NHMRC Glaucoma Guidelines - ANZGIG

NHMRC GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA
Chapter 9 – Medication
Table 9.9: Safety of glaucoma medications during lactation (AMH 2009)
Medication class
Beta-blockers
Alpha 2
-agonists
Carbonic anhydrase
inhibitors
Prostaglandin analogues
Cholinergics
Unlikely to cause adverse effects at usual doses.
Timolol listed as compatible with breastfeeding by the American Academy of Pediatrics.
No data available, unlikely to be of concern. Monitor infant for adverse effects.
No human data regarding topical carbonic anhydrase inhibitors.
Acetazolamide listed as compatible with breastfeeding by the American Academy
of Pediatrics.
No data available, but unlikely to be of concern. Latanoprost is safe to use.
Safe to use.
Evidence Statements
• Evidence supports using beta-blockers in pregnancy, but with caution due to the risks of foetal
bradycardia and interuterine growth restriction.
• Evidence supports laser therapy over surgical techniques in women who are pregnant or planning to
conceive in the near future.
point of note
The Working Committee notes that treating pregnant women with glaucoma is always difficult
and health care providers may have their own preference regarding treatment. The information
presented in this guideline should allow health care providers to make an informed decision based
on the current best evidence.
Other vulnerable patients
Glaucoma is a chronic disease that requires long-term management. However, unlike other chronic
diseases, patients may be initially symptom-free. Furthermore, patients must be highly dexterous to
master the instillation techniques required in common topical medication management strategies.
This means that certain groups of patients may have to rely on others for assistance. All these aspects
make it likely that some people suffering from glaucoma may experience challenges with maintaining
their medication regimens, which may impact on the successful management of their disease.
There is a paucity of information regarding the management of glaucoma in elderly patients such
as those in nursing homes and aged care facilities. For example, beta-blockers have been shown
to increase the risk of falls in the elderly (SEAGIG 2003). More research may be available to inform
subsequent revisions of this guideline.
point of note
Vulnerable patients may have particular difficulty in adhering to the sustained medication regimens
required for glaucoma management. An individual’s capacity to adhere to a medication regimen
should inform clinical decisions regarding appropriate management strategies, and the need to
organise patient support services.
National Health and Medical Research Council 135