- Pilocarpine is a synthetic direct cholinergic agonist that is less prone to destruction by cholinesterases and is thus long-acting. It is primarily used topically in the eye and mouth. Ophthalmologically it is used to to induce pupilary miosis in the medical management of acute closed-angle glaucoma. As a topical oral spray it promotes salivation and is used in the treatment of xerostomia. When used topically in these ways it displays few systemic adverse effects.