Medications associated with acute angle-closure glaucoma

Alpha/beta adrenergic agonists

Eye drops (topical mydriatics): Phenylephrine*, apraclonidine, dipivefrin

Nose drops: Ephedrine*, naphazoline*

Systemic: Ephedrine*, epinephrine, phenylephrine*

Anticholinergic agents

Eye drops (mydriatics): Atropine, homatropine, cyclopentolate, tropicamide

Inhaled: Ipratropium

Systemic: Atropine, scopolamine, other medicines with anticholinergic effect

Anticonvulsant/multipurpose analgesic

Topiramate

Antihistamines

H₁ receptor antagonists, eg, diphenhydramine, chlorpheniramine, loratadine

H₂ receptor antagonists, eg, cimetidine

Beta₂ adrenergic agonists

Inhaled bronchodilators: albuterol (salbutamol), terbutaline

Diuretics

Acetazolamide, hydrochlorothiazide, chlorthalidone, indapamide

Cholinergic agents

Pilocarpine, acetylcholine, carbachol

Psychiatric drugs

Tricyclic antidepressants (TCAs), eg, amitriptyline, imipramine

Selective serotonin reuptake inhibitors (SSRIs), eg, citalopram, paroxetine

Serotonin norepinephrine reuptake inhibitors (SNRIs), eg, venlafaxine

Stimulants (noncatecholamine)

Amphetamines, appetite suppressants (anorexiants)

Other

Trimethoprim-sulfamethoxazole (cotrimoxazole)

Daratumumab

NOTE: Drugs listed in this table have the potential to induce acute angle-closure glaucoma or worsen chronic angle-closure glaucoma among physiologically predisposed individuals (ie, eyes with narrow anterior chamber angles which inhibit drainage of the aqueous fluid). Patients with signs and symptoms suggesting an acute attack of angle-closure glaucoma require emergency treatment by an ophthalmologist.

* Available as an over-the-counter medicine for treatment of congestion and cough-cold symptoms.

Courtesy of authors with additional data from Lai JS, Gangwani RA. Medication induced acute angle-closure attack. Hong Kong Med J 2012; 18:139.

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Medications associated with acute angle-closure glaucoma