Pilocarpine hydrochloride 0.4%
Glaucoma · Rx
Trade namesQlosi
Drug classCholinergic (muscarinic) agonist / miotic, presbyopia formulation
Strength0.4%
AvailabilityRx
Mechanism of actionDirect muscarinic agonist; contracts the iris sphincter for a pinhole (miotic) effect that extends depth of focus for near vision. Lower concentration than Vuity (1.25%), formulated with dual lubricants (hyaluronic acid + HPMC) for comfort.
Indication / reason for usePresbyopia. A distinct product from Vuity, not indicated for glaucoma or angle-closure.
Usual adult dosing1 drop each eye, once or twice daily as needed. Onset ~20 min, duration up to ~8 h.
PreservativePreservative-free, single-use vials , a preservative-free option exists
Contact lensesRemove lenses; reinsert after 15 minutes.
Common / important adverse effectsBrow ache / accommodative spasm, dim vision at night (miosis), headache, eye redness; the usual miotic cautions apply at higher doses, but are minimal at this low concentration.
Contraindications & cautionsConditions where miosis is undesirable (e.g. acute uveitis); the same relative cautions as other miotics for peripheral retinal disease.
Pregnancy / lactationLimited data; use only if clearly needed.
Practice notesFDA-approved October 2023 (NEAR-1/NEAR-2 trials), available in the US since April 2025. A second FDA-approved presbyopia drop, competing directly with Vuity (1.25% pilocarpine, once daily).
Chair-side reference only. Dosing, contraindications and pregnancy guidance here are not exhaustive. Confirm against the current prescribing information and the patient’s full history before prescribing or advising.