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BNSSG Adult Joint Formulary

11.6 Treatment of glaucoma

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First line drugs Second line drugs Specialist drugs Secondary care drugs

 

  • A preservative free option (or single unit dose drops) may be prescribed if available for all formulary products listed if clinically necessary, as an alternative option
  • Please ensure that all prescriptions for eye drops clearly state the number of drops, into which eye(s), and the frequency of administration

For urgent reduction of intraocular pressure and before surgery, mannitol 20% (up to 500mL) is given by slow intravenous infusion until the intraocular pressure has been satisfactorily reduced.

Please see BNSSG glaucoma prescribing guidelines

 

Beta-Blockers

Recommended: (TLS Green)

Timolol 0.25% or 0.5% eye drops

  • Preservative free options are available for those patients who require them, see BNSSG Glaucoma guidelines for further information

Alternatives: (TLS Blue)

Levobunolol 0.5% eye drops

Timolol 0.1% long acting preservative free eye drops (Tiopex®)

Timolol 0.25% long acting eye solution (Timoptol LA®)

Timolol 0.5% long acting eye solution (Timoptol LA®)

N.B. If a long acting beta blocker is required, the most cost-effective is Timolol LA 0.25% and Timolol LA 0.5%

 

Prostaglandin Analogues and Prostamides

Recommended: (TLS Green)

Latanoprost 50microgram/mL eye drops

Travoprost 40microgram/mL eye drops

  • Preservative free options are available for those patients who require them, see BNSSG Glaucoma guidelines for further information

Alternatives: (TLS Blue)

Bimatoprost 100microgram/mL and 300microgram/mL eye drops

Specific indication: (TLS Blue)

Tafluprost 15microgram/mL preservative free unit dose eye drops

  • Only for use in patients that require preservative free drops

 

Sympathomimetics

Recommended: (TLS Green)

Brimonidine 0.2% eye drops

 

Carbonic Anhydrase Inhibitors and Systemic Drugs

Recommended: (TLS Green)

Brinzolamide 10mg/mL eye drops

Dorzolamide 2% eye drops

Alternative: (TLS Blue)

Acetazolamide immediate & modified release (oral)

 

Miotics

Recommended: (TLS Green)

Pilocarpine 1%, 2% or 4% eye drops

 

Combination Products

Specific indication: (TLS Blue)

Where there are compliance issues 

Latanoprost 50micrograms / Timolol 5mg/mL (brands include Xalacom®)

Travoprost 40 micrograms / Timolol 5mg/mL eye drops (brands include DuoTrav®)

Brimonidine 0.2% / Timolol 0.5% eye drops (brands include Combigan®)

Brinzolamide 10mg / Timolol 5mg/mL eye drops (brands include Azarga®)

Dorzolamide 2% / Timolol 0.5% eye drops

  • Cosopt iMulti® (preservative free) is the preferred brand of Dorzolamide/Timolol eye drops
  • Ensure suitable communication to the patient on use of the bottle and extended 60 day in use expiry

Tafluprost 15micrograms/mL / Timolol 5mg/mL (brands include Taptiqom®)

  • 1st line compared to bimatoprost 0.03% & timolol 0.5% eye drops

Bimatoprost 0.03% / Timolol 0.5% eye drops (brands include Ganfort®)

  • 2nd line compared to tafluprost 15micrograms/mL & timolol 5mg/mL Brinzolamide 10mg/mL & Brimonidine 2mg/mL eye drops (Brand - Simbrinza®)

 

Others

Specific indication:

Apraclonidine 0.5% eye drops (TLS Amber Specialist Recommended)

  • Reduction of elevated intraocular pressure for secondary occular hypertension/glaucoma
  • Indicated for short term use when on maximal therapy and further IOP reduction is required i.e. while awaiting glaucoma surgery

 

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