Pilocarpine
| Evidence Level: L5 | Predicted Indications: 10 |
Table of Contents
Pilocarpine: From Open-Angle Glaucoma to Primary Hereditary Glaucoma
One-Sentence Summary
Pilocarpine is a muscarinic agonist originally used to lower eye pressure in open-angle glaucoma and ocular hypertension. The TxGNN model predicts it may be effective for primary hereditary glaucoma, but there are currently 0 clinical trials and 0 publications for this specific condition, so the prediction rests on the model score and general pharmacology alone.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Open-angle glaucoma; ocular hypertension |
| Predicted New Indication | Primary hereditary glaucoma |
| TxGNN Prediction Score | 99.83% |
| Evidence Level | L5 |
| Singapore Market Status | ✓ Marketed |
| Number of Registrations | 2 |
| Recommended Decision | Hold |
The Singapore licence records contain no approved-indication text, so the original indications come from the TxGNN knowledge graph.
Why is This Prediction Reasonable?
Currently, detailed mechanism of action data is not available. Based on general pharmacology, pilocarpine is a muscarinic agonist. It contracts the ciliary muscle and increases outflow of aqueous humour through the trabecular meshwork, which lowers intraocular pressure (IOP). Its efficacy in open-angle glaucoma has been established over decades of clinical use.
Primary hereditary glaucoma is also a disease of raised IOP caused by impaired aqueous outflow. A drug that opens the outflow pathway could therefore plausibly help. This is a mechanistic inference only. No studies for this specific condition were found, and the high score is a model prediction rather than clinical evidence.
Clinical Trial Evidence
Currently no related clinical trials registered.
Literature Evidence
Currently no related literature available.
Singapore Market Information
| Authorization Number | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| SIN11683P | SALAGEN TABLET 5 mg | Film-coated tablet (oral) | — |
| SIN04712P | ISOPTO CARPINE STERILE OPHTHALMIC SOLUTION 2% | Solution (ophthalmic) | — |
Both licences are valid single-ingredient products, and none are cancelled. Only the ophthalmic solution matches the eye-related prediction. The oral tablet is a different route and would not be a like-for-like fit.
Safety Considerations
- Contraindication signals from the knowledge graph (disease-level associations, not package insert text):
- Eye: angle-closure (closed-angle) glaucoma, uveitis, iritis, iridocyclitis, keratitis, keratoconjunctivitis, retinal detachment.
- Respiratory: asthma, COPD, bronchial disease.
- Biliary and liver: cholelithiasis, cholecystitis, biliary tract disease, obstructive jaundice, liver failure.
- Kidney: nephrolithiasis, acute urate nephropathy.
- Drug interactions: 100 interactions were recorded. The ones rated Moderate are mostly other anticholinergic agents, which may blunt pilocarpine's effect. They include atropine, hyoscyamine, scopolamine, glycopyrronium, dicyclomine, clidinium, mepenzolate, methscopolamine, propantheline and trospium. Some others, such as pantoprazole, omeprazole, lansoprazole, metformin, morphine and epinephrine, are listed with an unknown severity level.
Please refer to the package insert for authoritative warnings and contraindications.
Conclusion and Next Steps
Decision: Hold
Rationale:
- No trials or publications support primary hereditary glaucoma specifically, so the prediction is based on the model score and general pharmacology alone (L5).
- Pilocarpine's established glaucoma use is already a labelled indication, so it adds little as a new repurposing signal. The related open-angle glaucoma entry has four linked trials, but they are small or non-efficacy studies, and none is a completed Phase 3 RCT.
To proceed, the following is needed:
- Package insert warnings and contraindications from the HSA, which are currently missing and block safety screening.
- Mechanism of action data, for example from DrugBank.
- A targeted literature search for pilocarpine in primary congenital or hereditary glaucoma, including case series and paediatric use.
- Confirmation of whether this is a genuinely new use or falls under the existing glaucoma indication, and whether the ophthalmic solution is the appropriate route.
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.