NHMRC Glaucoma Guidelines - ANZGIG

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<strong>NHMRC</strong> GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA Chapter 9 – Medication Class Contraindications Precautions to use Interactions Systemic Acetazolamide Sulfonamide allergy Renal stones/failure Respiratory/metabolic acidosis Hypokalaemia Hyponatraemia Severe renal impairment Hepatic failure Mild to moderate renal impairment Gout Diabetes Aspirin (high dose) Lithium Cyclosporine Diuretics Digoxin Cholinergics (Miotics) Pilcarpine Carbachol Uveitis - exacerbates blood– ocular barrier breakdown Secondary glaucomas associated with extensive outflow obstruction— ineffective, may worsen Asthma Urinary-tract obstruction High myopia, aphakia, peripheral retinal degeneration, previous retinal detachment— increased risk of retinal detachment Proprietary fixed combinations Combigan (brimonidine/timolol) Cosopt (dorzolamide/timolol) DuoTrav (travoprost/timolol) Xalacom (latanoprost/timolol) As for individual components As for individual components As for individual components Side effects Health care providers should not underestimate the potentially significant side effects associated with either topical or systemic use of medications for glaucoma. Side effects can be life-threatening and particular caution should be exercised when prescribing medications for infants and the elderly who may be more susceptible to various side effects (RCO 2004). Some side effects occur immediately, but most occur over time. Thus optimum management of patients with glaucoma should include regular monitoring and review of medication regimens. Details of side effects related to glaucoma medications are reported in Tables 9.4 and 9.5. Data were taken from the EGS (2003) and the Australian Medicines Handbook [AMH] (2009). Evidence Statement • Evidence strongly warns of the significant potential side effects from both topical and systemic medications in the management of glaucoma. National Health and Medical Research Council 115
<strong>NHMRC</strong> GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA Chapter 9 – Medication Table 9.4: Summary of ocular side effects Preparations by class Alpha 2 -agonists Brimonidine 0.2% Apraclonidine 0.5% Beta-blockers Non-selective agents Timolol 0.25%, 0.5%, 0.1% Levobunolol 0.25% Selective agents Betaxolol 0.25%, 0.5% Carbonic Anhydrase Inhibitors Topical Dorzolamide 2% Brinzolamide 1% Oral Acetazolamide 250mg Topical ophthalmic side effects Ocular allergic reaction Burning Stinging Blurring Foreign-body sensation Itching Hyperaemia Lid retraction Conjunctival blanching Photophobia Mydriasis (Apraclonidine) Burning Stinging Photophobia Itching Tearing Decreased corneal sensitivity Hyperaemia Punctate keratitis Diplopia Burning Stinging Itching Punctate epithelial keratopathy Blepharoconjunctivitis Corneal endothelial cell-decompensation Transient myopia Systemic side effects Central nervous system depression Oral dryness Headache Fatigue Drowsiness Bradycardia Systemic hypotension Hypothermia Apnoea Taste disturbance Syncope Bronchospasm Hypotension Bradycardia Heart block Mask hypoglycaemia Adversely affects lipid profile Impotence Fatigue Depression Reduced exercise tolerance Syncope Confusion Alopecia Bitter taste Headache Nausea Fatigue Dry mouth Dizziness Anaphylaxis (Up to 50% of patients do not tolerate acetazolamide) Fatigue/lethargy Anorexia/weight loss Gastro intestinal upset Paraesthesia Depression Loss of libido Taste disturbance Stevens-Johnson syndrome Blood dyscrasias Renal stones/failure Metabolic acidosis Hypokalaemia Agranulocytosis Aplastic anaemia Neutropenia Thrombocytopenia Anaphylaxis 116 National Health and Medical Research Council
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