Medications Used to Treat Glaucoma
Medication | Mechanism of Action on Eye | Comments |
|---|---|---|
Prostaglandin analogs (topical) | ||
BimatoprostBimatoprost | Primarily increases uveoscleral outflow with little effect on conventional (trabeculocanalicular) aqueous outflow | Increased pigmentation of the iris and skin Possible worsening of uveitis Elongated and thickened eyelashes Muscle, joint, and back pain Rash |
LatanoprostLatanoprost | ||
TafluprostTafluprost | ||
TravoprostTravoprost | ||
Beta-blockers (topical) | ||
Timolol Timolol | Decreases aqueous production | Systemic adverse effects (eg, bronchospasm, depression, fatigue, confusion, erectile dysfunction, hair loss, bradycardia) Effects may develop insidiously and be attributed by patients to aging or other processes |
Betaxolol Betaxolol | ||
Carteolol Carteolol | ||
Levobetaxolol | ||
Levobunolol Levobunolol | ||
Metipranolol | ||
Carbonic anhydrase inhibitors (oral or IV) | ||
AcetazolamideAcetazolamide | Decreases aqueous production | Used as adjunctive therapy Cause fatigue, altered taste, anorexia, depression, paresthesias, electrolyte abnormalities, kidney calculi, and blood dyscrasias Possibly nausea, diarrhea, weight loss Use with caution in patients with renal failure |
Methazolamide Methazolamide | ||
Carbonic anhydrase inhibitors (topical) | ||
Brinzolamide Brinzolamide | Decreases aqueous production | Low risk of systemic effects, but may cause bad taste in mouth and/or rash |
Dorzolamide Dorzolamide | ||
Rho kinase inhibitor (topical) | ||
NetarsudilNetarsudil | Increases conventional aqueous outflow | May develop conjunctival hyperemia (redness), corneal verticillata (corneal deposits), subconjunctival petechial hemorrhages |
Miotics, direct-acting (cholinergic agonists; topical)* | ||
CarbacholCarbachol | Cause miosis, increase aqueous outflow | Less effective as monotherapy than beta-blockers Possible need for higher strengths in patients with darker-pigmented pupils Hinder dark adaptation |
Pilocarpine Pilocarpine | ||
Miotic, indirect-acting (cholinesterase inhibitors; topical)* | ||
Echothiophate iodide Echothiophate iodide | Causes miosis, increases aqueous outflow | Very long acting: Irreversible inhibition; can cause cataracts and retinal detachment; should be avoided in angle-closure glaucoma because of the extreme miosis; hinders dark adaptation Systemic effects (eg, sweating, headache, tremor, excess saliva production, diarrhea, abdominal cramps, nausea) more likely than with direct-acting miotics May still be an option in pseudophakic patients |
Osmotic diuretics (oral, IV)† | ||
Glycerin Glycerin | Causes increased serum osmolarity, which draws fluid from eye | Used for acute angle closure Has adverse systemic effects Can rarely cause cerebral hemorrhage and acute, decompensated heart failure Ineffective in patients with moderate to severe renal failure |
Mannitol Mannitol | ||
Alpha-2-selective adrenergic agonists (topical) | ||
Apraclonidine Apraclonidine | Decreases aqueous production; may increase uveoscleral aqueous outflow; may cause mydriasis | With apraclonidine, high rate of allergic reactions and tachyphylaxis; less common with brimonidine, which may cause dry mouth and is contraindicated in children With apraclonidine, high rate of allergic reactions and tachyphylaxis; less common with brimonidine, which may cause dry mouth and is contraindicated in children< 2 years Systemic effects (eg, hypertension, tachycardia) less common than with nonselective agonists |
Brimonidine Brimonidine | ||
* Miotics are rarely used. | ||
† For acute use only. | ||