“…Notably, some of these topical medications (substrates, inducers, or inhibitors of P450s) are known to elicit both ocular and systemic effects ( Syed et al, 2021 ). For example, among the drugs for glaucoma treatment, a major cause of legal blindness ( Quigley and Broman, 2006 ), these are timolol metabolized by CYP2D6; betaxolol, a substrate for CYP1A2 and CYP2D6; dorzolamide eliminated by CYP2B1, CYP2C9, CYP2E1, and CYP3A2; and pilocarpine, which inhibits CYP2A6, CYP2A13, and CYP2E1 ( Kimonen et al, 1995 ). Particular caution is recommended when ophthalmic timolol or betaxolol are coadministered with paroxetine or other strong CYP2D6 inhibitors ( Farkouh et al, 2016 ; Vaajanen and Vapaatalo, 2017 ).…”