Topical medications		Ocular side effects	Systemic side effects	Contraindications	Drug interactions	Clinical notes	Cost for one container*
Beta blockers
Nonselective
	Timolol maleate (Timoptic, Timoptic-XE)	Burning/stinging; transient blurred vision (increased with gel); photophobia; conjunctivitis; blepharitis; punctate keratitis; contact dermatitis; eyelid erythema	Decreased heart rate/cardiac output; bronchospasm; hypotension; depression; decreased libido; impotence; worsened lipid profile; decreased stress response to hypoglycemia, surgery or anaphylaxis	Asthma; chronic obstructive pulmonary disease; congestive heart failure; sinus bradycardia; second- or third-degree atrioventricular block; hypersensitivity to beta blockers	Use cautiously with oral beta blockers, calcium channel blockers, quinidine, digitalis and catecholamine-depleting drugs (e.g., reserpine)	Lack of nocturnal effect; tachyphylaxis	Timoptic: 0.25 %, 5 mL, $16† Timoptic-XE: 0.25 %, 5 mL, $23
	Levobunolol (Betagan)	Increased relative to timolol	Same as timolol	Same as timolol, plus hypersensitivity to sulfite preservative	Same as timolol	Largest drop size	0.25 %, 5 mL, $17†
	Carteolol (Ocupress)	Same as timolol	Same as timolol	Same as timolol	Same as timolol	Some intrinsic sympathomimetic activity	5 mL, $19
	Metipranolol (Optipranolol)	Has the most ocular side effects of the beta blockers in this class; anterior uveitis	Same as timolol	Same as timolol	Same as timolol		5 mL, $13
Selective
	Betaxolol (Betoptic, Betoptic S)	Increased relative to timolol	Rare; fewer cardiopulmonary side effects than timolol	Sinus bradycardia; second- or third-degree atrioventricular block; overt congestive heart failure	Same as timolol, plus may antagonize adrenergic psychotropic drugs such as thioridazine (Mellaril)		Betoptic: 5 mL, $21 Betoptic S: 5 mL, $21
Miotics
Pilocarpine (Isopto Carpine, Ocusert Pilo)		Burning; blurred vision; difficulty with night vision; miosis or accommodative spasm; lens opacity (rare); retinal detachment (rare); precipitation of closed-angle glaucoma (rare)	Sweating; salivation; urinary frequency; nausea; diarrhea; bronchospasm; biliary colic; mental status change; variable cardiovascular response	Hypersensitivity; poorly controlled asthma; acute iritis	May precipitate if administered with sodium sulfacetamide	Blurred vision increased with gel; miosis decreased with Ocusert Pilo; retinal detachment increased in patients with myopia; use with caution in patients with cataracts, hyperthyroidism, parkinsonism or urinary tract obstruction	Isopto Carpine: 0.25 %, 15 mL, $14† Ocusert Pilo: $40‡
Carbonic anhydrase inhibitors
Dorzolamide (Trusopt)		Burning; punctate keratitis; ocular allergies; increased ocular side effects relative to timolol	Bitter taste; headache; nausea; asthenia; kidney stones (rare)	Hypersensitivity to sulfonamides; eye injury or surgery	Not recommended for use with systemic carbonic anhydrase inhibitors; may accentuate side effects of salicylate therapy; may promote excretion of acidic drugs and inhibit renal excretion of basic drugs	Contact lenses must be removed; may be reinserted 15 minutes after installation of medication; not studied in patients in patients with hepatic or renal dysfunction	2 %, 5 mL, $22
Brinzolamide (Azopt)		Possibly decreased ocular side effects compared with dorzolamide; blepharitis; foreign-body sensation	Bitter taste; headache; rhinitis sensation	Hypersensitivity to sulfonamides	Same as dorzolamide	Same as dorzolamide	1 %, 5 mL, $20
Sympathomimetics
Epinephrine-like Dipivefrin (Propine)		Burning; follicular conjunctivitis; macular edema in patients who are aphakic	Increased blood pressure; arrhythmias; tremor	Narrow-angle glaucoma	Use cautiously with cardiovascular or stimulant medications	Epinephrine prodrug; decreased ocular and systemic side effects relative to epinephrine; use cautiously in patients with cardiovascular disease	0.1 %, 5 mL, $17†
Clonidine-like
	Brimonidine (Alphagan)	Conjunctival blanching; ocular allergy (less than with apraclonidine, more than with timolol)	Headache; drowsiness; fatigue; variable blood pressure response	Hypertensive crisis; therapy with monoamine oxidase inhibitors; hypersensitivity to clonidine (Catapres)	Use cautiously with antihypertensive medications and digitalis	Tachyphylaxis (less common); not studied in patients with hepatic or renal dysfunction	0.2 %, 5 mL, $22
	Apraclonidine (Iopidine)	Allergic/local reaction; transient change in visual activity	Increased central nervous system effects change visual activity	Same as brimonidine	Same as brimonidine	Tachyphylaxis (common); short-term adjunctive agent, not first-line therapy	0.5 %, 5 mL, $12
Prostaglandin analogs
Latanoprost (Xalatan)		Burning/stinging; iris pigmentation; punctate keratitis	Headache; symptoms of upper respiratory infection; chest pain (rare); myalgias (rare)	Hypersensitivity; narrow-angle closure; ocular infection or inflammation	May be precipitated by eyedrops that contain thimerosol (antiseptic)	Prodrug; diurnal decrease in intraocular pressure; not studied in patients with hepatic or renal dysfunction	0.005 %, 2.5 mL, $42