EyeWorld Asia-Pacific March 2016 Issue

61 EWAP PHARMACEUTICALS March 2016 For eyes with glaucoma, fixed-combination agents may decrease the possibility of mistakes with eye drops. Source: Nathan M. Radcliffe, MD Coupling up glaucoma medications by Maxine Lipner EyeWorld Senior Contributing Writer Update on combination drugs A t least a third of the time, any given patient diagnosed with glaucoma or ocular hypertension will be on more than one medication, according to Nathan M. Radcliffe, MD , clinical professor of ophthalmology, New York University Langone Medical Center, New York. Many of these patients end up on fixed-combination medications. EyeWorld delves into the latest on these medications. In the U.S., there are currently three fixed combinations. The first to market was known by the brand name Cosopt and is a combination of dorzolamide hydrochloride 2% and timolol maleate 0.5%, Dr. Radcliffe noted, adding that this is now a generic drug. The other two medications are Combigan (brimonidine 0.2% and timolol 0.5%, Allergan, Dublin) and Simbrinza (brimonidine 0.2% and brinzolamide 1%, Alcon, Fort Worth, Texas). Considering the benefits Fixed-combination agents can offer patients advantages over taking two different drugs independently, said Parag Parekh, MD , DuBois, Pa. One benefit is convenience. Two different medications must each be dosed several times a day. “If you put two bottles into one, you decrease the amount of work that patients have to do,” Dr. Parekh said. “The other way to think of it is you decrease the number of possibilities for mistakes.” This may also result in financial savings for patients. “Depending on the insurance plan, it might only be one copay as opposed to two,” he said, adding that the flip side of that, however, is if the combined medication isn’t covered by insurance it might be more expensive for the combined product than the two individual agents. There can be other more subtle benefits as well. If someone is taking a combined medicine twice a day, he or she is getting lower eye pressure than someone taking a single medication twice a day. “You’re getting more effect for the same amount of work that you’re putting in as a patient,” Dr. Parekh said. Dr. Radcliffe pointed out that certain combinations may even have fewer side effects than when the medication is taken alone. “I did a review of the fixed combinations and found that for a medicine that had timolol in the bottle, oftentimes there would be less hyperemia or redness and allergy,” Dr. Radcliffe said. Specifically, he found that this was true for latanoprost, bimatoprost, and brimonidine. “Something about the timolol is either quieting for the eye or has some anti-allergy property,” he said, adding that this may run counter to what many practitioners have been taught. “The way many of us were trained, we were taught not to put two medicines in an eye if one might work,” Dr. Radcliffe said. “You don’t want to expose continued on page 62