the iris and secretory glands. Pilocarpine contracts the ciliary muscle, causing increased tension on the scleral spur and opening of the trabecular meshwork spaces to facilitate outflow of aqueous humor. Outflow resistance is reduced, lowering IOP. Pilocarpine also produces miosis through contraction of the iris sphincter muscle. Miosis relieves appositional angle narrowing and closure, which lowers IOP in certain types of angle-closure glaucoma.
12.3 Pharmacokinetics
Systemic exposure to pilocarpine was evaluated in 14 healthy subjects administered 2 drops of Isopto® Carpine (pilocarpine hydrochloride ophthalmic solution) 4% to both eyes four times daily for eight days. A comparison of Cmax values on Days 5 and 8 indicated that pilocarpine concentrations in plasma reached steady-state following topical administration of Isopto® Carpine 4%. The mean (SD) Cmax and AUC0-last values on Day 8 were 3.7 (3.2) ng/mL and 7.7 (8.4) ng×hour/mL, respectively. The Tmax values on Day 8 ranged from 0.5 to 1 hour.
13 NONCLINICAL TOXICOLOGY
14 CLINICAL STUDIES
In clinical trials reported in the medical literature, pilocarpine ophthalmic solution reduced IOP by 3-7 mmHg in patients with open-angle glaucoma. Pilocarpine ophthalmic solution has also been shown to be effective in the induction of miosis, in the prevention of postoperative elevated IOP, and in the management of acute angle-closure glaucoma.
16 HOW SUPPLIED/STORAGE AND HANDLING
Isopto® Carpine (pilocarpine hydrochloride ophthalmic solution) 1%, 2%, and 4% is supplied sterile in natural low density polyethylene plastic ophthalmic ®dispensers and green low density polyethylene tips with green polypropylene caps.
15 mL in 15 mL bottles
1%: NDC 0998-0203-15
2%: NDC 0998-0204-15
4%: NDC 0998-0206-15
STORAGE: Store at 20°C to 25°C (68° to 77°F), excursions permitted between 15°C and 30°C (59°F and 86°F) [see USP Controlled Room Temperature]. Protect from freezing.
17 PATIENT COUNSELING INFORMATION
Avoiding Contamination of the Product
Do not touch dropper tip to any surface, as this may contaminate the contents.
Night Driving
Caution is advised with night driving and when hazardous activities are undertaken in poor illumination.
Accommodative Spasm
Isopto® Carpine ophthalmic solution may cause problems when changing focus between near objects and distant objects. Do not drive or use machinery if vision is not clear.
Contact Lens Wear
Contact lens should be removed prior to the instillation of Isopto® Carpine ophthalmic solution. Wait 10 minutes after dosing before reinserting contact lenses.
Concomitant Topical Ocular Therapy
If more than one topical ophthalmic medication is being used, the medicines must be administered at least 5 minutes apart.
Systemic Exposure
To limit exposure to pilocarpine to the eye alone, close eyes gently and apply pressure with finger to the corner of eye by the nose for 2 minutes after instillation of Isopto® Carpine ophthalmic solution.
Distributed by:
Novartis Pharmaceuticals Corporation
East Hanover, New Jersey 07936
© Novartis
T2020-78
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INGREDIENTS AND APPEARANCE
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| Labeler - Alcon Laboratories, Inc. (008018525) |