NHMRC Glaucoma Guidelines - ANZGIG
NHMRC Glaucoma Guidelines - ANZGIG
NHMRC Glaucoma Guidelines - ANZGIG
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<strong>NHMRC</strong> GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA<br />
Chapter 9 – Medication<br />
Medication interaction<br />
Each medication family for the management of glaucoma has the potential to interact with any<br />
other, as well as with medications taken for other conditions. The additive effect of glaucoma<br />
medications is outlined in Table 9.2, derived from the EGS <strong>Guidelines</strong> (2003) and modified by<br />
expert opinion. The significance and severity of these interactions can vary greatly, so it is essential<br />
that accurate and timely information on a patient’s use of all prescription and over-the-counter<br />
medications is obtained.<br />
Medications for glaucoma may also interact with patients’ medical conditions, regardless of whether<br />
medications are being taken for other medical conditions or not. Therefore, for patients with other<br />
medical conditions, health care providers should be aware of any precautions or contraindications<br />
regarding the use of medications for the management of glaucoma. A summary of these<br />
interactions is provided in Table 9.3.<br />
Table 9.2: Additive effects of medications used in the treatment of glaucoma (modified from EGS 2003)<br />
Class of<br />
medication<br />
Alpha 2<br />
-<br />
agonists<br />
Betablockers<br />
Topical<br />
carbonic<br />
anhydrase<br />
inhibitor<br />
Cholinergic<br />
Prostaglandin<br />
analogues<br />
Alpha 2<br />
-agonists +* + + + -<br />
Sympathomimetics<br />
Beta-blockers +* +* + +* +<br />
Topical carbonic + +* + + +<br />
anhydrase<br />
inhibitor<br />
Cholinergic + + + +/- +<br />
Prostaglandin<br />
analogues<br />
+ +* + +/-<br />
+ good additive IOP-lowering effect<br />
- additional IOP-lowering effect is relatively poor<br />
* available in combined preparation<br />
Evidence Statement<br />
• Expert/consensus opinion suggests the need to establish the presence of other disease states when<br />
initiating, assessing or altering medication regimens for patients with glaucoma.<br />
These include, but are not limited to, diabetes, depression, hyperthyroidism, heart disease, asthma, liver<br />
and renal impairment.<br />
Point of note<br />
Communication between health care providers is important to ensure safe and effective<br />
medication management.<br />
National Health and Medical Research Council 113