Glaucoma Medicines
Glaucoma MedicinesGlaucoma Medicines (Eye Drops) are the First Treatment for Glaucoma in Most Cases
There are several classes of medications used to treat glaucoma. Each patient may have a different medication regimen based on their specific situation. The different classes include:
- Beta Adrenergic Antagonists
- Prostaglandin Analogs
- Adrenergic Agonists
- Cholinergic Agonists
- Hyperosmotic Agents
- Combination Drugs
Each of these classes has a different mechanism of action, different side effects and different contraindications which are outlined in the table below.
The process of developing a drug regimen will begin with setting a target number for the eye pressure in each eye. The target will be based on the severity of the glaucoma and the rate of progression of disease and often will be modified throughout treatment. If the disease is mild, the target should be a 20% reduction in pressure (pressure in high teens); if moderate glaucoma, the target will be a 30-40% reduction in pressure (mid teens pressure) and if severe it should be 50% (low teens pressure).
Usually treatment begins with one drug and additional drugs are added as needed to meet the target intraocular pressure in each eye.
How Long Do I Have to Take Eye Drop Medicine for Glaucoma?
Primary Open Angle Glaucoma (POAG) is a chronic, progressive condition that is controlled but never cured. It almost always worsens even when a patient is on treatment. Every time a dose is missed, the eye pressure can increase causing damage to the optic nerve. This means once a drug regimen is established it must be continued everyday without exception.
Throughout the course of the disease it is possible for the regimen to be changed by adding another medication or even taking one away. However, the drops should never be stopped without instruction from your doctor.
Following the disease will require appointments as often as every month to as little as every six months depending on the severtity and rate of progression of the glaucoma.
The following chart details most of the available medicines used in the U.S. to treat glaucoma (primary open angle glaucoma).
|
Medicine Brand Name (Generic) |
Class of Drug Usual Dosage |
Mechanism of Action |
Possible Side Effects and Adverse Reactions |
Expected Pressure Decrease |
Contraindications |
|
Travatan Z (Travoprost ophthalmic solution .004%)
Lumigan (Bimatoprost ophthalmic solution .03%)
Xalatan (Latanaprost 0.005%)
|
Prostaglandin Analog
1 drop at night |
Increase uveoscleral outflow of aqueous |
SYSTEMIC
LOCAL
|
25-36%
15% (Rescula)
A 7-8 mm Hg decrease is expected with a baseline reading of 26 mm Hg
No long term drift
|
Uveitic Glaucoma
Cystoid Macular edema
Light/mixed colored irides
Herpes Simplex Keratitis |
|
Timoptic Timoptic XE Istalol (Timolol maleate 0.25 and 0.5%)
Betimol (Timolol himihydrate)
Betagan 0.25 and 0.5% (Levobunolol)
Optipranolol (Metipranolol)
Ocupress (Carteolol)
*decreased effect with systemic beta-blocker *must have had physical exam within 180 days of prescription |
Sympathetic Nerve Blocker
β Blocker
1 drop two times per day |
Decrease aqueous production |
SYSTEMIC
LOCAL
|
25-30% non-selective beta-blocker
10-20% non-response rate
Long term drift (decreased effect) |
Asthma (may use beta-1 selective)
Chronic Obstructive Pulmonary Disease
Bradycardia
Cardiac failure
|
|
Betoptic (Betaxolol)
*decreased effect with systemic beta-blocker *must have had physical exam within 180 days of prescription |
Sympathetic Nerve Blocker
Βeta-1 Selective beta-Blocker
1 drop two times per day |
Decrease aqueous production |
SYSTEMIC
LOCAL
|
15-20% beta-1-selective beta-blocker
10-20% non-response rate
Long term drift (decreased effect) |
Asthma (may use beta-1 selective)
Chronic Obstructive Pulmonary Disease
Bradycardia
Cardiac failure
|
|
Propine (Dipivefrin)
(epiniephrine) |
Non-selective Alpha Adrenergic Agonist
One drop three times per day |
Increase aqueous outflow |
SYSTEMIC
LOCAL
|
15-30%
2-6 mm Hg decrease |
Narrow angles
Aphakia (epinephrine)
Cardiovascular disease |
|
Alphagan-P (brimonidine tartrate)
Iopidine (apraclonidine hydrochloride) |
Alpha-adrenergic agonists
|
Decrease aqueous production
increase uveoscleral outflow |
SYSTEMIC
LOCAL
|
20-30% |
Safe systemically MAO inhibitors TCA (tricyclic antidepressants) Severe carediovascular disease |
|
Azopt (brinzolamide)
Trusopt (dorzolamide)
|
Carbonic Anhydrase Inhibitors
2-3 drops per day |
Decrease aqueous production |
|
15% |
Liver disease COPD Pregnancy Sulfa allergy |
|
Diamox (acetazolamide)
Neptazane (methazolamide |
ORAL Carbonic Anhydrase inhibitor
2 (250mg) tabs
|
Decrease aqueous production |
|
20%+ |
Liver disease COPD Renal disease (diamox) Pregnancy Sulfa allergy |
|
Pilocarpine
Carbachol
Echothiopate (Indirect acting) |
Cholinergic agonists (Miotics) |
Increase trabecular outflow |
SYSTEMIC
LOCAL
|
20%+ |
Posterior Subcapsular Cataract Young patient Neovascular or uveitic glaucoma Retinal detachment High myopia asthma |
|
Combigan (Brimonidine .2% and Timolol Maleate 0.5%)
combination drop *should try each individually first |
One drop 2 times per day |
Decrease aqueous production
increase uveoscleral outflow |
|
|
Bronchial asthma Severe COPD Sinus bradycardia Atrioventricular block Cardiac failure Cardiogenic shock
|
|
Cosopt (timolol 0.5% and dorzolamide 2%)
Combination drop *should try each individually first |
One drop 2 times per day |
Decrease aqueous production |
|
25-30% |
Asthma Chronic Obstructive Pulmonary Disease Bradycardia Cardiac failure Liver disease COPD Pregnancy Sulfa allergy |
|
Ismotic (Isosorbide)
Osmoglyn (glycerin)
Mannitol (by IV only) |
Hyperosmotic |
Dehydrate and shrink the vitreous |
|
Good for acute primary angle closure glaucoma |
Diabetes (glycerin) Severe heart disease |
