Topical and Oral Medications for GlaucomaBeta Blockers • Carbonic Anhydrase Inhibitors • Alpha-agonists • Cholinergic-Miotic • Prostaglandin Analogs
Types of Eye Medications for Glaucoma
Current glaucoma treatment guidelines follow a step-up approach, with eye medications as the initial treatment of choice. Eye medications work by decreasing the production of the aqueous fluid in the eye (Beta Blockers, Carbonic Anhydrase Inhibitors, Alpha-agonists), facilitating aqueous fluid drainage out of the eye (Cholinergic-Miotic and Prostaglandin Analogs) or combination of both functions.
Prostaglandin Analogs are the most commonly prescribed glaucoma drugs available in the market today. They are well-known for their potency and minimal systemic side-effects compared to other types of glaucoma medications.
Although most doctors will initiate treatment with a single type of glaucoma medication, often a combination of two or more of these drugs is required for adequate pressure control. For most glaucoma patients, the use of glaucoma drops may be lifelong – even after surgical treatment.
Cost of Glaucoma Medications
One of the benefits of modern glaucoma treatment is the variety of pharmacologic treatment options now available to patients with this condition. That benefit, however, is not without cost. There is the real monetary cost of the medication, the cost of time depending on frequency of dosing and inconvenience, as well as the “cost” of side effects. Any of these costs will increase the risk of treatment failure. Knowing this triad of costs beforehand may increase compliance and lessen incidences of stopping treatment or decreasing dosage schedule. Unfortunately, if treatments are not used as prescribed they will likely be ineffective resulting in costs to the patient but without benefit.
Monetary Cost (Brand vs. Generic)
The monetary cost of any prescription therapy can be burdensome to some patients. Many patients with glaucoma also have cardiac or other systemic issues so glaucoma therapy may be only a small fraction of their monthly outlay on medications. Branded glaucoma drops often retail for over $80/month. The availability of generics (which can retail for as little as $4 at Walmart) is an important consideration.
Time and Inconvenience Cost (Dosing)
As they say, “time is money.” Time taken out of a patients’ day to administer medications is an added “cost” to their lifestyle. This cost is real as shown by multiple studies indicating that as the dosage frequency goes up, the compliance plummets resulting to sub-optimal treatment. Perhaps the mental cost of remembering and administering to use glaucoma drops multiple times a day is just too high.
Quality of Life Cost (Side Effects)
The potential side effects directly impact quality of life, commonly resulting in patients giving up on an otherwise effective treatment.
Glaucoma Medications and Their Side Effects
Below is a brief summary of these “costs” for each of the commonly used FDA approved classes of glaucoma medications.
RISKS AND SIDE EFFECTS
Timolol Maleate USP, Betoptic S®, Betagan®, OptiPranolol® ,
Istalol®, Timoptic-XE®, Betimol®
Shortness of breath, hypotension (low blood pressure), bradycardia (low heart rate), fatigue, depression, impotence, masking symptoms of low blood sugar (in diabetic patients), and rarely death
Carbonic Anhydrase Inhibitors
Topical: Azopt™, Trusopt®
Oral: Neptazane® (pill), Diamox®
Topical: Ocular stinging (worse with Trusopt®).
Oral: Dizzyness, tingling of extremities, frequent urination, metabolic acidosis, aplastic anemia (life threatening)
Isopto® Carpine, Isopto® Carbachol, Pilopine HS® Gel,
Pilocarpine HCl Ophthalmic Solution USP
Headache, decreased vision, change in refractive error, retinal detachment.
Travatan Z®, Lumigan®, ZIOPTAN™, Xalatan®
Lash growth (not always in a cosmetically pleasing manner), iris color change, darkening of the periocular skin, “tightening” and hollowing out of the periocular connective tissue (Prostaglandin associated periorbitopathy), nocturnal headaches (rare).
Iopidine®, Alphagan P®
Follicular conjunctivitis, oral dryness, sedation, drowsiness, headache, fatigue. Central nervous system depression (can be life threatening in infants and toddlers).
Fixed Combination Agents
Combigan®, Cosopt®, Simbrinza®
Combination agents combine the benefits of two separate classes of medication in one drop. Risks are also combined as follows:
Combigan® = Beta-blocker + Alpha-agonist Risks
Cosopt® = Beta-blocker + Carbonic Anhydrase Inhibitor Risks
Simbrinza® = Alpha-agonist + Carbonic Anhydrase Inhibitor Risks