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terminology and guidelines for glaucoma ii - Kwaliteitskoepel

terminology and guidelines for glaucoma ii - Kwaliteitskoepel

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3.3.2.2 - Category: ADRENERGIC ANTAGONISTS AND TOPICAL C.A.I. 74-75<br />

ß-Blockers & topical CAI<br />

Generics<br />

Timolol 0.5% <strong>and</strong> dorzolamide 2%<br />

Tradenames<br />

Cosopt<br />

Action<br />

Decreases intraocular pressure by reduction of the aqueous humor production. Peak effect in 2 hrs.<br />

Dosage <strong>and</strong> administration<br />

Starting dose is one drop in the affected eye twice a day. Dosing more than twice daily will not give any further<br />

pressure lowering effect.<br />

Additive effect with pilocarpine. Minimal extra effect with dipivefrine. No extra effect with adrenaline (epinephrine).<br />

Indications<br />

Elevations of intraocular pressure in patients where the IOP can be deleterious <strong>for</strong> the preservation of visual function.<br />

Major Contraindications<br />

Asthma, history of obstructive pulmonary disease, sinus bradycardia (< 60 beats/min), heart block, or cardiac failure,<br />

severe renal impairment (CrCl < 30 ml/min) or hyperchloremic acidosis, hypersensitivity to any component of<br />

the product. Relative contraindication in history of obstructive pulmonary disease.<br />

Major side effects<br />

Systemic:<br />

Bradycardia, arrhythmia, heart failure, syncope, bronchospasm, <strong>and</strong> airways obstruction.<br />

Peripheral edema, hypotension. Depression. Hypoglycemia may be masked in insulin dependent<br />

diabetes mellitus.<br />

Ocular (uncommon): Epithelial keratopathy, slight reduction in corneal sensitivity.<br />

Pregnancy <strong>and</strong> nursing mothers<br />

Only to be used if the potential benefit justifies the potential risk to the fetus or the infant.<br />

Drug interactions<br />

Caution should be used in the co-administration of beta-adrenergic blocking agents <strong>and</strong> oral or intravenous calcium<br />

antagonists, because of possible atrioventricular conduction disturbances, left ventricular failure, <strong>and</strong> hypotension.<br />

Digitalis <strong>and</strong> calcium antagonists: the concomitant use of beta-adrenergic blocking agents with digitalis <strong>and</strong> calcium<br />

antagonists may have additive effects in prolonging conduction time.<br />

Catecholamine-depleting drugs: because of possible additive effects <strong>and</strong> the production of hypotension <strong>and</strong>/or<br />

marked bradycardia.<br />

Wash-out<br />

The time needed to lose their activity completely is 2-4 weeks.<br />

Ch. 3 - 24 EGS

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