Medications for Glaucoma

Transcription

1 Main Page Risk Factors Symptoms Diagnosis Treatment Screening Reducing Your Risk Talking to Your Doctor Living With Glaucoma Resource Guide Medications for Glaucoma by Mary Calvagna, MS En Español (Spanish Version) The information provided here is meant to give you a general idea about each of the medications listed below. Note that this is not a comprehensive list. Your physician may prescribe a medication that is not on this list. Only the most general side effects are included, so ask your healthcare provider if you need to take any special precautions. Use each of these medications as recommended by your healthcare provider and according to the instructions provided. If you have further questions about usage or side effects, contact your healthcare provider. Some medications can cause side effects that are medical emergencies, such as difficulty breathing. If you have a medical emergency, call for an ambulance immediately. Eye drops or oral medications are often used to help control glaucoma. Both methods attempt to decrease the intraocular pressure by either slowing the production of fluid in the eye or by improving the drainage of fluid from the eye. Prescription Medications Eye Drops + Miotics (Parasympathomimetic agents) (rarely used) Pilocarpine (Isopto Carpine, Pilocar, Pilagan, Ocusert, Pilopine ) Carbachol/Carbamylcholine Echothiophate iodide (Phospholine Iodide) Physostigmine (Eserine ointment, Isopto Eserine) Demecarium bromide (Humorsol) Isoflurophate + Adrenergic Agents Epinephrine (Epifrin, Eppy/N,Glaucon, Epinal, Epitrate ) Dipivefrin (Propine) Apraclonidine (Iopidine) Brimonidine (Alphagan) + Beta-blockers Timolol maleate (Istalol, Timoptic XE, Timoptic, Ocudose, Timolol Gel) Timolol hemihydrate (Betimol) Levobunolol (Betagan) Metipranolol (OptiPranolol) Carteolol (Ocupress) Betaxolol (Betoptic) + Prostaglandin analogs Bimatoprost (Lumigan) Latanoprost (Xalatan) Travoprost (Travatan) Page 1 of 6

2 + Carbonic Anhydrase Inhibitors Dorzolamide (Trusopt) Dichlorphenamide (Azopt) Eye Drops It is imperative that you take your eye drops exactly as prescribed in order to best control your glaucoma. Eye drops can interact with other medications. Make sure you tell your doctor about any other medications or supplements that you are taking. Miotics (Cholinergic Agents) (Rarely Used) Common names include: Pilocarpine (Isopto Carpine, Pilocar, Pilagan, Ocusert, Pilopine) Carbachol /Carbamylcholine Echothiophate iodide (Phospholine Iodide) Physostigmine (Eserine ointment, Isopto Eserine) Demecarium bromide (Humorsol) Isoflurophate Miotics increase fluid drainage out of the eye by helping to open the drainage network. Miotics also reduce the size of the pupil. Miotics may cause adverse drug interactions with certain anesthetic agents. Pain inside/around the eye or brow Blurred vision Headache Dim vision Retinal detachment Worsening myopia (nearsightedness) Cataract formation Increased tearing Gastrointestinal upset (abdominal cramps, nausea, diarrhea, etc.) Increased saliva production Adrenergic Agents Epinephrine (Epifrin, Eppy/N, Glaucon, Epinal, Epitrate) Dipivefrin (Propine) Apraclonidine (Iopidine) Brimonidine (Alphagan) Available as generic 0.2% and as name brand Alphagan-P 0.15%, which causes fewer allergies. Epinephrine constricts blood vessels in the eye and enlarges the pupil. It reduces the amount of fluid in the eye by reducing the production of fluid and increasing the amount of fluid drainage. Dipivefrin is transformed into epinephrine in the eye. Apraclonidine and brimonidine are known as alpha2-adrenergic agonists. They are thought to have fewer side effects. Adrenergic agents should be used with caution in patients with cardiovascular disease, as well as in patients taking certain antidepressant, heart, and blood pressure medications. Page 2 of 6

