11.6. Treatment of glaucoma
11.6.1. Beta - blockers
Restrictions:
Restricted to specialist initiation.
Prescribing Notes:
The preserved eye drops are the first choice preparation. However, long-acting preparations of timolol should be reserved only for patients with compliance issues. For preservative-free preparations of timolol, see the Total Formulary
Restrictions:
Restricted to use in patients who have proven sensitivity to preservatives.
Prescribing Notes:
Timolol maleate preserved eye drops are considerd the first line topical beta-blocker for glaucoma (see preferred list)
11.6.2. Prostaglandin analogues and prostamides
Restrictions:
The preservative-free presentations are further restricted to use in patients who have proven sensitivity to the preservative benzalkonium chloride.
Prescribing Notes:
The preservative-containing eye drops are the first choice preparation.
Restrictions:
Restricted to specialist initiation. Prescribing of the single-dose eye drop preparation is further restricted to use only in patients who have a proven sensitivity to the preservative benzalkonium chloride.
Restrictions:
Restricted to specialist initiation. Restricted to use only in patients who cannot tolerate other prostaglandin preparations due to proven sensitivity to the preservative benzalkonium chloride.
11.6.3. Sympathomimetics
11.6.4. Carbonic anhydrase inhibitors and systemic drugs
11.6.5. Miotics
11.6.6. Combination preparations
Combination preparations that consist of drugs from different classes of glaucoma medicines are included in this sub-section.
Restrictions:
Restricted to specialist initiation. Preservative-free unit dose eye drops are further restricted to use only in patients who have proven sensitivity to preservatives.
Restrictions:
Restricted to specialist initiation. Preservative-free preparations are restricted to patients in whom a combination of these two agents is appropriate and who have proven sensitivity to benzalkonium chloride.
Restrictions:
Restricted to specialist initiation. Preservative-free latanoprost and timolol eye drops (Fixapost®) are further restricted to use in patients who have proven sensitivity to preservatives.
Restrictions:
Restricted to specialist initiation in patients for whom treatment with a prostaglandin analogue alone provides insufficient IOP reduction, only if:
- the patient has then tried a fixed-dose combination treatment and it has not sufficiently reduced IOP, or
- a fixed-dose combination treatment containing beta-blockers is unsuitable
Restrictions:
Use for the reduction of intraocular pressure in adults with open angle glaucoma or ocular hypertension who are insufficiently responsive to topical monotherapy with beta blockers is restricted to specialist initiation in patients who have proven sensitivity to preservatives.
11.6.7. Other agents for glaucoma and intra-ocular pressure
Restrictions:
Restricted to specialist initiation. Apraclonidine 0.5% eye drops are restricted to use on specialist advice only for short term adjunctive therapy of chronic glaucoma.