What is the Best Medicine for Glaucoma?
Prostaglandin analogues, a new group of ocular hypotensive drugs are the best medicine for treatment of glaucoma. Latanoprost and unoprostone are the two most widely researched prostaglandin drugs, still effectively in use. Both these anti-glaucoma drugs have proven to be safe for patients and very fewer cases of mild side effects have been recorded. Latanoprost was first introduced in the year 1996 in the US and Europe. Its mechanism is simple and different from other drugs. It decreases the intraocular pressure and increases the uveo-scleral outflow. Prostaglandins generally work by soothing muscles in the eye’s interior structure to allow better outflow of fluids, thus reducing the buildup of eye pressure. One of the major advantages of this latanoprost is one-time use in a day (50 μg/ml) can effectively reduce 30% of the intraocular pressure in glaucoma patients within a month.
Latanoprost is also available with other drugs as combined which is more effective for glaucoma. Carbonic anhydrase inhibitors, beta-receptor antagonists, adrenergic agonists, and cholinergic agonists are some of the other drugs available in combination form. It was once introduced as a second-line of the drug but it is now extensively used as primary therapy for the various cause of glaucoma. Iris pigmentation and cystoid macular edema have been reported as an adverse effect but very low frequency.
Unoprostone, is the top FDA approved topical prostaglandin analog after latanoprost, which is used widely in Japan. It has intraocular pressure lowering effects and it is used in 1.2 mg/ml twice daily. It effectively reduces 15% of the disease within two to four weeks. Prostaglandins are prescribed for all forms of open-angle glaucoma, including primary open angle glaucoma, pseudoexfoliation glaucoma, pigmentary glaucoma, and normal-tension glaucoma. These drugs are not effective in primary congenital glaucoma and angle closure glaucoma. Travoprost and bimatoprost are recently developed prostaglandins drugs widely used in the USA.
Xalatan (Brand name for Latanoprost) most widely sold drugs in western countries. It is available as generic medicines, works effectively within 4 hours and last up to end of the day. It has less stability and hence sold in 2.5 ml quantity. Its use in pregnant condition is limited due to high occurrence of abortion in women. FDA classified latanoprost as “C” category risk factor. Blurry vision, redness of the eye, itchiness, and darkening of the iris are common side effects of latanoprost. Unoprostone was marketed under the trade name Rescula for the management of open-angle glaucoma and ocular hypertension, but is now discontinued in the US. Travoprost sold under brand name of Travatan, Travatan Z and generic version of Travatan Z has been approved by the FDA.
Researcher advises that wiping the excess fluid near the eyes can result in loss of eyelashes. So contact of eyelashes with absorbent cotton must be avoided. Bimatoprost sold under brand name Lumigan used for the treatment of open-angle glaucoma and ocular hypertension in adult patients. It is either alone or in combination with a beta blocker typically timolol. Tafluprost (sold under zioptan) is a prodrug of the active substance, tafluprost acid, a structural and functional analogue of prostaglandin F2α. The most common side effect is conjunctival hyperemia, which occurs in 4 to 20% of patients.
All prostaglandin analogs should not be used with contact lenses and must be removed before instilling the drugs. After 20 minutes, the lens can be reinserted. Prostaglandin analogs can be used in conjunction with other eye drops or drugs but the experts suggest that it has to be used as separate drop i.e. administered at least 5 minutes later.
Available combinations for glaucoma therapy in the US include Dorzolamide/Timolol, Brimonidine/Timolol, and Brinzolamide/Brimonidine. Additional well-tolerated combination drops are available outside the US but are not FDA approved. The biggest drawback for patients prescribed combination medications is the high cost.
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