The information provided here is meant to give you a general idea about each of the medications listed below. Note that this is not a comprehensive list. Your physician may prescribe a medication that is not on this list. Only the most general side effects are included, so ask your healthcare provider if you need to take any special precautions. Use each of these medications as recommended by your healthcare provider and according to the instructions provided. If you have further questions about usage or side effects, contact your healthcare provider. Some medications can cause side effects that are medical emergencies, such as difficulty breathing. If you have a medical emergency, call for an ambulance immediately.

Eye drops or oral medications are often used to help control glaucoma. Both methods attempt to decrease the intraocular pressure by either slowing the production of fluid in the eye or by improving the drainage of fluid from the eye.

Prescription Medications

Eye Drops

Miotics (Parasympathomimetic agents) (rarely used)

  • Pilocarpine (Isopto Carpine, Pilocar, Pilagan, Ocusert, Pilopine )
  • Carbachol/Carbamylcholine
  • Echothiophate iodide (Phospholine Iodide)
  • Physostigmine (Eserine ointment, Isopto Eserine)
  • Demecarium bromide (Humorsol)
  • Isoflurophate

Adrenergic Agents

  • Epinephrine (Epifrin, Eppy/N,Glaucon, Epinal, Epitrate )
  • Dipivefrin (Propine)
  • Apraclonidine (Iopidine)
  • Brimonidine (Alphagan)

Beta-blockers

  • Timolol maleate (Istalol, Timoptic XE, Timoptic, Ocudose, Timolol Gel)
  • Timolol hemihydrate (Betimol)
  • Levobunolol (Betagan)
  • Metipranolol (OptiPranolol)
  • Carteolol (Ocupress)
  • Betaxolol (Betoptic)

Prostaglandin analogs

  • Bimatoprost (Lumigan)
  • Latanoprost (Xalatan)
  • Travoprost (Travatan)

Carbonic Anhydrase Inhibitors

  • Dorzolamide (Trusopt)
  • Dichlorphenamide (Azopt)

Combination Drops

  • Timolol/Dorzolamide (Cosopt)
  • Epinephrine/Pilocarpine (E-Pilo)
  • Timolol/Brimonidine (Combigan)

Oral Medications

Carbonic Anhydrase Inhibitors

  • Acetazolamide (Diamox)
  • Dichlorphenamide (Daranide)
  • Methazolamide (Neptazane)

Eye Drops

It is imperative that you take your eye drops exactly as prescribed in order to best control your glaucoma. Eye drops can interact with other medications. Make sure you tell your doctor about any other medications or supplements that you are taking.

Miotics (Cholinergic Agents) (Rarely Used)

Common names include:

  • Pilocarpine (Isopto Carpine, Pilocar, Pilagan, Ocusert, Pilopine)
  • Carbachol /Carbamylcholine
  • Echothiophate iodide (Phospholine Iodide)
  • Physostigmine (Eserine ointment, Isopto Eserine)
  • Demecarium bromide (Humorsol)
  • Isoflurophate

Miotics increase fluid drainage out of the eye by helping to open the drainage network. Miotics also reduce the size of the pupil. Miotics may cause adverse drug interactions with certain anesthetic agents.

Possible side effects include, but are not limited to:

  • Pain inside/around the eye or brow
  • Blurred vision
  • Headache
  • Dim vision
  • Retinal detachment
  • Worsening myopia (nearsightedness)
  • Cataract formation
  • Increased tearing
  • Gastrointestinal upset (abdominal cramps, nausea, diarrhea, etc.)
  • Increased saliva production

Adrenergic Agents

  • Epinephrine (Epifrin, Eppy/N, Glaucon, Epinal, Epitrate)
  • Dipivefrin (Propine)
  • Apraclonidine (Iopidine)
  • Brimonidine (Alphagan) – Available as generic 0.2% and as name brand Alphagan-P 0.15%, which causes fewer allergies.

Epinephrine constricts blood vessels in the eye and enlarges the pupil. It reduces the amount of fluid in the eye by reducing the production of fluid and increasing the amount of fluid drainage. Dipivefrin is transformed into epinephrine in the eye. Apraclonidine and brimonidine are known as alpha2-adrenergic agonists. They are thought to have fewer side effects. Adrenergic agents should be used with caution in patients with cardiovascular disease, as well as in patients taking certain antidepressant, heart, and blood pressure medications.