3 Burning or stinging of the eye Red eyes (especially when medication is stopped) Allergic reaction Large pupils, causing increased sensitivity to light Colored deposits on the conjunctiva Elevated blood pressure and heart rate Abnormal heart rhythms Headache Anxiety Apraclonidine is often used to control eye pressure after laser or surgical procedures. Dry mouth and nose Eye discomfort Allergic reaction Decreased blood pressure (potentially leading to fainting) Tiredness Brimonidine is the most commonly used medication in the category to reduce pressure in the eye. Burning, stinging or tearing of the eye Blurred vision Allergic reaction Dry eye Drowsiness or fatigue Headache Decreased blood pressure Tiredness Depression Anxiety Beta-Blockers Common names include: Timolol maleate (Istalol, Timoptic XE, Timoptic, Ocudose, Timolol Gel) Timolol hemihydrate (Betimol) Levobunolol (Betagan) Metipranolol (OptiPranolol) Carteolol (Ocupress) Betaxolol (Betoptic) Beta-blockers work to lower the intraocular pressure by decreasing the rate at which fluid is produced in the eye. Beta-blockers are usually contraindicated in patients with such medical conditions as asthma, chronic obstructive pulmonary disease, slow heart beat, heart block, or other heart or lung problems. Blurred vision Eye irritation Page 3 of 6

4 Allergic reaction Breathing difficulty Slowing pulse rate Hair loss Decreased blood pressure Impotence Dizziness or fainting Fatigue and weakness Hallucinations Insomnia Depression Memory loss Prostaglandin Analogs Bimatoprost (Lumigan) Latanaprost (Xalatan) Travoprost (Travatan) Prostaglandin analogs reduce pressure in the eye by increasing the outward flow of fluid from the eye. Darkening of the iris (colored part of the eye) Darkening and increased growth of eye lashes Conjunctival hyperemia (red eyes) Eye irritation Flu-like symptoms Body aches and pains Topical or Oral Medications Carbonic Anhydrase Inhibitors Common names include: Dorzolamide (Trusopt) Dichlorphenamide (Azopt) Acetazolamide (Diamox) Methazolamide (Neptazane) Carbonic anhydrase inhibitors inhibit the enzyme carbonic anhydrase, which results in a reduction of the production of fluid in the eye. Oral forms are usually only used in emergent situations, such as in an angle-closure attack. They are contraindicated with history of sulfa allergy and should be used with caution in patients with certain medical problems such as blood disorders or liver disease. They are also contraindicated in patients with sickle cell. Blood cell counts are often monitored regularly while taking these drugs. Frequent urination Tingling or numbness sensation in the fingers or toes Kidney stones Rashes Page 4 of 6

5 Depression, fatigue, and lethargy Weight loss Gastrointestinal upset Diarrhea Impotence Unpleasant taste in mouth Abnormal lab tests: Abnormal blood electrolytes (especially potassium) Abnormal blood cell count (red or white blood cells or platelets) Neuroprotective medications Researchers are currently evaluating the possibility of protecting the optic nerve from damage. One of the potential medications that are being considered is brimonidine (Alphagan). Another is memantine, an oral medication used in the treatment of Alzheimer's disease. Special Considerations Whenever you are taking a prescription medication, take the following precautions: Take them as directed not more, not less, not at a different time. Do not stop taking them without consulting your doctor. Don t share them with anyone else. Know what effects and side effects to expect, and report them to your doctor. If you are taking more than one drug, even if it is over-the-counter or herbal, be sure to check with a doctor or pharmacist about drug interactions. Plan ahead for refills so you don t run out. Check the expiration date. Let your doctor know if you take any other medications or supplements. This includes vitamins and herbal remedies. For most eyedrops, only one drop is necessary at each recommended time interval. Placing two or more drops at one time is usually a waste of medicine. Ask your doctor how many drops you need to place. When to Contact Your Doctor If you have side effects or an allergic reaction to a medication (stop taking the medication and call your doctor immediately) If you begin taking any new vitamins, herbal supplements, or another medication, whether prescribed or over-the-counter REFERENCES: American Academy of Ophthalmology website. Available at: The Glaucoma Foundation website. Available at: National Eye Institute website. Available at: Weinreb RN, Khaw PT. Primary open-angle glaucoma. Lancet. 2004; 363:1711. Maier PC, Funk J, Schwarzer G, et al. Treatment of ocular hypertension and open angle glaucoma: meta-analysis of randomised controlled trials. BMJ. 2005;331:134. Last reviewed September 2011 by Christopher Cheyer, MD Page 5 of 6

6 Last Updated: 9/1/2011 Page 6 of 6