Class | Mechanism of action | Reduction in intra-ocular pressure | Dosing*/cap color | Local adverse effects | Systemic adverse effects | Contraindications/drug interactions | Agents | Cost† |
---|---|---|---|---|---|---|---|---|
Prostaglandin analogues | Increase uveoscleral outflow | 25% to 35% | Once daily/teal cap | Hyperemia, burning, stinging, itching, foreign body sensation, eye pain, iris pigmentation, eye-lash lengthening, periocular skin hyperpigmentation | Rare; dyspnea, asthma are the most common | Active uveitis No interactions reported | Bimatoprost (Lumigan) Durysta (one intraocular implant) Latanoprostene bunod (Vyzulta‡) Tafluprost (Zioptan) Travoprost (Travatan Z) | $26 ($230) $1,900 – ($450) – ($170) $40 ($200) |
Beta blockers | Decrease aqueous production | 20% to 25% | Twice daily§/yellow cap | Corneal hypesthesia, burning, stinging | Cardiopulmonary, hallucinations, fatigue, malaise; can mask hypoglycemia | Severe asthma, chronic obstructive pulmonary disease, bradycardia (heart rate < 55 beats per minute), second- and third-degree heart block; uncontrolled heart failure High doses of systemic beta blockers, digoxin, quinidine, diltiazem, verapamil | Betaxolol (Betoptic S) Carteolol Levobunolol (Betagan) Timolol (Timoptic) | $15 ($325) $10 $12 (−) $5 ($220) |
Carbonic anhydrase inhibitors | Decrease aqueous production | 15% to 20% | Three times daily/orange cap | Burning, stinging, bitter taste, punctate keratitis | Few, if any, systemic adverse effects | Sickle cell disease, use caution in patients with sulfa allergy | Brinzolamide (Azopt) Dorzolamide (Trusopt) | $130 ($360) $85 ($85) |
Alpha-adrenergic agents | Decrease aqueous production and increase outflow | 20% to 25% | Three times daily/purple cap | Burning, stinging | Dry mouth | Fatigue, drowsiness, hypotension Sedatives (especially midazolam), hydrocodone, monoamine oxidase inhibitors | Apraclonidine (Iopidine) Brimonidine (Alphagan P) | $30 ($180) $5 ($190) |
Rho-kinase inhibitors | Increase aqueous outflow, decrease episcleral venous pressure | 10% to 20% | Once daily/white cap | Conjunctival hyperemia, blurred vision, cornea verticillata, keratitis | None reported | Active uveitis No interactions reported | Netarsudil (Rhopressa) | – ($300) |
Parasympathomimetic agents | Increase aqueous outflow | 20% to 30% | Three to four times daily/green cap | Miosis with refractive changes, burning, stinging, headache, cataracts | Rare cholinergic adverseeffects; increased salivation | Ocular inflammation Dicyclomine | Pilocarpine | $20 |
Combination medications|| | — | — | — | — | — | — | Brinzolamide/brimonidine (Simbrinza) Latanoprost/netarsudil (Rocklatan) Timolol/brimonidine (Combigan) Timolol/dorzolamide (Cosopt; Cosopt PF) | – ($185) – ($320) $70 ($210) $2 ($200) |