Miokarpin 2% eye drops, solution – pilocarpine for glaucoma and raised eye pressure

Miokarpin contains pilocarpine hydrochloride, a parasympathomimetic medicine (a muscarinic receptor stimulant). Dropped into the eye, it constricts the pupil (a miotic) and improves the outflow of aqueous humour, which lowers raised pressure in the eye.

In Serbia it is authorised as Miokarpin, 20 mg/ml (2%), eye drops, solution (Hemofarm AD Vršac), in a 10 ml dropper bottle. According to the leaflet, it is a third-line medicine for raised eye pressure and is usually used together with other medicines, e.g. beta-blockers or sympathomimetics.

What are Miokarpin eye drops used for and how are they applied correctly?

Key facts about the medicine

What is Miokarpin used for?

According to the package leaflet, Miokarpin is used as a miotic (a medicine that constricts the pupil):

• to lower raised intraocular pressure in open-angle glaucoma or ocular hypertension;
• in acute angle-closure glaucoma;
• to prevent a postoperative rise in eye pressure after laser surgery;
• to induce miosis (constriction of the pupil).

How is it taken and dosed?

The concentration and frequency are decided by the doctor. Usually 1–2 drops of the 2% solution are applied several times a day (1–6 times, on average 3–4 times). According to the leaflet:

• Wash your hands, tilt your head back, pull down the lower lid and apply the drop without touching the eye with the bottle tip.
• After applying, close the eye and press the inner corner of the eye with a finger for 1 minute – this reduces the amount of medicine reaching the bloodstream.
• If you use more than one type of eye drop, wait at least 5 minutes between them.
• Do not use the solution if it is cloudy or discoloured; close the bottle tightly after use.

Special patient groups

• Children: concentrations up to 2% may be safe; treatment starts with the lowest available dose and concentration, and the doctor increases it if needed.
• Elderly: use is as safe as in other adults; poorer vision in dim light is more common in the elderly and with lens opacity.
• Darkly pigmented irises: higher concentrations or more frequent application may be needed.

Contraindications – when the medicine must not be used

Do not use Miokarpin if you:

• are hypersensitive to pilocarpine or any excipient;
• have conditions in which constriction of the pupil is undesirable – acute iritis, anterior uveitis and some forms of secondary glaucoma;
• have an acute inflammatory disease of the front of the eye;
• wear soft contact lenses.

Warnings and precautions

Tell your doctor if you have an overactive thyroid, heart failure, a recent heart attack, bronchial asthma, a stomach or duodenal ulcer, Parkinson’s disease, abdominal cramps, difficulty passing urine, high or low blood pressure, or inflammation of the iris. If you are prone to retinal detachment (previous retinal disease, young short-sighted patients), an eye examination is needed before use. Caution is also needed with damage to the cornea or conjunctiva.

In patients with a damaged trabecular meshwork (e.g. traumatic angle closure), a paradoxical rise in eye pressure is possible. Do not touch the bottle tip with your hands or let it touch any surface.

The medicine contains benzalkonium chloride, which can irritate the eyes and discolours soft lenses; remove lenses before use and wait at least 15 minutes before reinserting them.

Interactions with other medicines, food and drink

• The miotic effect may be reduced by long-term local or systemic corticosteroids, and by systemic anticholinergics, antihistamines, pethidine, sympathomimetics (e.g. adrenaline) and tricyclic antidepressants.
• Simultaneous use of two miotics is not recommended.
• Wait at least 5 minutes between two different types of eye drops.

Pregnancy and breast-feeding

• Pregnancy: the medicine may be used only if recommended by your doctor.
• Breast-feeding: it is not known whether pilocarpine passes into breast milk – use only on your doctor’s advice.

Driving and using machines

After application, adapting to darkness may be difficult. Take care when driving at night and doing precise or dangerous work in poor light; do not drive or use machines until your vision is completely clear.

Possible side effects

• Local: burning or stinging in the eye, visual disturbances, watering, ciliary muscle spasm, redness (congestion) of the conjunctiva, superficial keratitis, accommodative short-sightedness (especially in younger people), difficulty adapting to darkness, poorer vision in dim light, lens opacity with long-term use; extremely rarely retinal detachment, vitreous haemorrhage and optic disc swelling.
• Headache: at the temples or around the eye socket, especially in younger patients at the start of treatment.
• Systemic: raised blood pressure, fast heart rate, narrowing of the airways and increased bronchial secretions, pulmonary oedema, increased salivation, sweating, muscle cramps, nausea, vomiting, rarely diarrhoea. Systemic toxicity is more common in adults than in children.

Report any suspected side effect to your doctor, pharmacist or ALIMS.

Overdose, missed dose and stopping treatment

• Overdose or swallowing: if you have applied more drops than prescribed, swallowed the medicine or someone else has taken it by accident, contact a doctor, pharmacist or the nearest health facility immediately.
• Missed dose: apply it as soon as possible, but if it is almost time for the next dose, continue as scheduled; never use a double dose.
• Stopping treatment: your doctor will advise you when to stop.

Related information

For eye care and lubrication, see also the category Eye drops – products in this category do not replace the medicine you have been prescribed; leave at least 5 minutes between different drops.

Composition, pack and manufacturer

• Active substance: pilocarpine hydrochloride – 20.0 mg per 1 ml of solution.
• Excipients: benzalkonium chloride (preservative); sodium citrate; sodium chloride; disodium edetate; hypromellose; water for injections.
• Pack: 10 ml LDPE bottle with LDPE dropper and HDPE cap, in a carton.
• Marketing authorisation holder and manufacturer: Hemofarm AD Vršac, Beogradski put bb, Vršac, Republic of Serbia.

Storage

• The unopened medicine does not require any special temperature storage conditions.
• After first opening, store below 30 °C and use within 28 days.
• Keep out of the sight and reach of children; do not use after the expiry date.

Frequently asked questions

How long can I use an opened bottle of Miokarpin?

According to the leaflet, once opened the drops must be used within 28 days and stored below 30 °C.

Can I wear contact lenses with Miokarpin?

Soft contact lenses are a contraindication. The medicine contains benzalkonium chloride, which discolours soft lenses and can irritate the eyes – discuss other lens types with your ophthalmologist.

Why do I see worse in the dark after the drops?

Pilocarpine constricts the pupil, so less light enters the eye – difficulty adapting to darkness and poorer vision in dim light are known side effects. Take particular care when driving at night.

What if I use other eye drops as well?

At least 5 minutes should pass between two different types of drops. Simultaneous use of two miotics is not recommended.

Sources

• ALIMS – Summary of Product Characteristics Miokarpin 20 mg/ml eye drops, solution (SmPC, Serbian)
• ALIMS – Package leaflet Miokarpin 20 mg/ml eye drops, solution (PIL, Serbian)

Date sources checked: 25.10.2026.