Alpha Agonists - Glaucoma Medications | Driving with Dr. David Richardson

The Alpha-Agonist class of #glaucoma medications is an effective medical treatments available.

This class of medication works primarily on the ciliary body to reduce production of aqueous fluid. Like the prostaglandin analogs, alpha-agonists seem to further open the uveoslceral outflow pathway. Additionally, they may also provide a “neuroprotective” benefit.

Alpha-agonists lower the IOP almost as much as timolol but are not quite as effective as the prostaglandin analog class of intraocular pressure (IOP) lowering medications.

The most commonly prescribed alpha-agonist is brimonidine. This medication is generally is rarely the first glaucoma medication to be prescribed for someone with elevated IOP or glaucoma. However, brimonidine may be preferred over timolol (a beta blocker) in those with normal (or low) tension glaucoma.

Common brands and generic formulations of the alpha-agonist class:
Brand Name: Alphagan-P 0.1%
Generics: brimonidine 0.2% or 0.15%

It's worth noting that Alphagan-P is not preserved with benzalkonium chloride (BAK). Instead, it is preserved with PURITE® 0.005% which appears to be less toxic to the eye.

Brimonidine is also available as the following Fixed Combinations in the USA:
Combigan (brimonidine plus timolol)
Simbrinza (brimonidine plus brinzolamide)
Brim-Dor (brimonidine plus dorzolamide) which is available through Imprimis Pharmacy

These eye drops are often prescribed to be used twice daily. However, there is evidence that three times daily provides additional benefits.

Side effects:
Local
Irritation/dryness of the eye
Hyperemia (redness) of the eye
Allergic reaction relatively common (~10-15%)
Pupil dilation (usually mild)
Mild elevation of the eyelid (sometimes desirable)
Dry mouth

Systemic
Rare in young adults; more likely to be experienced in the elderly; but could be serious in infants and young children:
Headache
Low blood pressure
Lethargy
Apnea (breathing stops)

Interactions with other medications:
Monoamine oxidase (MAO) inhibitors.

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► Summary:
The alpha-agonist class works primarily by reducing the production of fluid in the eye. It also has an important secondary mechanism of action: improving the exit of fluid through the uveoscleral outflow pathway. Additionally, there is evidence that it may also have a neuroprotective benefit.

0:00 Intro
0:40 Alpha agonist class
1:59 Neuroprotectant effect / benefit?
3:18 How does it really work? Does it work well?
6:09 Fixed combination
7:27 Cost of medication
8:45 How the alpha-agonist class / brimonidine class is used
9:30 Side effects
12:35 How to minimize the side effects
13:24 Interaction with other medications
14:07 Summary

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