Douglas J. Rhee, MD

Cosopt see notes see notes Cosopt is a combination agent with timololmethazolamide Neptazane, MZM , Glauctabs 25, 50 mg tabs BID-QIDmaleate (see Combination Agents listedbelow)1 For listing of preservatives of anti-glaucoma medications, refer to Appendix 5.D. HYPEROSMOLAR AGENTS 1Mechanism of Action: Osmotically decreases intraocular fluid volume and intraocular pressure in acute situations.Side Effects: Mannitol : CHF, urinary retention in men, back ache, myocardial infarction, headache, mental confusion.Glycerin : Vomiting, less likely to produce CHF than mannitol , otherwise similar to mannitol.Isosorbide : Same as glycerin except perhaps safer in diabetes.Contraindications: CHF, DKA (glycerin ), subdural or subarachnoid hemorrhage, preexisting severe dehydration.Drug Trade Concentration Usual Dose Notesglycerin Osmoglyn 50% soln 1–1.5 gm/kg POisosorbide Ismotic 45% soln 1.5 gm/kg PO Onset in 30 min, lasts 5–6 hrmannitol Osmitrol 5–20% soln 0.5–2 gm/kg IV Onset 30–60 min, lasts 6 hr; infuse over 45 minutes1 For listing of preservatives of antiglaucoma medications, refer to Appendix 5.Antiglaucoma Agents 59