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terminology and guidelines for glaucoma ii - Kwaliteitskoepel

terminology and guidelines for glaucoma ii - Kwaliteitskoepel

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3.3.2.3 - Category: PROSTAGLANDINS AND ADRENERGIC ANTAGONISTS<br />

Prostagl<strong>and</strong>in & ß-Blocker<br />

Generics<br />

Latanoprost 0.005% <strong>and</strong> Timolol 0.5%<br />

Tradenames<br />

Xalcom, Xalacom<br />

Action<br />

In latanoprost the most evident action is the increase of the uveo-scleral outflow, reducing IOP 20% - 35%. Timolol<br />

decreases intraocular pressure by reduction of the aqueous humor production. Peak effect in 2 hrs. <strong>for</strong> timolol <strong>and</strong> 8-12<br />

hours <strong>for</strong> latanoprost.<br />

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

Starting dose is one drop in the morning.<br />

Indications<br />

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

spite of medical <strong>glaucoma</strong> monotherapy.<br />

Major Contraindications<br />

Non-selective β-blockers: Asthma, history of obstructive pulmonary disease, sinus bradycardia (< 60 beats/min), heart<br />

block, or cardiac failure<br />

Known hypersensitivity to latanoprost, timolol, benzalkonium chloride, or any other product ingredient.<br />

Patients should not administer these drugs while wearing contact lenses, but contact lenses can be reinserted 15 minutes<br />

following administration of the drugs.<br />

Major side effects<br />

Systemic:<br />

Ocular:<br />

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

hypotension. Depression. Hypoglycemia may be masked in insulin dependent diabetes mellitus. Betablocking<br />

agents are associated with nocturnal hypotension, which may be a risk factor in progression of<br />

<strong>glaucoma</strong>tous optic nerve damage.<br />

Conjunctival hyperemia, burning <strong>and</strong> stinging, <strong>for</strong>eign body sensation <strong>and</strong> itching.<br />

Eyelash changes (increased length, thickness, pigmentation, <strong>and</strong> number of lashes).<br />

Increased iris pigmentation in patients treated with melanocytes is increased. Especially seen in patients<br />

with green-brown, blue/gray-brown or yellow-brown irides. The long-term effects on the melanocytes <strong>and</strong><br />

the consequences of potential injury to the melanocytes <strong>and</strong> /or deposition of pigment granules to other<br />

areas of the eye are currently unknown. The effect may be permanent.<br />

Cystoid macular edema in aphakes/pseudophakes has been reported in few cases, most occurring in<br />

aphakic patients, in pseudophakic patients with a posterior lens capsule rupture, or in patients with known<br />

risk factors <strong>for</strong> macular edema.<br />

Epithelial keratopathy, slight reduction in corneal sensitivity.<br />

Reactivation of herpes keratitis.<br />

Anterior uveitis.<br />

Precautions<br />

Cystoid macular edema in aphakes/pseudophakes has been reported in few cases, most occurring in aphakic patients, in<br />

pseudophakic patients with a posterior lens capsule rupture, or in patients with known risk factors <strong>for</strong> macular edema.<br />

Unilateral treatment may cause a difference in iris colour between the eyes.<br />

Patients with uveitis.<br />

Ch. 3 - 25 EGS

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