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Azopt: Effective primary, adjunct therapy
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Azopt (brinzolamide ophthalmic suspension 1%, Alcon), a topical carbonic anhydrase inhibitor (CAI), is effective for managing open-angle glaucoma and ocular hypertension.
The agent is available in a 10-mL suspension, and the recommended (Food and Drug Administration-approved) dosage is one drop of Azopt in the affected eye(s) three times daily. Clinically, the medication has been demonstrated to be effective in a twice-daily dosage. Because Azopt is in a suspension, patients should be instructed to shake the bottle prior to instillation.
Azopt is clinically effective in reducing IOP in open-angle glaucoma and ocular hypertension as a primary treatment. However, most practitioners use it as an adjunctive therapy to beta-blockers, prostaglandin analogs and alpha agonists.
Beware of sulfa allergy
-- Reducing IOP: While the recommended dosage of Azopt is one drop three times daily, it has been clinically effective at a twice-daily dosage.
Like all CAIs, Azopt is in a class of medications known as sulfonamides. Although the actual chemical structure is different from oral sulfa medications, it should not be used in patients with a sulfa allergy history.
The most common ocular complaints from using Azopt are blurred vision and stinging. The most common non-ocular complaints are a bitter, sour or unusual taste and headaches. Ocular comfort studies have demonstrated that the stinging associated with Azopt is significantly lower than that reported with Trusopt (dorzolamide 2%, Merck).
In addition to lowering IOP, animal studies also suggest that CAIs increase blood flow to the optic nerve head. Our paradigm on glaucoma continues to evolve with more emphasis on blood flow analysis and protection from neurotoxins. This increase in blood flow may have even greater implications in the management of low-tension glaucoma.
Azopt gives approximately a 15% reduction in IOP and is effective as a monotherapy or as an adjunct medication. The problem is when to use the medication. Clinically, beta-blockers, alpha agonists and latanoprost (Xalatan, Pharmacia & Upjohn) seem to be better choices as first-line therapy. Azopt is a good choice as an adjunct medication when other drugs are contraindicated.
Case study
Mrs. A.T. is a 71-year-old woman whose IOP was not controlled on monotherapy with a selective beta-blocker. She has a history of cystoid macular edema, so I decided not to use a prostaglandin analog. Instead, she was started on an alpha agonist and subsequently developed a moderately severe allergic reaction. In her case, the use of Azopt as an adjunct to her selective beta-blocker was ideal, and she is able to achieve good pressure control with twice daily dosing.
For Your Information:
- Azopt is available from Alcon Laboratories, 6201 S. Freeway, Fort Worth, TX 76134-2099.