Prostaglandins: Lumigan, Travatan, Xalatan

Dosage: Once a day, at bedtime
Reduction in pressure (1): 28-33% (Lumigan, and Travatan may be slightly stronger than Xalatan
Cost (2)
Side effects: Redness and dryness in the first 4-6 weeks of use is common and usually goes away. Longer lasting symptoms may include: red eyes and eyelids, dryness, longer, thicker eyelashes, may darken light brown or green colored eyes, dark circles around the eyes. The darkening effects may be permanent. Lumigan may be more irritating than Xalatan.

Beta Blockers: Timolol (Timoptic, Betimol, Istalol), Metipranolol (Optipranolol), Betaxolol (Betoptic), Carteolol (Ocupress)

Dosage: Once or Twice daily
Reduction in pressure (1): Timolol, Optipranolol, 25% Betaxolol is a little weaker
Cost (2)
Side effects: Should not be used by asthmatics or patients with emphysema. May result in slow heart rate, congestive heart failure or arrhythmia (may be very serious in susceptible individuals). Low blood pressure. Fatigue.

Alpha-Agonists: Brimonidine (Alphagan, Alphagan P)

Dosage: Two or Three times daily (every 8 hours or every 12 hours, as directed)
Reduction in pressure (1): 18-25%
Cost (2)
Side effects: Cannot be used with certain medications for depression (monoamine oxidase inhibitors or tricyclic antidepressants). Red, itchy eyes and eyelids. Generic brimonidine is more likely to cause irritations than Alphagan P®

Carbonic Anhydrase Inhibitors (drops or pills): Dorzolamide (Trusopt), Brinzolamide(Azopt), Acetazolamide (Diamox pills)

Dosage: Two or Three times daily (every 8 hours or every 12 hours, as directed)
Reduction in pressure (1): Dorzolamide 17-22%, and Brinzolamide 17%
Cost (2)
Side effects: May experience a bitter, sour, or unusual taste. Should not be used by patients allergic to sulfonamides. Should not be used in patients with G6PD. Kidney stones. Rarely severe anemia. CAI pills are more likely to cause side effects than CAI drops.

Miotics: Pilocarpine drops, Pilopine Gel HS, carbachol, phospholine iodide

Dosage: One to four times daily as prescribed.
Reduction in pressure (1): 30%
Cost (2)
Side effects: Headaches or achy eyebrows. Should not be used by patients with inflammatory eye diseases. May predispose to retinal detachment in higher doses.

Combination Drops: Cosopt (Timolol + Dorzolamide), Combigan (Timolol and Alphagan)

Dosage: Twice daily
Reduction in pressure (1): A little better than either drug alone
Cost (2)
Side effects: See Beta Blockers, alpha agonists and CAI- drops

 

(1) Pressure reduction data from Van der Valk et al. “Intraocular Pressure-Lowering Effects of All Commonly Used Glaucoma Drugs. “ July 2005 Ophthalmology, Volume 112, Number 7.

(2) Prices are always changiong, as are drug formulary benefits.