Pilocarpine in KCS

Re: Pilocarpine in KCS

Rob Loxley — Sun, 10 Jan 2010 10:58:50 GMT

You need to give optimmune upto 6-8wks before saying it's not working, beyond that I'd try 2% cyclosporin.

If you've got an ipsilateral dry nose then neurogenic KCS is a possibility; these won't respond to KCS but use pilocarpine orally.

Re: Pilocarpine in KCS

Yvonne Black — Tue, 05 Jan 2010 11:57:18 GMT

Isn't tacrolimus ointment just a skin prep of cyclosporin? Anyway, to update you on this case, I decided to trial oral pilocarpine as per the protocol in BSAVA SA formulary yesterday, only to find that my patient now has STT of 15mm/min in the eye which previously had <5, and 20mm/min in the other! My client stopped using optimmune 11 days ago due to a communications breakdown between myself & her, and has been using maxitrol & hypromellose only. I double-checked the STT in both eyes after having the dog in hospital with no eye drops at all for 6 hours - I'm not sure whether the optimmune just started working eventually, and the eyes will get worse again without it, or whether the steroid in the maxitrol drops has helped. Anyway, the client isn't keen to pay for any more optimmune for now, so we'll see what happens! Thanks for all your advice though!

Re: Pilocarpine in KCS

Kevin Castle — Mon, 04 Jan 2010 15:40:36 GMT

Maybe you are thinking of Tacrolimus ointment?

Re: Pilocarpine in KCS

Laurence Webb — Fri, 01 Jan 2010 22:38:48 GMT

I'm still trying to remember who the flier was from or what the drug was. I think it was probably Jim Carter, but if not then it may have been Bath vet referrals or Rowe vets in Bristol.

Re: Pilocarpine in KCS

Yvonne Black — Fri, 01 Jan 2010 11:40:50 GMT

As I understand it, the reason for using pilocarpine is to treat neurogenic KCS. That was why I thought of trialing it, in case this was a neurogenic case. I'd be very interested to hear about any other treatments you've heard of though, and could try a stronger ciclosporin prep.

Re: Pilocarpine in KCS

Laurence Webb — Thu, 31 Dec 2009 19:16:28 GMT

I disgree, as 1% ciclosporin is not available as a licensed animal product in any species so there is no suitable alternative. It would be illegal to use a generic preparation if Optimmune would do the job but if it isn't then it's within the cascade to use a stronger preparation. Personally, if optimmune has failed I try a 0.5% preparation followed by a 1% if required. If that fails then i give up and refer it.

This differs from the diltiazem thread as a 1% ciclosporine preparation is different to just giving more 0.2% Optimmune whereas half a 60mg diltiazem tablet can be substituted for 3 x 10mg Hypercard.

I'm sure I got a flier through the post from a referral centre saying that they were using something I hadn't heard of with good results. If I remember who/what it was I'll let you know. May also be worth double checking it isn't a neurogenic cause

Re: Pilocarpine in KCS

Ian Mostyn — Thu, 31 Dec 2009 16:27:19 GMT

Pilocarpine causes excess sweating and salivation but I can find no record of increased lacrimation. As KCS is usually auto-immune destruction, if the tear producing cells are destroyed, nothing will bring them back to life.

I have seen some eye specialists use 1% cyclosporin ointment rather than optimmune at 0.2% but that ties in with the diltiazem thread!!

Ian