terminology and guidelines for glaucoma ii - Kwaliteitskoepel

3.3.1.3 - Category: CARBONIC ANHYDRASE INHIBITORS 46
Generics
Tradenames
Topical: Brinzolamide 1% Azopt
Dorzolamide 2%
Trusopt
Systemic: Acetazolamide Diamox, Diamox Sequels, Diamox Retard
Dichlorphenamide
Methazolamide
Antidrasi, Daranide, Glaumid, Oralcon
Neptazane
Action
Topical: Carbonic anhydrase inhibitor. Reduces aqueous formation resulting in lowered IOP.
Systemic: Carbonic anhydrase inhibitor. Reduces aqueous formation resulting in lowered IOP.
Dosage and administration
Topical: Dorzolamide 2% Monotherapy: three times daily.
As adjunctive therapy with topical betablocker: two times daily
Brinzolamide 1% Monotherapy: two - three times daily
As adjunctive therapy with topical betablocker: two times daily
Systemic: Acetazolamide 250 mg tablets (given QID as full dose)
500 mg slow- release capsule (given BID as full dose)
Dichlorphenamide 50 mg 1-3 times daily
Methazolamide 50-100 mg 2-3 times daily
Indications
Topical: Elevations of intraocular pressure in patients where the IOP can be deleterious for the
preservation of visual function.
Systemic: When topical medications not effective or feasible. When long-term systemic CAI are needed, glaucoma
surgery should be considered.
Major contraindications
Topical: Hypersensitivity to any component of the product
Systemic: Contraindicated in situations in which sodium and/or potassium blood levels are depressed, in cases of
kidney and liver disease or dysfunction, in suprarenal gland failure, and in hyperchloremic acidosis.
Precautions
Topical: For the treatment of acute angle-closure glaucoma attack with corneal edema and inflamed conjunctiva,
systemic CAI treatment is preferable.
In patients with low corneal endothelial cell count, there is increased risk of corneal edema.
Since no data on patients with severe renal impairment (CrCl < 30 mL/ml) are available, they should not
be used in such patients. The concomitant use of topical and oral carbonic anhydrase inhibitors is not
additive and not recommended.
These compounds are sulfonamides; the same kind of adverse reactions that are attributable to any sulfonamide
may occur.
Systemic: Increasing the dose may increase the incidence of drowsiness and /or paresthesia. Adverse reaction common
to all sulfonamide derivatives may occur like anaphylaxis, fever rash (erythema multiforme),
Stevens-Johnson syndrome, bone marrow depression, thrombocytopenic purpura, hemolytic anemia,
leukopenia, pancytopenia and agranulocytosis. Some of the above can be irreversible and lethal. If the
patient is on another diuretic orally periodic monitoring of serum electrolytes is indicated.
Ch. 3 - 14 EGS