title: A review of additivity to prostaglandin analogs: fixed and unfixed combinations.
abstract: Prostaglandin analogs are currently the first-line agents in the medical treatment of glaucoma. Frequently, more than one drug is needed to control intraocular pressure. Beta-blockers, topical carbonic anhydrase inhibitors, and alpha-adrenergic agonists are commonly used in addition to prostaglandin analogs. Topical carbonic anhydrase inhibitors are more effective in lowering intraocular pressure at trough than alpha-adrenergic agonists. Although similarly effective as topical carbonic anhydrase inhibitors during the day, adequate nocturnal intraocular pressure reduction with beta-blockers is controversial. Three fixed combinations of prostaglandins with timolol (0.005% latanoprost with 0.5% timolol, 0.004% travoprost with 0.5% timolol, and 0.03% bimatoprost with 0.5% timolol) are available. Fixed-combination therapy has advantages over multi-drop, multi-bottle therapy in terms of patient convenience and adherence without sacrificing the additive effects of the unfixed combinations. In countries where they are available, fixed combinations of prostaglandins/beta-blockers may become second-line treatment. Fixed and unfixed adjunctive combinations with prostaglandin analogs have demonstrated, in multiple comparative studies, to be effective, but none has been shown to be an ideal combination.
authors.affiliation: University of Texas Health Science Center-Houston, Houston, Texas, USA.
authors.forename: Rania
authors.initials: R
authors.lastname: Tabet
authors.forename: William C
authors.initials: WC
authors.lastname: Stewart
authors.forename: Robert
authors.initials: R
authors.lastname: Feldman
authors.forename: Anastasios G P
authors.initials: AG
authors.lastname: Konstas
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005902:Glaucoma, Open-Angle / Q000188:drug therapy*; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects*; D011461:Prostaglandins F, Synthetic / Q000627:therapeutic use*
chemical_list: D000959:Antihypertensive Agents; D004338:Drug Combinations; D011461:Prostaglandins F, Synthetic