Douglas J. Rhee, MD

56A. ALPHA AGONISTS 1 (WHITE TOP – IOPIDINE ; PURPLE TOP – ALPHAGAN )Mechanism of Action: Activation of alpha-2 receptors in ciliary body inhibits aqueous secretion. Brimonidine also reported to increaseuveoscleral outflow.Side Effects: Local irritation, allergy, mydriasis, dry mouth, dry eye, hypotension, lethargy.Contraindications: MAO inhibitor use.Drug Trade Concentration Usual Dose Notesapraclonidine Iopidine Soln, 0.5% TID For short term useSoln, 1% single dose For prophylaxis of postlaser IOP spikebrimonidine Alphagan-P Soln, 0.1% or 0.15% TID/BID Highly selective alpha-2 agonistMay cause apnea in children(generic) Soln, 0.2% TID/BID Highly selective alpha-2 agonistMay cause apnea in children1 For listing of preservatives of antiglaucoma medications, refer to Appendix 5.B. BETA BLOCKERS 1 (0.25%-LIGHT BLUE TOP, 0.5%-YELLOW TOP)Mechanism of Action: Beta blockade in ciliary body reduces intraocular pressure by decreasing aqueous humor production.Side Effects: Local: Blurred vision, corneal anesthesia, superficial punctate keratitis.Systemic: Bradycardia/heart block, bronchospasm, fatigue, mood change, impotence, decreases sensitivity to hypoglycemicsymptoms in insulin dependent diabetics, worsening of myasthenia gravis.Contraindications: Asthma, severe COPD, bradycardia, heart block, CHF, myasthenia gravis.