Types of Medication for Glaucoma

Glaucoma refers to a group of eye diseases that damages the optic nerve. The optic nerve gives visual information to the brain from the eyes and is crucial for good vision. The optic nerve gets damaged because of the buildup of high pressure in the eye. Glaucoma commonly affects older adults and is the leading cause of blindness in people above the age of 60 years.

It is important to have regular eye check-ups to prevent vision loss caused by glaucoma.

Prescription eye drops are the first-line therapy for the treatment of glaucoma. Some of the commonly prescribed eyes drops used for treating glaucoma include

1. Prostaglandins: These increase the outflow of the fluid in the eye, thereby reducing eye pressure. Some examples include:
   • Latanoprost
   • Travoprost
   • Tafluprost
   • Bimatoprost
   • Latanoprostene bunod
2. Beta-blockers: These drugs alleviate the production of fluid in the eye, thus lowering eye pressure. Some examples include:
   • Timolol
   • Betaxolol
3. Alpha-adrenergic agonists: These drugs alleviate the production of fluid that flows throughout the inner portion of the eyes. Some examples include:
   • Apraclonidine
   • Brimonidine
4. Carbonic anhydrase inhibitors: These drugs reduce the generation of fluid in the eye. Examples include:
   • Dorzolamide
   • Brinzolamide
5. Rho kinase inhibitors: Netarsudil suppresses the action of Rho kinase enzymes responsible for the fluid increase.
6. Miotic or cholinergic agents: It aggravates the outflow of fluid from the eye. Pilocarpine is the cholinergic agent commonly used to treat glaucoma.

Earlier, prostaglandin analogs were commonly prescribed for glaucoma. However, newer additions like Latanoprostene bunod and Netarsudil are more effective in treating glaucoma. Combining beta-blockers and carbonic anhydrase inhibitors can also be effective in treating glaucoma.

Common side effects of prostaglandins include:

• Eye color change
• Darkening of the eyelid skin
• Eyelash growth
• Droopy eyelids
• Sunken eyes
• Stinging, eye
• Redness 
• Itching

Common side effects of beta blockers include:

• Low blood pressure
• Reduced pulse rate
• Fatigue
• Shortness of breath
• Reduced libido
• Depression

Common side effects of alpha agonists include:

• Burning or stinging
• Fatigue
• Headache
• Drowsiness
• Dry mouth and nose
• Relatively higher likelihood of an allergic reaction

Common side effects of carbonic anhydrase inhibitors include:

• Stinging, burning
• Eye discomfort

Common side effects of Rho kinase inhibitors include:

• Eye redness
• Corneal deposits
• Stinging
• Small bleeds on the white of the eye

Common side effects of miotic or cholinergic agents include:

• Headache
• Eye ache
• Smaller pupils
• Possible blurred or dim vision
• Nearsightedness

This is not a complete list of side effects and other serious side effects or health problems that may occur because of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

Brimonidine is the safest option for the first trimester. Other anti-glaucoma medications like beta blockers, prostaglandins, and carbonic anhydrase inhibitors should be avoided during the first trimester to reduce the risk of potential fetal abnormalities or premature abortion.

Brimonidine can cause side effects like dizziness, drowsiness, and difficulty concentrating. Taking alcohol with brimonidine may worsen these side effects. Additionally, alcohol can increase the pressure inside the optic nerve, thereby worsening the symptoms of glaucoma. So, it is best to avoid alcohol when you have symptoms of glaucoma.