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A Guide to Glaucoma Medications

A number of medications are currently in use to treat glaucoma. Your doctor may prescribe a combination of medications or change your prescription over time to reduce side effects or provide a more effective treatment. Typically medications are intended to reduce elevated intraocular pressure and prevent damage to the optic nerve.

Eye drops used in managing glaucoma decrease eye pressure by helping the eye’s fluid to drain better and/or decreasing the amount of fluid made by the eye. Drugs to treat glaucoma are classified by their active ingredient. These include: prostaglandin analogs, beta blockers, alpha agonists, carbonic anhydrase inhibitors, and rho kinase inhibitors. Combination drugs are available for patients who require more than one type of medication.

Alpha Agonist

 
CompanyBrand NameGeneric Name
Allergan Inc.Alphagan® PBrimonidine tartrate 0.1%, 0.15%
NovartisIopidine®Apraclonidine HCI 0.5%, 1%

Alpha agonists work to both decrease production of fluid and increase drainage. Alphagan P has a Purite preservative that breaks down into natural tear components and may be more effective for people who have allergic reactions to preservatives in other eye drops. Brimonidine is available in a generic form.

Side Effects
Side effects can include burning or stinging upon instillation of the eye drop, fatigue, headache, drowsiness, dry mouth and dry nose.

 

Beta Blockers

 
CompanyBrand NameGeneric Name
Akorn Inc.Betimol®Timolol hemihydrate 0.25%, 0.5%
Akorn Inc.Timolol Maleate USPTimolol Maleate 0.5%
Allergan Inc.Betagan®Levobunolol HCI ophthalmic solution, USP 0.25%, 0.5%
Bausch & Lomb Inc.OptiPranolol®Metipranolol 0.3%
Bausch & Lomb Inc.Istalol®Timolol Maleate Ophthalmic Solution 0.5%
Bausch & Lomb Inc.Timoptic in Ocudose (PF)Timolol maleate ophthalmic solution 0.25%, 0.5% in Ocudose dispenser
Bausch & Lomb Inc.Timoptic-XE®Timolol maleate ophthalmic gel forming solution 0.25%, 0.5%
NovartisBetoptic® SBetaxolol HCI 0.25%, 0.5%

Beta blockers work by decreasing production of intraocular fluid. They are available in generic form and, therefore, are relatively inexpensive. Systemic side effects can be minimized by closing the eyes following application or using a technique called punctal occlusion that prevents the drug from entering the tear drainage duct and systemic circulation.

Side Effects
Side effects can include low blood pressure, reduced pulse rate, and fatigue. Beta blockers can also cause a shortness of breath in people who have a history of asthma or other respiratory disorders. Additionally, beta blockers can change cardiac activity by decreasing the amount of blood the heart pumps out, which may reduce the pulse rate and/or slow down the heart’s response rate during exercise. Rare side effects include reduced libido and depression.

 

Carbonic Anhydrase Inhibitors

 

Manufacturer

Product name 

Generic Name

Alembic Pharmaceuticals

Diamox

Acetazolamide

Fera Pharmaceuticals

Neptazane®

Methazolamide

Merck & Co., Inc. 

Trusopt® 

Dorzolamide HCI 2%

Novartis

Azopt

Brinzolamide ophthalmic suspension 1%

Teva 

Diamox® Sequels® 

Acetazolamide

Carbonic anhydrase inhibitors (CAIs) reduce eye pressure by decreasing the production of intraocular fluid. These are available as eye drops and as pills. If you need to use more than one type of eyedrop, you may need to take each medicine in a certain order as prescribed by your doctor. If you are using more than one type of eyedrop, wait 5 minutes between eyedrop medicines. The pill form is an alternative for people whose glaucoma is not controlled by medication eye drops.

Side Effects
Side effects of the pill form of these medications can include tingling or loss of strength of the hands and feet, upset stomach, mental fuzziness, memory problems, depression, kidney stones, and frequent urination. Side effects of the eye drop include stinging, burning and other eye discomfort.

