II. Indication

  1. Open Angle Glaucoma
  2. Patients unable to tolerate Beta Blocker or as adjunct

III. Mechanism

  1. Inhibits bicarbonate formation in the ciliary body
  2. Results in decreased aqueous production

IV. Preparations

  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. Acetazolamide (Diamox)
    2. Methazolamide (Neptazane)

V. Efficacy

VI. Adverse Effects

  1. Topical is well tolerated (contrast with oral)
    1. May cause bitter taste
  2. Systemic
    1. Paresthesias in hands and face
    2. Malaise, anorexia, and severe weight loss
    3. Hypokalemia
    4. Nephrolithiasis

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Cost: Medications

dorzolamide (on 8/17/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
DORZOLAMIDE HCL 2% EYE DROPS Generic $1.14 per ml
DORZOLAMIDE-TIMOLOL EYE DROPS Generic $1.10 per ml
azopt (on 4/20/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
AZOPT 1% EYE DROPS $24.19 per ml