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New alpha-2 agonist offers another medication to treat glaucoma
CHARLOTTE, N.C. — The availability of Alphagan (brimonidine tartrate 0.2% ophthalmic solution, Allergan) is a welcome addition to the drugs on the market to treat glaucoma and ocular hypertension, according to two optometrists in private practice here.
--- Randall K. Thomas, OD
"It appears to be one of the safer agents to reduce intraocular pressure," said Randall K. Thomas OD. "It's another piece of the armamentarium that we can use to reduce pressure and preserve optic nerve function. It will be great to have another new drug on the market."
Alternative to beta-blockers
--- Ron Melton, OD
According to Ron Melton, OD, one important feature of the drug, an alpha-2 agonist, is that it can be used with patients for whom timolol (Timoptic, Merck) and other beta-blockers are contraindicated. Such contraindications may include a history of asthma, congestive heart failure or pulmonary problems, said Melton, who conducted clinical studies of Alphagan.
Alphagan, on the average, reduces intraocular pressure (IOP) slightly less than timolol, Melton said. "It produces about a 20% reduction in pressure, as opposed to an average of 25% for timolol," he said.
The new drug has an advantage over Iopidine (apraclonidine, Alcon), another alpha agonist. "The studies show that Alphagan is more alpha-2 selective than Iopidine, which, we hope, means that it will be a bit more effective with fewer side effects, such as the redness, stinging and allergic responses that can develop with Iopidine," Melton said.
Alphagan also can be used in pa tients who are allergic to sulfa, which would generally rule out Trusopt (dorzolamide hydro chloride, Merck), said Melton.
Reduced dosing beneficial
Alphagan is approved as three times daily therapy; however, like Iopidine, it works nearly as well twice daily, said Melton. Thomas added that the reduced dosing makes Alphagan more attractive for patients, increasing patient compliance.
Further more, drugs that are effective at a twice-a-day dosage are less expensive, also making them more attractive, Thomas added.
Alphagan becomes available at a time when other new drugs such as Xalatan (latanoprost solution .005%, Pharmacia & Upjohn) and Trusopt are also becoming widespread for glaucoma treatment. With so many options now available, optometrists are in a good position to offer effective treatment alternatives to their patients. According to Thomas the first-, second- and third-line choices of therapy will be highly individualized for each patient.
"This is a great age for people with glaucoma," Thomas said. "We finally have good drugs available. The beauty is that we can medically manage more of these patients, and there will be less need to involve some of the expensive modalities such as argon laser therapy and even surgical trabeculectomy."
For Your Information:
- Ron Melton, OD, can be reached at 1918 Randolph Road, Charlotte, NC 28207; fax: (704) 344-2695.