Intraocular Carbonic Anhydrase Inhibitor

Aka: Intraocular Carbonic Anhydrase Inhibitor, Dorzolamide, Trusopt, Brinzolamide, Azopt

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II. Indications

  1. Open Angle Glaucoma
    1. Second-line agent for patients unable to tolerate topical Beta Blocker or as adjunctive agent
  2. Narrow Angle Glaucoma
    1. Acetazolamide (Diamox) IV is used in emergent management
    2. Dorzolamide may also be used

III. Contraindications

  1. Sickle Cell Disease
  2. Sulfa Allergy (relative, Exercise caution)
    1. Carbonic Anhydrase Inhibitors cross react with sulfa agents (structurally similar)

IV. Mechanism

  1. Inhibits bicarbonate formation in the ciliary body
  2. Results in decreased aqueous production (lowers IOP 15-20%)

V. Medications (orange cap)

  1. Topical
    1. Dorzolamide (Trusopt) 2%, 1 drop three times daily
    2. Brinzolamide (Azopt) 1%, 1 drop three times daily
      1. Available as combination with Brimonidine (Simbrinza)
  2. Systemic
    1. Methazolamide (Neptazane)
    2. Acetazolamide (Diamox)
      1. See Narrow Angle Glaucoma for protocol

VI. Efficacy

  1. Less effective than Intraocular Beta Blocker and Intraocular Prostaglandin

VII. Adverse Effects

  1. Topical
    1. Well tolerated (contrast with systemic)
    2. May cause bitter taste
    3. Punctate Keratitis
    4. Eye burning Sensation
  2. Systemic
    1. Paresthesias in hands and face
    2. Malaise, Anorexia, and severe weight loss
    3. Hypokalemia
    4. Nephrolithiasis
  3. Allergic Reaction
    1. Cross-reactivity with Sulfa Allergy

VIII. References

  1. (1995) Med Lett Drugs Ther 37:(956):76-77 [PubMed]
  2. Harris (2023) Am Fam Physician 107(3): 238-46 [PubMed]

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