Possible side effects include, but are not limited to:

  • Burning or stinging of the eye
  • Red eyes (especially when medication is stopped)
  • Allergic reaction
  • Large pupils, causing increased sensitivity to light
  • Colored deposits on the conjunctiva
  • Elevated blood pressure and heart rate
  • Abnormal heart rhythms
  • Headache
  • Anxiety

Apraclonidine is often used to control eye pressure after laser or surgical procedures.

Possible side effects include, but are not limited to:

  • Dry mouth and nose
  • Eye discomfort
  • Allergic reaction
  • Decreased blood pressure (potentially leading to fainting)
  • Tiredness

Brimonidine is the most commonly used medication in the category to reduce pressure in the eye.

Possible side effects include, but are not limited to:

  • Burning, stinging or tearing of the eye
  • Blurred vision
  • Allergic reaction
  • Dry eye
  • Drowsiness or fatigue
  • Headache
  • Decreased blood pressure
  • Tiredness
  • Depression
  • Anxiety

Beta-Blockers

Common names include:

Beta-blockers work to lower the intraocular pressure by decreasing the rate at which fluid is produced in the eye. Beta-blockers are usually contraindicated in patients with such medical conditions as asthma, chronic obstructive pulmonary disease, slow heart beat, heart block, or other heart or lung problems.

Possible side effects include, but are not limited to:

  • Blurred vision
  • Eye irritation
  • Allergic reaction
  • Breathing difficulty
  • Slowing pulse rate
  • Hair loss
  • Decreased blood pressure
  • Impotence
  • Dizziness or fainting
  • Fatigue and weakness
  • Hallucinations
  • Insomnia
  • Depression
  • Memory loss

Prostaglandin Analogs

Prostaglandin analogs reduce pressure in the eye by increasing the outward flow of fluid from the eye.

Possible side effects include, but are not limited to:

  • Darkening of the iris (colored part of the eye)
  • Darkening and increased growth of eye lashes
  • Conjunctival hyperemia (red eyes)
  • Eye irritation
  • Flu-like symptoms
  • Body aches and pains

Topical or Oral Medications

Carbonic Anhydrase Inhibitors

Common names include:

Carbonic anhydrase inhibitors inhibit the enzyme carbonic anhydrase, which results in a reduction of the production of fluid in the eye. Oral forms are usually only used in emergent situations, such as in an angle-closure attack. They are contraindicated with history of sulfa allergy and should be used with caution in patients with certain medical problems such as blood disorders or liver disease. They are also contraindicated in patients with sickle cell. Blood cell counts are often monitored regularly while taking these drugs.

Possible side effects include, but are not limited to:

  • Frequent urination
  • Tingling or numbness sensation in the fingers or toes
  • Kidney stones
  • Rashes
  • Depression, fatigue, and lethargy
  • Weight loss
  • Gastrointestinal upset
  • Diarrhea
  • Impotence
  • Unpleasant taste in mouth
  • Abnormal lab tests:
    • Abnormal blood electrolytes (especially potassium)
    • Abnormal blood cell count (red or white blood cells or platelets)

Neuroprotective medications

Researchers are currently evaluating the possibility of protecting the optic nerve from damage. One of the potential medications that are being considered is brimonidine (Alphagan). Another is memantine , an oral medication used in the treatment of Alzheimer's disease .

Special Considerations

Whenever you are taking a prescription medication, take the following precautions:

  • Take them as directed—not more, not less, not at a different time.
  • Do not stop taking them without consulting your doctor.
  • Don’t share them with anyone else.
  • Know what effects and side effects to expect, and report them to your doctor.
  • If you are taking more than one drug, even if it is over-the-counter or herbal, be sure to check with a doctor or pharmacist about drug interactions.
  • Plan ahead for refills so you don’t run out.
  • Check the expiration date.
  • Let your doctor know if you take any other medications or supplements. This includes vitamins and herbal remedies.
  • For most eyedrops, only one drop is necessary at each recommended time interval. Placing two or more drops at one time is usually a waste of medicine. Ask your doctor how many drops you need to place.

When to Contact Your Doctor

  • If you have side effects or an allergic reaction to a medication (stop taking the medication and call your doctor immediately)
  • If you begin taking any new vitamins, herbal supplements, or another medication, whether prescribed or over-the-counter