 

Cholinergic (Miotic)

 
CompanyBrand NameGeneric Name
Bausch & Lomb Inc.Pilocarpine HCl Ophthalmic Solution USPPilocarpine HCI 1%, 2%, 4%
NovartisIsopto® CarpinePilocarpine HCl 1%, 2%, 4%
NovartisIsopto® CarbacholCarbachol 0.75%, 1.5%, 3%
NovartisPilopine HS® GelPilocarpine HCl gel 4%

These medications reduce eye pressure by increasing the drainage of intraocular fluid through the trabecular meshwork. Cholinergics can be used alone or combined with other glaucoma medications. A combination of medications can help control how much fluid is produced in the eye and increase the amount of fluid that drains out of the eye.

Side Effects
Many people who use these medications complain of dim vision, especially at night or in darkened areas such as movie theaters. This is due to constriction of the pupil. Miotics increase drainage of intraocular fluid by making the pupil size smaller, thereby increasing the flow of intraocular fluid from the eye.

 

Combined Medications

 
CompanyBrand NameGeneric Name
Aerie Pharmaceuticals, Inc.Rocklatan®Netarsudil and Latanoprost ophthalmic solution 0.02%/0.005%
Akorn Inc.Cosopt®Dorzolomide HCI & Timolol Maleate
Akorn Inc.Cosopt® PFDorzolomide HCI & Timolol Maleate
Allergan Inc.Combigan™Brimonidine Tartrate & Timolol Maleate ophthalmic solution 0.2%/0.5%
NovartisSimbrinza®Brinzolamide & Brimonidine tartrate 1%/0.2%

Increases drainage of intraocular fluid.

Combined medications can offer an alternative for patients who need more than one type of medication. In addition to the convenience of using one eyedrop bottle instead of two, there may also be a financial advantage, depending on your insurance plan. Rocklatan is a combination of a rho kinase inhibitor and a prostaglandin analog. Combigan is a combination of beta blocker and alpha agonist. Cosopt is a combination of beta blocker and carbonic anhydrase inhibitor. Cosopt is available in generic form, and also as a presevative-free formulation (Cosopt PF). Simbrinza is a combination of Brinzolamide (a carbonic anhydrase inhibitor) and Brimonidine (an alpha agonist).

Side Effects
Side effects of Rocklatan include eye redness and stinging. Side effects of Combigan include the symptoms of beta blockers and alpha agonists. Side effects of Cosopt include burning and/or stinging of the eyes and changes in sense of taste. Side effects of Simbrinza Suspension include blurred vision, eye irritation, bad taste, dry mouth, and eye allergy.

 

Prostaglandin Analogs

 
CompanyBrand NameGeneric Name
Akorn Inc.ZioptanTafluprost ophthalmic solution 0.0015% (PF)
Allergan Inc.Durysta™Bimatoprost 10 mcg implant
Allergan Inc.Lumigan®Bimatoprost 0.01%, 0.03%
Bausch & Lomb, Inc.Vyzulta™Latanoprostene bunod 0.024%
NovartisTravatan® ZTravoprost 0.004%
Pfizer Inc.Xalatan®Latanoprost 0.005%
Sun OphthalmicsXelpros™Latanoprost ophthalmic emulsion 0.005%

Prostaglandin analogs work by increasing the outflow of intraocular fluid from the eye. They have few systemic side effects but are associated with changes to the eye itself, including change in iris color and growth of eyelashes. Depending on the individual, one brand of this type of medication may be more effective and produce fewer side effects. Prostaglandin analogs are taken as eye drops (except Durysta™ which is an implant). They are effective at reducing intraocular pressure in people who have open-angle glaucoma. Latanoprost and some formulations of bimatoprost and travoprost are available in generic form. Tafluprost is a preservative-free prostaglandin analog.

Side Effects
Side effects can include eye color change, darkening of eyelid skin, eyelash growth, droopy eyelids, sunken eyes, stinging, eye redness, and itching.

 

Rho Kinase Inhibitors

 
CompanyBrand NameGeneric Name
Aerie Pharmaceuticals, Inc.Rhopressa®Netarsudil 0.02%

Rho Kinase Inhibitors increase drainage of intraocular fluid by improving outflow of the trabecular meshwork.

Side Effects
Side effects can include eye redness, corneal deposits, stinging, and small bleeds on the white of the eye.

Last reviewed on June 19, 2020

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