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©2013 UpToDate ® Print Email Agents that reduce intraocular pressure Class Examples Side effects Agents that suppress aqueous inflow β adrenergic blockers Betaxolol, carteolol, levobunolol, metipranolol, timolol Ocular irritation and dry eyes. Contraindicated in patients with bradycardia, heart block, heart failure, asthma, or obstructive airway disease. α 2 adrenergic agonists Apraclonidine, brimonidine Red eye and ocular irritation. CNS effects and respiratory arrest in young children (brimonidine). Caution in patients with cerebral or coronary insufficiency, Raynauds, postural hypotension, hepatic or renal impairment. Carbonic anhydrase inhibitors Dorzolamide and brinzolamide (topical), acetazolamide and methazolamide (oral) Oral form can cause transient myopia, nausea, diarrhea, loss of appetite and taste, parasthesiae, lassitude, renal stones, and hematological problems. Topical forms much less likely to cause systemic side-effects but can cause local irritation and redness. Agents that increase aqueous outflow Prostaglandin analogues, (prostamide) Brimatoprost, latanoprost, tafluprost, travoprost, unoprostone* Brown discoloration of iris, lengthening and darkening of eyelashes, ocular irritation and redness, macular edema or iritis in susceptible individuals α adrenergic agonists Apraclonidine, brimonidine Red eye and ocular irritation. CNS effects and respiratory arrest in young children (brimonidine). Caution in patients with cerebral or coronary insufficiency, Raynauds, postural hypotension, hepatic or renal impairment. Cholinergic agonists Pilocarpine, carbachol Ciliary spasm leading to headaches especially in younger patients, myopia, dim vision (small pupil). Cataracts and iris-lens adhesions in long term. * Not available in US or Canada. Adapted with permission from: Weinreb RN, Khaw PT. Primary open-angle glaucoma. Lancet 2004; 363:1711. Copyright © 2004 Elsevier.