terminology and guidelines for glaucoma ii - Kwaliteitskoepel

Alpha-2 selective: Apraclonidine 0.5% For temporary chronic dosing as adjunctive
treatment on maximally tolerated medical
therapy where additional IOP lowering is
required (increased risk of allergy with time).
The addition of apraclonidine to patients
already using two aqueous suppressing drugs
(i.e. beta-blocker plus carbonic anhydrase inhibitor)
may not provide additional IOP lowering
effect.
Apraclonidine 1.0%
To control or prevent severe elevations in IOP
following anterior segment laser procedures.
Brimonidine 0.2%
Elevation of intraocular pressure in patients
where the IOP can be deleterious for the
preservation of visual function.
Useful as adjunctive treatment or as
monotherapy.
Clonidine 0.125-0.5%
Elevations of intraocular pressure in patients
where the IOP can be deleterious for the preservation
of visual function.
Major contraindications
Non-selective:
Occludable angles (iridotomy needed)
Aphakic patients (macular edema)
Alpha-2 selective:
Most frequent side effects
Non-selective:
Alpha-2 selective:
Oral monoamine oxidase (MAO) inhibitor users
Pediatric age
Follicular conjuctivitis, tachycardia, arrhythmias and arterial hypertension
Dry mouth
Lid elevation
Pupil dilation for apraclonidine
No effect on the pupil for brimonidine
Allergy (brimonidine up to 15%, apraclonidine up to 36%)
Decrease in systolic blood pressure (clonidine)
Fatigue, sleepiness (brimonidine), especially in children.
Pregnancy and nursing mothers
Only to be used if the potential benefit justifies the potential risk to the fetus or the infant.
Drug interactions
Possibility of additive or potentiating effect with CNS depressants. Caution is advised in the patients taking tricyclic
antidepressant.
Apraclonidine and brimonidine should not be used in small children and patients receiving MAO inhibitors.
Wash-out
The time needed for these compounds to completely lose their action is 1-3 weeks
Ch. 3 - 11 EGS