title: Interaction of pilocarpine with latanoprost in patients with glaucoma and ocular hypertension.
abstract: OBJECTIVE
  To study any interaction between pilocarpine and latanoprost when administered together, and to determine the optimal timing of dosage to maximize reduction of intraocular pressure (IOP).
  
  
  METHODS
  Nineteen adult patients with either primary open-angle glaucoma or ocular hypertension participated in a single-center, prospective case study with masked observer. After a baseline measurement of IOP during treatment with latanoprost was obtained, initial treatment with pilocarpine three times daily was added without bedtime administration. This was followed by three different dose regimens in which pilocarpine was administered four times daily, altering the bedtime pilocarpine dose to precede the latanoprost dose by 1 hour, or to follow it by 10 minutes or 1 hour. Intraocular pressure was measured at 8:00 AM and 75 minutes after administration of the morning dose of pilocarpine.
  
  
  RESULTS
  Comparison of IOP at 8:00 AM with baseline showed no significant change when pilocarpine was taken three times daily, or when pilocarpine was taken four times daily when the bedtime dose preceded administration of latanoprost by 1 hour. There were significant decreases in IOP versus baseline when the bedtime dose of pilocarpine was taken simultaneously with or 1 hour after administration of latanoprost. Application of pilocarpine immediately after the 8:00 AM IOP measurement revealed a significant additional decrease in pressure. There were no significant differences between dosage schedules in the magnitude of the additional reduction in IOP.
  
  
  CONCLUSIONS
  The order and timing of administration of pilocarpine and latanoprost can significantly alter their ocular hypotensive activity. Pilocarpine is most effective when administered four times daily, and when the bedtime dose is administered 1 hour after administration of latanoprost.
authors.affiliation: Glaucoma Service, Storm Eye Institute, Medical University of South Carolina, Charleston 29425-2236, USA.
authors.forename: A R
authors.initials: AR
authors.lastname: Kent
authors.forename: D T
authors.initials: DT
authors.lastname: Vroman
authors.forename: T J
authors.initials: TJ
authors.lastname: Thomas
authors.forename: R L
authors.initials: RL
authors.lastname: Hebert
authors.forename: C E
authors.initials: CE
authors.lastname: Crosson
mesh_terms: D000368:Aged; D004334:Drug Administration Schedule; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D005260:Female; D005902:Glaucoma, Open-Angle / Q000188:drug therapy*; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D000077338:Latanoprost; D008297:Male; D018721:Muscarinic Agonists / Q000008:administration & dosage*; D009798:Ocular Hypertension / Q000188:drug therapy*; D010862:Pilocarpine / Q000008:administration & dosage*; D011446:Prospective Studies; D011461:Prostaglandins F, Synthetic / Q000008:administration & dosage*; D013997:Time Factors
chemical_list: D018721:Muscarinic Agonists; D011461:Prostaglandins F, Synthetic; D010862:Pilocarpine; D000077338:Latanoprost