The question has come up on the board about how to obtain the .125%
pilocarpine. Has anyone been able to successfully obtain this
concentration???

The dennervation hypersensitivity of the Adie's eye allows an
extremely dilute .125% solution of pilocarpine to constrict the
pupil. In the US, this solution is only available as 2% solution,
which is nearly 20 times the required strength. Those of you who
are using 2% drops are probably unneccessarily suffering through far
more side effects than you might need.

My pharmacist said he only had the 2% solution. I asked him to make
up a .125% solution and he refused, telling me that the risk of
contamination was too great. He suggested that I find an "old
school" pharmacist.

When I told him I was going to do the dilution myself using an OTC
product such as "Murine Tears," he seemed alarmed, and told me that
I needed to be very careful, and that if I saw any particulate
(floating solids) in the fluid whatsoever, that I would need to
discard the solution. He also told me that in medical school, he
was taught to dilute eye drops with sterlized distilled water (too
bad he was too chicken to apply that education to his practice!!!)

I presume any contamination, or the mixing of the wrong solutions,
could result in some serious damage to the eye. So this post is not
advice nor a recommendation, but merely a report of my own
experience and I don't recommend that you do what I've done (in
fact, if you decided to foolishly do what I've done, you do so at
your own risk!!!). You should seek the advice of your opthamologist
(hopefully more competent than mine).

I bought a 15 mL over-the-counter bottle of Murine Tears (advertised
as the "closest to natural tears." I squeezed out maybe 3 to 5% of
the contents (roughly 1/20 of the container). I then opened the
bottle of 2% pilocarpine hydrocholoride opthalmic solution (also a
15 mL bottle). I squeezed the air out of the Murine bottle, and
allowed it to "suck up" some of the pilocarpine solution as I
squeezed that bottle slightly. The result, I believe, was probably
something like a .05% to .1% pilocarpine solution with what seems to
be minimal chance of contamination. I noticed no particulate in the
murine tears bottle, and have seen been using two drops of my new
diluted solution whenever I need to do extended close work, or if I
plan to be outside for a long period of time. After using the
drops, my pupil contracts slowly over the next half hour until it is
pin-point small. My vision improves greatly, and I get angry all
over again about the assault that has robbed me of my perfect
vision. My eye slowly dilates over the next 4 or 5 hours.
The only side effect I notice is a somewhat bloodshot eye, a bit of
a dry feeling in the eye, and, of course, my affected eye sees
darker indoors due to the constricted
pupil.

With the 15 mL bottle of 2% solution, and my 20 to 1 dilution, I
probably have enough pilocarpine to last me through the 2006
expiration date!!!

I'd like to hear how long and how regularly any of you have been
using pilocarpine, and if any of you know of, or have heard of, any
long-term effects or consequeneces of using it?