ClassMechanism of actionReduction in intra-ocular pressureDosing*/cap colorLocal adverse effectsSystemic adverse effectsContraindications/drug interactionsAgentsCost
Prostaglandin analoguesIncrease uveoscleral outflow25% to 35%Once daily/teal capHyperemia, burning, stinging, itching, foreign body sensation, eye pain, iris pigmentation, eye-lash lengthening, periocular skin hyperpigmentationRare; dyspnea, asthma are the most commonActive 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 blockersDecrease aqueous production20% to 25%Twice daily§/yellow capCorneal hypesthesia, burning, stingingCardiopulmonary, hallucinations, fatigue, malaise; can mask hypoglycemiaSevere 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 inhibitorsDecrease aqueous production15% to 20%Three times daily/orange capBurning, stinging, bitter taste, punctate keratitisFew, if any, systemic adverse effectsSickle cell disease, use caution in patients with sulfa allergyBrinzolamide (Azopt)
Dorzolamide (Trusopt)
$130 ($360)
$85 ($85)
Alpha-adrenergic agentsDecrease aqueous production and increase outflow20% to 25%Three times daily/purple capBurning, stingingDry mouthFatigue, drowsiness, hypotension
Sedatives (especially midazolam), hydrocodone, monoamine oxidase inhibitors
Apraclonidine (Iopidine)
Brimonidine (Alphagan P)
$30 ($180)
$5 ($190)
Rho-kinase inhibitorsIncrease aqueous outflow, decrease episcleral venous pressure10% to 20%Once daily/white capConjunctival hyperemia, blurred vision, cornea verticillata, keratitisNone reportedActive uveitis
No interactions reported
Netarsudil (Rhopressa)– ($300)
Parasympathomimetic agentsIncrease aqueous outflow20% to 30%Three to four times daily/green capMiosis with refractive changes, burning, stinging, headache, cataractsRare cholinergic adverseeffects; increased salivationOcular 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)