Merck Manual

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Drugs Used to Treat Glaucoma

Drugs Used to Treat Glaucoma

Drug

Some Side Effects

Comments

Prostaglandin-like compounds

Bimatoprost

Latanoprost

Tafluprost

Travoprost

Increased eye and skin pigmentation

Elongated and thickened eyelashes

Muscle, joint, and back pain

Rash

Possible worsening of inflammation within the front part of the eye (uveitis)

How they work: Increase aqueous humor outflow

Given as: Eye drops

Other comments: These drops have few serious bodywide side effects.

Beta-blockers

Timolol

Betaxolol

Carteolol

Levobetaxalol

Levobunolol

Metipranolol

Shortness of breath in people with asthma or other lung disorders that cause wheezing

Slow heart beat

Insomnia

Fatigue

Depression

Confusion

Sexual dysfunction

How they work: Decrease aqueous humor production

Given as: Eye drops

Other comments: These drops do not affect pupil size. Some side effects are worse in people with heart or blood vessel disease.

Some side effects may develop slowly and may be mistakenly attributed to aging or other bodily processes.

Cholinergic drugs*

Carbachol

Pilocarpine

Sweating

Headache

Involuntary, shaking movement

Tremor

Excess saliva production

Diarrhea, abdominal cramps, nausea

How they work: Constrict the pupil (miosis) and increase aqueous humor outflow

Given as: Eye drops

Other comments: These drops are not as effective as beta-blockers.

People who have darker pupils may need high-strength drops.

These drugs make it harder for the eyes to adapt to darkness.

Cholinesterase inhibitors*

Echothiophate

Same as for cholinergic agonists but more likely to occur

How they work: Constrict the pupil (miosis) and increase aqueous humor outflow

Given as: Eye drops

Other comments: These drops are very long acting.

They can cause cataracts and retinal detachment and should not be taken by people who have angle-closure glaucoma.

These drugs make it harder for the eyes to adapt to darkness.

Rho kinase inhibitor

Netarsudil

Eye redness

Broken blood vessels in the eye

Corneal deposits

How they work: Increase aqueous humor outflow

Given as: Eye drops

Alpha-adrenergic agonists

Apraclonidine

Brimonidine

Increase in blood pressure or heart rate

Abnormal heart rhythm

May excessively dilate the pupil

Apraclonidine: High rate of allergic reactions and decreased response if given over a period of time so that larger doses are required to have the same effect (tachyphylaxis)

Brimonidine: May cause dry mouth, has a lower rate of allergic reactions than the other drugs, and can be fatal in children less than 2 years of age

How they work: Decrease aqueous humor production and increase aqueous humor outflow

Given as: Eye drops

Carbonic anhydrase inhibitors

Acetazolamide

Brinzolamide

Dorzolamide

Methazolamide

Acetazolamide and methazolamide:

Fatigue

Altered taste

Loss of appetite

Depression

Kidney stones

Body salt (electrolyte) abnormalities

Numbness or tingling

Low or high blood cell counts (blood dyscrasias)

Weight loss

Nausea

Diarrhea

Brinzolamide and dorzolamide:

Bad taste in the mouth

Rash

How they work: Decrease aqueous humor production

Given as: For acetazolamide: By mouth or by vein

For methazolamide: By mouth

For brinzolamide and dorzolamide: Eye drops

Osmotic diuretics

Glycerin

Mannitol

Increase urine production

Can have serious side effects in some people (for example, worsening of heart failure or brain dysfunction) by changing body salt (electrolyte) levels or may cause dehydration

How they work: Increase concentration of salts in the blood, which draws fluid from the eye by osmosis

Given as: For glycerin: By mouth

For mannitol: By vein

Other comments: These drugs are used most often to treat acute closed-angle glaucoma.

* These drugs are rarely used.