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Medications for Glaucoma

by Mary Calvagna, MS


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 health care provider if you need to take any special precautions. Use each of these medications as recommended by your health care provider and according to the instructions provided. If you have further questions about usage or side effects, contact your health care 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)

  • 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 (Timoptic XE, Timoptic, Ocudose, Timolol Gel)
  • Timolol hemihydrate (Betimol)
  • Levobunolol (Betagan)
  • Metipranolol (OptiPranolol)
  • Carteolol (Ocupress)
  • Betaxolol (Betoptic)

Prostaglandin analogs

  • Bimatoprost (Lumigan)
  • Latanaprost (Xalatan)
  • Travoprost (Travatan)
  • Unoprostone (Rescula)

Carbonic Anhydrase Inhibitors

  • Dorzolamide (Trusopt)
  • Dichlorphenamide (Azopt)

Combination Drops

  • Timolol / Dorzolamide (Cosopt)
  • Epinephrine / Pilocarpine (E-Pilo)

Oral Medications

Carbonic Anhydrase Inhibitors

  • Acetazolamide (Diamox)
  • Dichlorphenamide (Daranide)
  • Methazolamide (Neptazane)

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.

Adrenergic Agents

  • Epinephrine (Epifrin, Eppy/N, Glaucon, Epinal, Epitrate)
  • Dipivefrin (Propine)
  • Apraclonidine (Iopidine)
  • Brimonidine (Alphagan)

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 less 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.


Possible side effects include, but are not limited to:

  • 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 used to control eye pressure, especially after eye surgery.


Possible side effects include, but are not limited to:

  • Dry mouth and nose
  • Eye discomfort
  • Allergic reaction
  • Decreased blood pressure (potentially leading to fainting)
  • Tiredness

Brimonidine is used to reduce pressure in the eye.


Possible side effects include, but are not limited to:

  • 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 (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 flows into the eye. Beta-blockers are usually contraindicated in patients with such medical conditions as asthma, chronic obstructive pulmonary disease, slow heart beat, heart block, heart failure, or other heart or lung problems.


Possible side effects include, but are not limited to:

  • Blurred vision
  • Eye irritation
  • Allergic reaction
  • Breathing difficulty
  • Slowing pulse rate
  • Hair loss
  • Decreased blood pressure
  • Impotence
  • Dizziness or fainting
  • Fatigue and weakness
  • Hallucinations
  • Insomnia
  • Depression
  • Memory loss

Topical or Oral Medications

Carbonic Anhydrase Inhibitors

Common names include:

  • Dorzolamide (Trusopt)
  • Dichlorphenamide (Azopt)
  • Acetazolamide (Diamox)
  • Dichlorphenamide (Daranide)
  • 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. Blood cell counts are often monitored regularly while taking these drugs.

Possible side effects include, but are not limited to:

  • Frequent urination
  • Tingling or numbness sensation in the fingers or toes
  • Kidney stones
  • Rashes
  • 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)

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 health care provider.
  • Don't share them with anyone else.
  • Know what effects and side effects to expect, and report them to your health care provider.
  • If you are taking more than one drug, even if it is over-the-counter or herbal, be sure to check with a physician or pharmacist about drug interactions.
  • Plan ahead for refills so you don't run out.
  • Check the expiration date.
  • Let your physician know if you take any other medications or supplements. This includes vitamins and herbal remedies.

When to Contact Your Health Care Provider

  • If you have side effects or an allergic reaction to a medication
  • If you begin taking any vitamins, herbal supplements, or another medication, whether prescribed or over-the-counter

SOURCES:

American Academy of Ophthalmology


The Glaucoma Foundation


National Eye Institute



Last reviewed September 2003 by Marc Ellman, MD


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