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Medications for Glaucoma
by Mary Calvagna, MS
En Español (Spanish Version)
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 healthcare provider if you need to take any special
precautions. Use each of these medications as recommended by your healthcare provider and according to the
instructions provided. If you have further questions about usage or side effects, contact your healthcare 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) (rarely used)
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 (Istalol, Timoptic XE, Timoptic, Ocudose, Timolol Gel)
Timolol hemihydrate (Betimol)
Levobunolol (Betagan)
Metipranolol (OptiPranolol)
Carteolol (Ocupress)
Betaxolol (Betoptic)
+ Prostaglandin analogs
Bimatoprost (Lumigan)
Latanoprost (Xalatan)
Travoprost (Travatan)
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+ Carbonic Anhydrase Inhibitors
Dorzolamide (Trusopt)
Dichlorphenamide (Azopt)
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.
Miotics (Cholinergic Agents) (Rarely Used)
Common names include:
Pilocarpine (Isopto Carpine, Pilocar, Pilagan, Ocusert, Pilopine)
Carbachol /Carbamylcholine
Echothiophate iodide (Phospholine Iodide)
Physostigmine (Eserine ointment, Isopto Eserine)
Demecarium bromide (Humorsol)
Isoflurophate
Miotics increase fluid drainage out of the eye by helping to open the drainage network. Miotics also reduce the size
of the pupil. Miotics may cause adverse drug interactions with certain anesthetic agents.
Possible side effects include, but are not limited to:
Pain inside/around the eye or brow
Blurred vision
Headache
Dim vision
Retinal detachment
Worsening myopia (nearsightedness)
Cataract formation
Increased tearing
Gastrointestinal upset (abdominal cramps, nausea, diarrhea, etc.)
Increased saliva production
Adrenergic Agents
Epinephrine (Epifrin, Eppy/N, Glaucon, Epinal, Epitrate)
Dipivefrin (Propine)
Apraclonidine (Iopidine)
Brimonidine (Alphagan) – Available as generic 0.2% and as name brand Alphagan-P 0.15%, which causes
fewer allergies.
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 fewer 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:
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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 often used to control eye pressure after laser or surgical procedures.
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 the most commonly used medication in the category 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 (Istalol, 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 is produced in the eye.
Beta-blockers are usually contraindicated in patients with such medical conditions as asthma, chronic obstructive
pulmonary disease, slow heart beat, heart block, or other heart or lung problems.
Possible side effects include, but are not limited to:
Blurred vision
Eye irritation
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Allergic reaction
Breathing difficulty
Slowing pulse rate
Hair loss
Decreased blood pressure
Impotence
Dizziness or fainting
Fatigue and weakness
Hallucinations
Insomnia
Depression
Memory loss
Prostaglandin Analogs
Bimatoprost (Lumigan)
Latanaprost (Xalatan)
Travoprost (Travatan)
Prostaglandin analogs reduce pressure in the eye by increasing the outward flow of fluid from the eye.
Possible side effects include, but are not limited to:
Darkening of the iris (colored part of the eye)
Darkening and increased growth of eye lashes
Conjunctival hyperemia (red eyes)
Eye irritation
Flu-like symptoms
Body aches and pains
Topical or Oral Medications
Carbonic Anhydrase Inhibitors
Common names include:
Dorzolamide (Trusopt)
Dichlorphenamide (Azopt)
Acetazolamide (Diamox)
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. They are also contraindicated in patients with
sickle cell. 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
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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)
Neuroprotective medications
Researchers are currently evaluating the possibility of protecting the optic nerve from damage. One of the potential
medications that are being considered is brimonidine (Alphagan). Another is memantine, an oral medication used
in the treatment of Alzheimer's disease.
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 doctor.
Don’t share them with anyone else.
Know what effects and side effects to expect, and report them to your doctor.
If you are taking more than one drug, even if it is over-the-counter or herbal, be sure to check with a doctor or
pharmacist about drug interactions.
Plan ahead for refills so you don’t run out.
Check the expiration date.
Let your doctor know if you take any other medications or supplements. This includes vitamins and herbal
remedies.
For most eyedrops, only one drop is necessary at each recommended time interval. Placing two or more
drops at one time is usually a waste of medicine. Ask your doctor how many drops you need to place.
When to Contact Your Doctor
If you have side effects or an allergic reaction to a medication (stop taking the medication and call your
doctor immediately)
If you begin taking any new vitamins, herbal supplements, or another medication, whether prescribed or
over-the-counter
REFERENCES:
American Academy of Ophthalmology website. Available at: http://www.aao.org/ .
The Glaucoma Foundation website. Available at: http://www.glaucomafoundation.org/ .
National Eye Institute website. Available at: http://www.nei.nih.gov/ .
Weinreb RN, Khaw PT. Primary open-angle glaucoma. Lancet. 2004; 363:1711.
Maier PC, Funk J, Schwarzer G, et al. Treatment of ocular hypertension and open angle glaucoma: meta-analysis
of randomised controlled trials. BMJ. 2005;331:134.
Last reviewed September 2011 by Christopher Cheyer, MD
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Last Updated: 9/1/2011
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