Considerations in glaucoma therapy: Fixed combinations versus their component medications

Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, GA, USA.
Clinical Ophthalmology (Impact Factor: 0.76). 02/2010; 4(1):1-9. DOI: 10.2147/OPTH.S6645
Source: PubMed


Fixed combinations of medications that lower intraocular pressure (IOP) are increasingly used in the treatment of glaucoma and ocular hypertension and offer several potential advantages over combined use of the separate component medications including enhanced convenience, improved adherence, reduced exposure to preservatives, and possible cost savings. This review aims to examine the current role of IOP-lowering fixed combinations in disease management. The results of studies that compared the efficacy and safety of IOP-lowering fixed combinations with their component medications are summarized, including those fixed combinations that consist of a prostaglandin analog and timolol. The fixed combinations currently available for use in the United States are fixed-combination dorzolamide/timolol (FCDT) and fixed-combination brimonidine/timolol (FCBT). Both of these fixed combinations reduce IOP more effectively than their component medications used separately as monotherapy. FCBT therapy also demonstrates a more favorable safety profile and reduced ocular allergy compared to monotherapy with brimonidine, a component medication. Few studies have directly compared the efficacy and safety of FCDT and FCBT, but available evidence suggests that FCBT is at least as effective as FCDT in lowering IOP and is more comfortable and better tolerated. Additional studies are needed to further evaluate the comparative efficacy and tolerability of FCDT and FCBT in the management of glaucoma and ocular hypertension.

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Available from: Eve Higginbotham, Dec 23, 2014

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Article: Considerations in glaucoma therapy: Fixed combinations versus their component medications

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    • "Timolol+dorzolamide FDC was the most commonly prescribed FDC. It is more convenient (both easier and faster) to instill 1 drop of a fixed combination than 2 drops from separate bottles of the component medications.[14] So, FDCs if rational, offer benefits of convenience, cost and safety. "
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    ABSTRACT: To study drug use pattern in patients of primary open angle glaucoma (POAG) and to analyze the cost of different anti-glaucoma medications. This prospective study was carried in the glaucoma clinic of a tertiary care teaching hospital over a period of 9 months. The data collected for patients with POAG included the patient's demographic details and the drugs prescribed. Data were analyzed for drug use pattern and cost drugs used. In a total 180 prescriptions (297 drugs) analyzed, most drugs (83.83%) were prescribed by topical route as eye drops. β blockers (93.88%) were found to be the most frequently prescribed for POAG. Timolol (82.22%) was the most frequently prescribed drug and timolol with acetazolamide (17.22%) was the most commonly prescribed drug combination. Fixed dose combinations constituted 26.66% of prescriptions. β blockers were found to be cheaper than other anti-glaucoma drugs while prostaglandins analogs were the costliest. Instructions about the route, frequency and duration of treatment were present in all prescriptions. However, instructions regarding instillation of eye drops were missing in all prescriptions.
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    • "This, in and of itself, can lead to a vicious cycle, because more complex regimens with multiple medications may present an even greater challenge to adherence. (Tsai, 2006; Higginbotham, 2010) Intermittent dosing will not lead to sustained lowering of IOP, and deterioration of the visual field may increase. If the patient presents at the next visit with an optimal IOP, but there is evidence of visual field progression, it is impossible to distinguish whether the target IOP needs to be lowered by adding therapy, or if the target IOP is appropriate and the progression is due to nonadherence. "

    Glaucoma - Current Clinical and Research Aspects, 11/2011; , ISBN: 978-953-307-263-0
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    • "Fixed combination formulations may improve compliance by reducing the number of daily eye drops, thereby simplifying the dosing regimen.11,13–15 Pilocarpine and epinephrine were combined to treat glaucoma as early as the 1960s. "
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    ABSTRACT: Glaucoma is a collection of diseases characterized by multifactorial progressive changes leading to visual field loss and optic neuropathy most frequently due to elevated intraocular pressure (IOP). The goal of treatment is the lowering of the IOP to prevent additional optic nerve damage. Treatment usually begins with topical pharmacological agents as monotherapy, progresses to combination therapy with agents from up to 4 different classes of IOP-lowering medications, and then proceeds to laser or incisional surgical modalities for refractory cases. The fixed combination therapy with the carbonic anhydrase inhibitor dorzolamide hydrochloride 2% and the beta blocker timolol maleate 0.5% is now available in a generic formulation for the treatment of patients who have not responded sufficiently to monotherapy with beta adrenergic blockers. In pre- and postmarketing clinical studies, the fixed combination dorzolamide-timolol has been shown to be safe and efficacious, and well tolerated by patients. The fixed combination dorzolamide-timolol is convenient for patients, reduces their dosing regimen with the goal of increasing their compliance, reduces the effects of "washout" when instilling multiple drops, and reduces the preservative burden by reducing the number of drops administered per day.
    Clinical Ophthalmology 11/2010; 4(1):1331-46. DOI:10.2147/OPTH.S14054 · 0.76 Impact Factor
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