Glaucoma Medications To Avoid

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Glaucoma Medications To Avoid: A wide range of medications have the potential to raise ocular pressure and raise the likelihood of developing glaucoma. This article investigates the drug classes that may have an impact on angle-closure and open-angle glaucoma.

Important: Before stopping any prescription medicine, speak with your doctor.

Angle-Closure Glaucoma: What is it? 

The second most prevalent type of glaucoma, known as angle-closure glaucoma, is primarily inherited and is brought on by an abnormally small angle in the channel where aqueous fluid normally drains. There are two ways that this form of glaucoma can develop:

Like open-angle glaucoma, the chronic form advances gradually and can harm the optic nerve. Prior to a noticeable loss of peripheral vision, there are no symptoms. Medication, laser therapy, and surgery are all forms of treatment.

When the usual flow of the fluid between the iris and lens is interrupted, the acute (also known as closed-angle) type abruptly starts to develop. Severe eye discomfort, nausea, vomiting, an abrupt onset of visual disruption (typically in dim light), blurred vision, haloes surrounding lights, and eye reddening are some of the symptoms. This situation needs prompt medical attention as a medical emergency. The first step in treatment is to stop the attack, which is done by combining laser iridotomy with drugs that lower eye pressure. Blindness may occur in one or two days without treatment. You should go to the closest emergency room if you do not have established care or access to an eye doctor.

Most glaucoma medicines that have the potential to worsen glaucoma symptoms or raise the risk of developing glaucoma also have the capacity to constrict the trabecular meshwork, the eye’s drainage angle. This would result in improper ocular fluid drainage and elevated eye pressure. The angle between the iris, which consists of the colorful portion of your eye, and the cornea, which is the transparent front portion of your eye, is the “angle” that is being discussed.

Therefore, you should absolutely see your ophthalmologist before taking any medicine that contains a glaucoma warning if you have a history of narrow angles or the disease known as angle-closure glaucoma. Your ophthalmologist will go over the new drug with you and consider the advantages and disadvantages.

Pre-existing narrow angles are one of the risk factors for medication-induced angle closure. These are additional risk factors.

  • Getting older
  • Female
  • (Farsightedness) hyperopia
  • Being of Asian decent
  • Family history of angle-closure glaucoma 

Glaucoma Medications To Avoid

A class of pharmaceuticals known as anticholinergic medications prevents the neurotransmitter acetylcholine from acting in the central and peripheral nervous systems. Numerous medical disorders, including Parkinson’s disease, urinary incontinence, and asthma, are treated with them. They may, however, also be harmful to sufferers of narrow-angle glaucoma, a condition in which the eye’s drainage system becomes obstructed, raising intraocular pressure and perhaps harming the optic nerve.

The anticholinergic drugs listed below, along with their intended uses and potential effects on narrow-angle glaucoma, include:

Atropine

An antidote for cholinergic toxicity, atropine is a drug used to treat bradycardia (slow heart rate), to lessen salivation before surgery, and to treat bradycardia. It may result in mydriasis, which reduces the area available for fluid drainage and worsens narrow-angle glaucoma.

Scopolamine

This drug is used to treat irritable bowel syndrome as an adjunctive therapy, to manage salivary and bronchial secretions before surgery, and to avoid motion sickness. It can lead to mydriasis and raise intraocular pressure in those with narrow-angle glaucoma, similar to atropine.

Glycopyrrolate

Glycopyrrolate is a medicine that is used to treat peptic ulcers and to lessen respiratory tract secretions. Patients with narrow-angle glaucoma run the risk of injury from it since it can lead to mydriasis and raise intraocular pressure.

Tiotropium

Tiotropium is a drug used to treat COPD or chronic obstructive pulmonary disease. For people with narrow-angle glaucoma, it can worsen mydriasis and raise intraocular pressure.

Ipratropium

Ipratropium is a drug that is used to treat asthma and COPD. Similar to tiotropium, it has the potential to affect patients with narrow-angle glaucoma since it can lead to mydriasis and raise intraocular pressure.

Medications for overactive bladder and incontinence

Ditropan (oxybutynin) and Detrol (tolterodine) are among the drugs in this class.

Digestive disorders

Drugs like Zantac (ranitidine) and Tagamet (cimetidine), which are weak anticholinergics, may cause angle closure.

Nausea

Anticholinergic effects can be seen in some nausea treatments, including Phenergan (promethazine).

Spasms of muscles

Angle-closure has been linked to drugs like Norflex (orphenadrine) and Artane (trihexyphenidyl).

Depression

Numerous antidepressants may have negative side effects in persons with narrow angles. These include SSRIs, such as Prozac (fluoxetine) and Paxil (paroxetine), which are selective serotonin reuptake inhibitors. Tricyclic antidepressants, including Elavil (amitriptyline) and Tofranil (imipramine), may also exhibit modest anticholinergic effects; as a result, they should be used cautiously in individuals with narrow angles.

Allergies

Patients with narrow angles run the risk of adverse reactions from over-the-counter allergy medications containing diphenhydramine.

Anxiety

One illustration is the anxiety-relieving drug Vistaril (hydroxyzine), which can have potent anticholinergic effects and raise the likelihood of angle closure.

People with narrow-angle glaucoma should exercise caution when taking anticholinergic drugs since they may increase intraocular pressure and result in mydriasis. If they must take these medications, they should be closely watched by their doctor to avoid any negative effects on the health of their eyes.

