Compatibility of systemic drugs and local antihypertensive therapy in patients with primary open-angle glaucoma (analytical review)

The prevalence of glaucoma in the world today is extremely high: according to different authors total prevalence number reach as high as 66 to 105 million people. It accounts for about 29% in the structure of causes of irreversible blindness and visual impaireness. The only effective way to treat glaucoma, regardless of its type, is to reduce and stabilize intraocular pressure at an individually safe level. In most cases, this can be achieved by the appointment of local antihypertensive therapy. The need for daily and often lifelong adherence to hypotensive drops makes the problem of drug choice extremely important. The presence of systemic diseases, their therapy and the interaction of drugs received by the patient should all be taken into account. Local hypotensive drugs are often embedded into the daily regimen of patients’ systemic medications. Up to 80% of the active substances of ophthalmic drugs are absorbed systematically, while avoiding the primary stages of metabolism. Antiglaucoma drugs can cause serious side effects: symptomatic bradycardia, various violations of cardiac muscle conductivity, orthostatic hypotension, syncope, dyspepsia, exacerbation of chronic diseases of the liver and kidneys, etc. In the present work we considered all currently used groups of local hypotensive drugs: prostaglandin analogues, selective and non-selective β-blockers, carbonic anhydrase inhibitors, α-adrenoceptor agonists, parasympathomimetics. The article describes the pharmacological groups of drugs, the mechanisms of intraocular pressure reduction, systemic absorption and utilization of each group of drugs, possible local and systemic adverse reactions — the most significant information that must be taken into account in the selection and appointment of a drug to each patient. The review presents data on the most common concomitant diseases in patients with primary open-angle glaucoma, the specifics of local and general exposure to antiglaucoma drugs, as well as the information on the possible drug interactions of local antihypertensive drugs and systemic medicines.

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