Topical glaucoma medications and cardiovascular risk in the elderly

Monane, Mark; Bohn, Rhonda L.; Gurwitz, Jerry H.; Glynn, Robert J.; Choodnovskiy, Igor; Avorn, Jerry

doi:10.1038/clpt.1994.13

Cited by 17 publications

(7 citation statements)

References 14 publications

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“…It is comforting that a recent review disclosed that major cardiovascular side effects did not occur at an increased rate in a population‐based study of elderly patients using topical β blockers or other glaucoma medications, compared to normal subjects 35 . These observations are in line with the belief that individuals with underlying pulmonary and/or cardiac abnormalities are likely to be those most susceptible to adverse effects from systemic β blockade.…”

Section: Discussionmentioning

confidence: 71%

“…These can include either physiologic β blocker effects (e.g., bradycardia) or complications known to accompany use of this drug class. Thus, it should be no great surprise that topical β blockade can lead to bradyarrhythmias, syncope, daytime and/or nocturnal hypotension, congestive heart failure, reduced exercise tolerance, and/or lipid abnormalities 12,28–37 …”

Section: Cardiac Effectsmentioning

confidence: 99%

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Ophthalmically Administered β Blockers and Their Cardiopulmonary Effects

Sica

2001

J of Clinical Hypertension

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Early clinical studies revealed that timolol and other topical beta blockers were effective in reducing intra-ocular pressure, without the side effects associated with other antiglaucoma agents. However, because persons with cardiovascular or respiratory diseases were generally excluded from many of these early studies, the risk of serious cardiovascular and respiratory side effects was seriously underestimated. Once these drugs were made available to the general population, reports of systemic side effects began to proliferate. Very quickly, adverse effects from topical beta blockade became "old news." Despite this recognition, many treating physicians remained unaware of the potential for systemic beta blockade from topically applied beta blockers. A significant portion of a topically administered dose of a beta blocker can be absorbed and thereby affect systemic beta blockade. Sensitivity to systemic beta blockade can be quite dramatic in certain highly susceptible patients, particularly those with either cardiac or pulmonary abnormalities. Careful review of patients' medications will generally lessen, but not completely eliminate, the risk of undesired complications attributable to topical beta blockade.

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Section: Discussionmentioning

confidence: 71%

Section: Cardiac Effectsmentioning

confidence: 99%

Ophthalmically Administered β Blockers and Their Cardiopulmonary Effects

Sica

2001

J of Clinical Hypertension

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“…Interestingly when beta blocker was used topically for treatment of glaucoma, it additionally caused CHF 71 . In an epidemiological study, no association between use of topical beta blocker and CHF was found 72 .…”

Section: Beta -Adrenoceptor Antagonist Andmentioning

confidence: 95%

Untitled

2018

IJPSR

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Cardiotoxicity associated with the clinically used drugs is a global concern of safety for healthcare professionals. Various animal models have been used to study the drug-induced cardiotoxicity but the exact molecular involvement of toxicity is not much clear. Despite the recurrent occurrence of toxicities, drugs such as doxorubicin, calcium channel blockers, antiarrhythmics and immunomodulators are regularly used. Anticancer drugs mainly anthracyclines, 5-fluorouracil and cyclophosphamide exert prominent cardiotoxicity. Till date, there is only one drug approved for doxorubicin-related cardiotoxicity i.e. dexrazoxane. Few other drugs are used routinely by clinicians to reduce the severity of toxicity which includes ACE inhibitors, L-carnitine, probucol, CoQ 10 , N-acetylcysteine, Vitamin E and deferoxamine, whereas antidepressants drugs, specifically tricyclic antidepressants are potential candidates for cardiotoxicity. Calcium channel blockers, antiarrhythmic and beta receptor antagonist aggravate cardiac heart failure (CHF) and left ventricular arrhythmia. Interferons, mainly interferon-α is also associated with prominent and dose-dependant toxicity. Some other drugs like zidovudine, chloroquine, cocaine, minoxidil, ketoconazole, prostaglandin E2 and anagrelide are also reported to have cardiotoxic effects. A complication associated with the use of these drugs include hypoxia, coronary ischemia, calcium overload, oxidative stress, contractile dysfunction, left ventricular arrhythmia and cardiomyopathy.

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“…Recognition and management of systemic sequelae, patient intolerance to adverse events, and the impact of these factors on compliance with therapy and quality of life have previously been discussed and reviewed in the literature. [61][62][63] Several new glaucoma agents with demonstrated efficacy in reducing IOP have been shown to have systemic adverse effect profiles that appear to be more favorable than those found with traditional therapies, including timolol maleate, These new drugs offer alternatives to the ophthalmologist that also may portend advantages in patient management for both the ophthalmologist and the primary care physician.…”

Section: New Agents With Potentially Reduced Systemic Effectsmentioning

confidence: 99%

β-Blocker–Induced Complications and the Patient With Glaucoma

Stewart¹,

Garrison²

1998

Arch Intern Med

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Primary open-angle glaucoma is a condition associated with an elevated intraocular pressure (IOP) that is defined as optic degeneration with a slowly progressive deterioration of the visual field that may lead to blindness. More than 1 million Americans are being treated for glaucoma, and 80,000 are legally blind as a result of the disease. Glaucoma has its highest prevalence among the elderly population, with an incidence of approximately 1% in those older than 60 years, 3% in those between the ages of 70 and 80 years, and more than 9% in those older than 80 years. Treatment is directed at lowering high ocular pressures. The initial treatment, in most cases topical therapy with a beta-adrenergic blocking agent, reduces the IOP to help preserve sight. But such topical agents may also have adverse systemic effects on cardiac, pulmonary, central nervous system (CNS), and endocrine functions.

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Topical glaucoma medications and cardiovascular risk in the elderly

Cited by 17 publications

References 14 publications

Ophthalmically Administered β Blockers and Their Cardiopulmonary Effects

Ophthalmically Administered β Blockers and Their Cardiopulmonary Effects

Untitled

β-Blocker–Induced Complications and the Patient With Glaucoma

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