Open-angle glaucoma and medications to avoid

Steroid medications

You may not be aware of the dangers of steroid-induced ocular hypertension. Steroids may alter the trabecular meshwork at the microscopic level, increasing the aqueous outflow’s resistance as a result. Steroid-induced ocular hypertension is defined as an increase in IOP of at least 6 to 15 mmHg over the patient’s normal IOP.

Because they are showing up more and more frequently in popular, widely-used therapy regimens, steroids constitute a noteworthy worry. Injections of steroids are regularly used for conditions like arthritis and joint damage. Steroids are also commonly used to treat allergies in oral, inhaled, topical, or nasal forms. In addition to oral and inhaled steroids being given for lung diseases including asthma and COPD, dermatologists often prescribe steroid creams for a variety of skin conditions. As a result, many individuals habitually take steroid drugs that may have an adverse effect on their eyes; they may or may not be aware of this.

The fact that it is uncertain what the actual incidence of steroid-induced ocular hypertension is makes management of this issue difficult. Many patients on steroid therapy may not have their IOP measured; in certain cases, they may not even have eye problems. We estimate that around one-third of the general population will experience an increase in IOP after using steroids, based on some research. The prevalence in people with glaucoma may be as high as 70 to 80 percent, according to some research, but it will be much higher in those who have the condition. 

Other than steroids, a number of drugs can boost the eye’s production of aqueous fluid. The structures of the eye receive nourishment and oxygen from the clear fluid known as aqueous humor, which also supports intraocular pressure maintenance. Aqueous humor production and drainage issues, on the other hand, can increase intraocular pressure and potentially harm the optic nerve, resulting in glaucoma.

Below is a list of medications that although the occurrence is rare of the aqueous humor increasing in production is possible. 

Beta-blockers

By lowering the production of aqueous humor, beta-blockers like timolol and betaxolol are frequently used to treat glaucoma. In a few rare instances, beta-blockers, ironically, might raise aqueous humor production and intraocular pressure.

Epinephrine

Also known as adrenaline, epinephrine is a drug used to treat glaucoma by boosting aqueous humor outflow and decreasing aqueous humor production. However, it can aggravate intraocular pressure and produce more aqueous fluid in some people.

Cholinergic agonists

Aqueous humor generation and secretion are stimulated by cholinergic agonists like carbachol and pilocarpine. They may, however, increase aqueous fluid production and aggravate intraocular pressure in some people.

Certain antidepressants

Trazodone and mirtazapine, two antidepressants, can cause an increase in aqueous humor production and a worsening of intraocular pressure.

Some antihistamines

Some antihistamines, including diphenhydramine, might exacerbate intraocular pressure and increase the generation of aqueous fluid.

It’s crucial to remember that not all patients who take these medications will see a rise in aqueous humor production, and most will have the opposite, desired effect. However, glaucoma patients should disclose their condition to their doctor before beginning any new prescriptions and should be aware of any potential hazards related to specific medications.

Summary of Glaucoma Medications To Avoid

The disorder known as glaucoma causes the eye’s pressure to rise, potentially harming the optic nerve. While certain drugs can help people manage their glaucoma, others should be avoided or taken with caution by those who have this condition.

Corticosteroids, anticholinergics, some antidepressants, some decongestants, and some migraine treatments are the most typical drugs to be cautious of that can harm glaucoma sufferers. These drugs have the potential to aggravate the condition by either raising intraocular pressure or decreasing aqueous fluid discharge from the eye.

Before beginning any new medications, patients with glaucoma should let their doctor know about their condition and be aware of any possible hazards that may come with particular medications. For the proper management of glaucoma, regular eye exams and careful monitoring of intraocular pressure are also crucial.

FAQs for Glaucoma Medications To Avoid

What medication for glaucoma is the safest?

However, prostaglandin-based glaucoma eye drops like Xalatan appear to be the most well-tolerated by most patients. Prostaglandin eye drops are a standard first choice due to this and its once-daily dosage.

What may make glaucoma worse?

It has been established that high trans fat diets harm the visual nerve. It’s time to stop eating fried foods, baked products, and anything whose ingredient list contains hydrogenated or partially hydrogenated oils. Additionally, saturated meals like red meat, steak, lard, shortening, and oils might make glaucoma worse.

What are 2 typical adverse effects of glaucoma drugs?

The majority of oral glaucoma treatments are carbonic anhydrase inhibitors, which reduce pressure by reducing the amount of fluid produced in the eyes. Fatigue, an upset stomach, memory problems, increased urination, and tingling in the hands and feet are possible side effects.

What is the most effective glaucoma treatment?

Lowering intraocular pressure is the best glaucoma treatment. Depending on the patient’s condition, our doctors may employ a combination of various therapies, including prescription eye drops, oral medications, laser therapy, and eye surgery.

What is the latest glaucoma medication?

Eye drops with the names Rhopressa (netarsudil ophthalmic solution) and VYZULTA (latanoprostene bunod ophthalmic solution) are two of the more recent treatments available. Prostaglandin analogs, a class of drugs currently used to treat glaucoma, are modified in VYZULTA.

What is a glaucoma patient’s normal eye pressure?

The intraocular pressure should be between 10 and 21 mm Hg on average, but in hypotony, it can be as low as 0 mm Hg and as high as 70 mm Hg. The pressure and whether the glaucomatous damage is early or advanced determine how quickly increased intraocular pressure damages the optic nerve.

About the Author:
Dr. Shaun Larsen

Dr. Shaun Larsen

Dr. Shaun Larsen is an optometrist who specializes in low vision services and enhancing vision with contact lenses. He has a passion for making people's lives better by helping them see well enough to read, write, or drive again. He always keeps up with the latest technology so he can help people regain their independence.

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