A review of additivity to prostaglandin analogs: fixed and unfixed combinations.
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.
Tabet
Rania
R
University of Texas Health Science Center-Houston, Houston, Texas, USA.
Stewart
William C
WC
Feldman
Robert
R
Konstas
Anastasios G P
AG
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*
D000959:Antihypertensive Agents; D004338:Drug Combinations; D011461:Prostaglandins F, Synthetic