Prostaglandin Analogs and Prostamides
While there is no cure for glaucoma, it can be controlled.

Elevated intraocular pressure (IOP) may damage the optic nerve, which can lead to vision loss. Treatment for glaucoma focuses on lowering IOP to a level that is unlikely to cause further optic nerve damage. This is known as the "target pressure" or "goal pressure." The target pressure differs from individual to individual. Your target pressure may change during your course of treatment.

If you have glaucoma, your ophthalmologist (Eye MD) may prescribe medication to lower your eye pressure. There are many more choices for topical treatment of glaucoma today than there were only a few years ago. Your ophthalmologist has chosen a prostaglandin analog or prostamide medication as a good choice for treating your glaucoma.

How Do Prostaglandin Analogs or Prostamides Work?
These medications lower the intraocular pressure by increasing the outflow of the fluid that the eye continually makes, called the aqueous humor. These medications are all taken once a day (except Rescula, which is taken twice per day).

What Are the Prostaglandin Analogs or Prostamide medications?
Latanoprost (Xalatan)
Bimatoprost (Lumigant)
Travoprost (Travatanu)
Uniprostone (ResculaD)
No generic versions are available at this time.

Possible Side Effects of Prostaglandin Analogs or Prostamides
All medications, including eyedrops, have benefits, but they may also have side effects. Some people taking these eyedrops may experience:

Redness of the eye
The iris (the colored part of the eye) may darken or turn brown (this change in color occurs slowly and may not be noticeable for months or even years)
Increased growth, thickness and pigmentation of the eyelashes
Eye irritation or itching
Blurred vision
Darkening of the eyelid skin
Muscle aches (rare)
Headache (rare)

Patients with a history of uveitis (inflammation in the eye), ocular herpes infection or a history of swelling in the retina (called cystoid macular edema), should use this medication with caution. If you have a history of any of these conditions, please discuss this with your doctor. For glaucoma medications to work you must take them regularly and continuously as prescribed by your doctor.


Alpha Agonists
How Do Alpha Agonists Work?
Alpha agonist medications are reliable for lowering the intraocular pressure. They work by decreasing the production of the fluid that the eye continually makes, called the aqueous humor.

What Are the Alpha Agonists?
There are two alpha agonist drugs:
Apraclonidine (lopidine)
L1 Brimonidine (Alphagan)
Generic versions of these medications are not yet available.

Beta Blockers
How Do Beta Blockers Work?
Beta blocker (beta andrenergic antagonists) medications are reliable for lowering intraocular pressure. They work by decreasing the amount of fluid that the eye continually produces, called the aqueous humor. For many years, beta blockers were the mainstay of treatment. Hence, we have a lot of experience with this medication for the treatment of glaucoma.

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Types of Beta Blocker Medication There are two general classes of beta blockers: nonselective and selective. Nonselective beta blockers have more effects on the body's beta receptors system-wide, and are associated with more side effects. The nonselective beta-blockers are also more effective at lowering intraocular pressure.
The nonselective beta blockers include:
Levobunolol (Betagan)
Timolol hemihydrate (Betimol)
Carteolol (Ocupress)
Metipranolol (Optipranolol)
Timolol maleate (Timoptic) and Timolol maleate gel (Timoptic XE)
(Generic versions of Timolol are now available. Check with your ophthalmologist to make sure that a generic product is an acceptable alternative for you.)

The only available selective beta blocker medication is:
Betaxolol (Betoptic-S)

While a selective beta blocker eyedrop has a better safety profile, especially in terms of breathing symptoms, it still must be used with caution in patients with asthma or emphysema. The eye pressure lowering effect is slightly less with selective beta blockers. There is only a minimal additive effect in terms of lowering eye pressure in patients already taking oral beta blockers and there is the risk of further additive side effects. If you are already taking a beta blocker medication by mouth or if your primary care doctor newly prescribes a beta blocker, please notify your Eye MD.

Possible Side Effects of Beta Blockers
All medications, including eyedrops, have not only benefits but may also have side effects. Some people taking beta blocker eyedrops may experience:
Increased or worse asthma or emphysema
Slow or irregular heart beat and/or decreased response of heart rate to exercise
Increased risk for heart failure
Depression or change in sex drive (impotence)
Headache or dizziness or weakness
In diabetics, difficulty sensing blood sugar changes
Eye in-itation or allergy

Carbonic Anhydrase Inhibitors (CAls)
How Do Carbonic Anhydrase Inhibitors (CAls) Work?
Carbonic anhydrase inhibitor medications are very reliable at lowering the intraocular pressure. They work by decreasing the production of the fluid that the eye continually makes, called the aqueous humor.

What are Carbonic Anhydrase Inhibitor Medications?
Topical drugs:
Dorzolamide (Trusopt) Brinzolamide (Azopt)
Brinzolamide (Azopt)

Oral Medications:
Acetazolamide (Diamox)
Methazolamide (Neptazane)
Generic versions of the eyedrop formulations are not yet available.

Possible Side Effects of Carbonic Anhydrase Inhibitors
All medications, including eyedrops, have benefits but may also have side effects. Some people taking carbonic anhydrase medications may experience:
Blurred vision
Change in taste (especially with carbonated beverages)
Dry Eye
Eye irritation or allergy with a red eye and/or red eyelids
Headache or dizziness
Upset stomach

The oral (pill) form of these medications has more side effects, including:
Increased need to urinate
Tingling sensation in fingers and toes
Rarely, severe allergic reactions or blood disorders can occur

WARNING: These medications are sulfonamides, therefore, if you are allergic to sulfa antibiotics, the same types of adverse reactions can occur with carbonic anhydrase inhibitors. Also, rare adverse drug interactions have occurred in patients taking high doses of aspirin and carbonic anhydrase inhibitors.

For glaucoma medications to work, you must take them regularly and continuously as prescribed by your doctor.

Medication Tips:
With each new medication that your ophthalmologist prescribes, make sure you understand the following:
• The name of the medication
• How to take it
• How often to take it How to store it
• If you can take it with your other medications
(make sure each of your doctors knows about all the different medications you take, including nonprescription medications)
• What the possible side effects may be
• What you should do if you experience side effects
• What you should do if you miss a dose

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