title: Risk of angle-closure glaucoma with bupropion and topiramate.
abstract: OBJECTIVE
  Epidemiologic studies have shown that antidepressants may increase the risk of angle-closure glaucoma. We examined the risk of angle-closure glaucoma with bupropion hydrochloride, a unique, popular antidepressant also marketed as a smoking cessation aid.
  
  
  METHODS
  A nested case-control study was conducted using a large health claims database in the United States from January 1, 2006, to March 31, 2014. The database contained deidentified information pertaining to a cohort of 6 110 723 patients. Cases were defined according to the first coding for angle-closure glaucoma. For each case, 10 control participants were selected and matched to the cases using density-based sampling. Adjusted rate ratios were computed for bupropion, topiramate (positive control group drug), and esomeprazole (negative control group drug). The adjusted rate ratio was 1.09 (95% CI, 0.75-1.59) for bupropion and 2.59 (95% CI, 1.56-4.30) for topiramate. In a prespecified analysis of patients younger than 50 years, the adjusted rate ratio was 1.98 (95% CI, 1.02-3.84) for bupropion and 5.30 (95% CI, 2.54-11.04) for topiramate.
  
  
  CONCLUSIONS
  Both bupropion and topiramate are widely prescribed drugs. The risk of angle-closure glaucoma in patients younger than 50 years was twice as high in patients taking bupropion and more than 5 times higher in patients taking topiramate.
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Symes
authors.affiliation: Collaboration for Epidemiology of Ocular Diseases (CEPOD), Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Mahyar
authors.initials: M
authors.lastname: Etminan
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Frederick S
authors.initials: FS
authors.lastname: Mikelberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects*; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects*; D016642:Bupropion / Q000009:adverse effects*; D016022:Case-Control Studies; D016208:Databases, Factual; D064098:Esomeprazole / Q000009:adverse effects; D005260:Female; D005632:Fructose / Q000009:adverse effects / Q000031:analogs & derivatives*; D015812:Glaucoma, Angle-Closure / Q000139:chemically induced* / Q000175:diagnosis; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D054328:Proton Pump Inhibitors / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D014065:Tonometry, Ocular; D000077236:Topiramate; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D018687:Antidepressive Agents, Second-Generation; D054328:Proton Pump Inhibitors; D016642:Bupropion; D000077236:Topiramate; D005632:Fructose; D064098:Esomeprazole