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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[@Foreverdoubtfree]

It is very helpful to hear the specifics regarding these eye drops. The information that comes with the medication is difficult to comprehend and it is very seldom that the doctors have the time to talk about the benefits and contraindications. Much appreciation for your time and education on these topical treatments. Thank you.

[@donlumahai9767]

Thank you for your videos! Your discussions are clear, informative, and beneficial. Most doctors now days don't take the time to explain the what, why and how of their medical actions. Few doctors like yourself are born with that personal touch especially important when patients are worried about their current treatments.

[@willaaxenfield9692]

Excellent video and very informative! I hope that you are taking new patients.

[@DrDavidDRichardsonMDSanMarino]

So glad you found this video informative. I am accepting new patients. My practice is located just south of Pasadena, California (in the greater Los Angeles area).

[@beckiewrites]

These videos are so helpful. Thank you.

[@deborarichardson6605]

Your information doctor is "Heaven Sent". Thank you so very much!

[@carolhuntington3820]

Thank you!

[@sodapop4244]

straight to the point, so much information Tks A+

[@Userzmxncbv]

Thank you so much for the information! 😊

[@halfglassfull]

Been on latanoprost for 3-4 years. Doc says pressure went up - was 14 now 20 - so last week started me on B&L .2% generic brimonidine; after 3 days experiecing itching, discharge and pain around the eyes. Have not called Dr. yet they are a large chain clinic always too busy. So far reading and watching videos there does not appear to be alternatives but the info about less dosage and preservatives is helpful. Thanks for the careful walk through.

[@thejerrytsao]

you are definitely a good doctor with love.

[@sithlordbilly4206]

Thanks for the information! 👀

[@Userzmxncbv]

So helpful. I am very grateful you giving critical information with best knowledge in the field. I was very frustrated when my doctor just telling me to choose between timolol and carbonic anhydrase inhibitor. I don't think he knows all my medical history... I tried study myself for meds and this video is the best. I am more comfortable what should I choose. Thank you very much!

[@wyro1741]

THAAAAAAANK YOU for this :)

[@heatherbent6065]

Thanks for the info would like some insight on Cosopt PF. I currently take this medication. Am in my late forties.

[@gaiacarfora7814]

Thanks so much for this :). I wonder if this type of eye drops is the best option for patients that have congenital corneal thinning together with glaucoma

[@doloresmalone8000]

So helpful could you please give the name and address of the compound impressions in New Jersey with no chemical the email would be good thank you so much🙏

[@Steph_7d7]

What is your opinion of timoptic xe, ive been prescribed it and cant stand how cold it makes me, i work in the cold btw -30c. I dont want to continue with this medication as it affects my entire hot cold tolerance at work. My follow up appointment is coming up and im gonna ask for an alternative that doesnt affect my entire body like the timoptic xe does. Do you have any suggestions that i could mention, the drops are only for one eye and only one drop a day. Even if you dont have any suggestions that's fine, thanks for this great information regardless.

[@glendajohnson3580]

What about Cataracts are both of them can use the same diet?

[@kcmic7225]

My issue is with exhaustion and low heart rate 52-60bpm with timilol. Will I get this with bromonidine? Is a betaxoloyl any good? What about red eyes anything I can do when starting Bromonidine?

[@tcfbrp8807]

Great video doctor, very in-depth and informative. Following with the theme of neuroprotection, have you heard about the research being done on noran protein? Sounds like it could be a game-changer for people with retinal damage. Curious if there is any connection with glaucoma or if there are any promising neuroprotective treatments for glaucoma in the works? Also, is the raised eyelid side effect permanent or only during use of this drug?

[@lynnemaitland3767]

The raised eyelid occurs only when using the drops. As the day goes on, the lid goes back to normal level until using the next drop dose.

[@willaaxenfield9692]

I also have the raised eyelid side effect. Unfortunately, I’m only using the drop in one eye so it is quite noticeable to me.

[@thejerrytsao]

do timolol qd be one of your prescription for POAG?

[@thejerrytsao]

what kind of vitamin do you suggest as a supplement to protect glaucoma optic nerve damage ?

[@sunbinsamin5588]

Can u make videos on Juvenile hypertension?

[@marlene0212]

Dr. Richardson-what about safety during pregnancy? I noticed that was left out.

[@johns2105]

I wished I watched this before my First visit today. I was prescribed Drops, don't know which brand,( haven't picked up yet) but the possible side effects the doctor described were the red eye, eyelash growth and darkening around the eyes. Wasn't too happy with these. I'm sure they have a preservative in them. I doubt it'll have the purite one.

[@doloresmalone8000]

Dr I’m prone to. Allergies and could you please recommend the best eye drops you could recommend for me I am very interested in preservative free drops🙏

[@DrDavidDRichardsonMDSanMarino]

Although I cannot make a specific recommendation for you, I can share what I often recommend for my patients with allergic conjunctivitis: preservative-free Alaway (ketotifen).

[@douglee8158]

For those that can’t tolerate drops of any kind, what’s your plan B for them?

[@SD-ip2wb]

Laser

[@kibredesta7145]

Thank you for posting great information👏👏👏 Called ur office several times to make appointment. Answering service told me w’ll back 15th Dec. Hopefully get to say u then. Pls it’s urgent to get second opinion & watched all ur videos!!! very helpful. A week ago diagnosed w glaucoma & using 3 types eye droops. and medication ordered to lower pressure but because of side effects got scared to take it. It’s called ACETAZOLAMIDE. Waiting to your response eagerly. God bless you

[@lindaowen6761]

Wish you were my doctor !! Maybe someday I can afford the trip from Florida to have a consult !! Thank you for ALL your KZbin drives !!

[@garypodmoroff2982]

Cosopt vs Brimonidine?

[@lanceolivan60]

What about food and glaucoma? I still eat refined sugar after diner?