Researchers identify 18 drugs associated with angle-closure glaucoma
Click Here to Manage Email Alerts
Key takeaways:
- Tropicamide had the strongest association with angle-closure glaucoma and was reported the most frequently, with 520 cases.
- Sulfonamides, serotonergic agents and antimuscarinic agents also showed signals.
Eighteen medications appeared to be associated with angle-closure glaucoma, including sulfonamides, serotonergic agents and antimuscarinic agents, according to a retrospective analysis published in Ophthalmology Glaucoma.
“Medications used for weight loss, epilepsy, over-the-counter cold treatments, among others, are known to induce angle-closure glaucoma,” Owais M. Aftab, BS, of the Institute of Ophthalmology and Visual Science at Rutgers New Jersey Medical School, and colleagues wrote. “As angle-closure glaucoma constitutes an ophthalmic emergency with the potential for blindness, it is key to recognize medications associated with angle-closure glaucoma.”
To do so, Aftab and colleagues conducted a retrospective analysis of 1,629 adverse event reports related to angle-closure glaucoma reported from 2004 to September 2023 to the FDA Adverse Event Reporting System. These reports were linked to 611 possible drugs.
The researchers used four metrics to identify which drugs may be responsible for angle-closure glaucoma, including reporting odds ratio (ROR), proportional reporting ratio (PRR), empirical Bayes geometric mean (EBGM) and information component (IC). Drugs that yielded positive results in all four metrics were considered to have statistically significant association with drug-induced glaucoma.
Two-thirds of the cases (66.1%) involved women, and 23.6% involved men, with 10.3% unknown. The largest portion of cases occurred in the U.S. (33.4%). The patients included in the cases had been exposed to 3.09 medications on average before the adverse event occurred.
The most frequently reported drugs associated with angle-closure glaucoma included topiramate (520 cases), citalopram (69 cases), levothyroxine (68 cases), escitalopram (58 cases) duloxetine (45 cases) and salbutamol (44 cases).
When analyzed by classes of drugs, sulfonamides had the most reports, at 642, although researchers noted these primarily derived from topiramate. The second most reported class, with 318 reports, were serotonergic agents.
Researchers identified 18 drugs with positive associations with angle-closure glaucoma using their four metrics. Tropicamide showed the strongest association (PRR =164.263; ROR = 167.95; 95% CI, 104.994-268.655; EBGM = 162.421; IC = 7.344), followed by acetazolamide (PRR = 113.088; ROR = 114.782; 95% CI, 86.665-152.021; EBGM = 109.506; IC = 6.775).
Other drugs with positive results included the sulfonamides topiramate, hydrochlorothiazide and chlorthalidone; the serotonergic agents citalopram, escitalopram, duloxetine, fluoxetine, venlafaxine and sumatriptan; the antimuscarinic agents olanzapine, quetiapine, tiotropium and pilocarpine; the sympathomimetic agents phentermine and salmeterol; and ranibizumab, a VEGF inhibitor.
“We identified positive safety signals for both well-known drugs such as topiramate, escitalopram and tiotropium, as well as lesser-known drugs such as olanzapine, phentermine and ranibizumab,” the researchers wrote. “While further investigation and monitoring are needed, clinician awareness of these findings is important.”
Perspective
Back to Top
This study identified several medications that have been associated with angle-closure glaucoma, as reported by the FDA Adverse Event Reporting System over 20 years. It is unclear how best to utilize this information, given that prescription monitoring for these medications would seem impractical due to the sheer volume of medications prescribed and the low frequency of angle-closure glaucoma.
However, it seems appropriate for eye care professionals to counsel patients with known characteristics predisposing them to angle closure about safety concerns with various classes of medications.
The easiest measure involves educating patients about medications that may cause mydriasis, particularly those with existing narrow angles, hyperopia, shallow anterior chambers and aging crystalline lenses. The prevention approach through education is less clear for medications resulting in angle closure through ciliochoroidal effusion and anterior lens displacement.
It would be beneficial to further define the morphologic features that increase the risk for angle closure via these mechanisms so that specific protocols could be developed before and during treatment. In the interim, patient education regarding angle closure could be aimed at patients with conditions known to be treated specifically with some of these medications, such as epilepsy, migraine and mental health conditions.
Collapse
Read more about
Click Here to Manage Email Alerts