Commonly Prescribed Drugs

The following is a list of commonly prescribed glaucoma drugs and an abbreviated description of some of their side effects. If a patient experiences side effects, he or she should talk to his or her physician rather than discontinue the medication. The following is intended as an informational guide for patients, their families, and caregivers. In no way is it to be considered an alternative to discussing issues of medication and treatment with your ophthalmologist or primary care physician.

• Adrenergic: the generic name for this drug is dipivefin (common brand name is Pilopine). These eyedrops increase drainage of intraocular fluid.
  
  Side effects include allergic reactions and blurred vision. For people who have had cataracts removed, this medication can cause reduced vision. Headache and burning eyes are also common side effects. Rapid heart rate or fluctuations in heart rhythm may also occur.
  
  
• Alpha agonist: The generic drug name is brimonidine (common brand name, Alphagan). These eyedrops reduce the production of aqueous fluid and enhance drainage.
  
  Side effects may include dryness of the mouth, burning and stinging of the eye, headache, blurring of vision, and the sensation of a foreign body in the eye.
  
  
• Beta blockers: There are several drugs in this category, and their generic names are betaxolol hydrochloride, carteolol, levobunolol, metipranolol, timolol hemihydrate, and various forms of timolol maleate. (Brand names include Timoptic, Betoptic S, Betagan, OptiPranolol, Timoptic-XE, Ocupress, and Betimol.) These drugs decrease the production of aqueous fluid.
  
  Side effects may include lowering of blood pressure and slowing of the heart rate as well as fatigue. Beta-blockers can also cause a shortness of breath in people who have a history of respiratory disorders.
  
  
• Carbonic anhydrase inhibitors: There are several drugs in this category, and their generic names are acetazolamide, brinzolamide, dorzolamide, and methazolamide. (Brand names include Azopt, Trusopt, Diamox, and Neptazane.) These drugs decrease the production of aqueous fluid.
  
  Side effects of these eyedrops include stinging, burning, and temporary discomfort. Allergic reactions can cause inflammation of the cornea. Bitter, sour, or unusual taste sensations can also occur. Side effects of the pill form include tingling in the extremities, hearing dysfunction or earache, loss of appetite, taste alteration, nausea, vomiting, diarrhea, and occasional drowsiness or confusion.
  
  
• Carbonic anhydrase inhibitors and beta-blockers: The generic product in this category is a combination of dorzolomide hydrochloride and timolol maleate (brand name, Cosopt). This medication reduces production of aqueous fluid through two different mechanisms simultaneously.
  
  Side effects include taste perversion (bitter, sour, or unusual taste), burning and/or stinging, blurred vision, superficial corneal inflammation, and itching. Side effects of beta-blockers (see above) are also a concern with this eyedrop.
  
  
• Cholinergic (miotic): The generic name for these drugs are pilocarpine and carbachol. They decrease internal eye pressure by enhancing the drainage of fluids from the eye.
  Side effects include tearing, burning or discomfort, headache, superficial corneal infections, and induced nearsightedness.
  
  
• Cholinesterase inhibitor: Echothiophate (brand name, Phospholine Iodide) increases fluid drainage.
  
  Side effects include stinging, burning, tearing, eyelid muscle twitching, redness, eyebrow ache, induced nearsightedness, and blurring of vision.
  
  
• Docosanoid: Unoprostone (brand name, Rescula) increases drainage of ocular fluid. This drug is often used as a second line of treatment for patients with primary open-angle glaucoma or ocular hypertension who are intolerant of other pressure-lowering medications or for whom other pressure-lowering medications are inadequate.
  Side effects include burning or stinging, dry eyes, itching, growth of eyelashes, and eyelid and tear production disorders.
  
  
• ”Prosta-drugs:” This category of drugs includes prostaglandins such as travaprost (brand name, Travatan) and latanoprost (brand name, Xalatan), and prostamide such as bimatoprost (brand name, Lumigan). These powerful drugs increase drainage of ocular fluid.

Side effects include intraocular inflammation, growth of eyelashes, and change from a light-colored iris to a brown iris. The color change happens slowly over months or years but may be permanent.

Drops of the drug from the applicator or drops caused by blinking or squeezing of the eyes after installation that fall on the skin below the eye may cause the skin to darken. Such darkening may be reduced or eliminated if the patient applies skin cream or Vaseline to the skin under the eye before instilling the eyedrop.