Page 36 - 21st Century Perspective - Glaucoma Supplement
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Adjunctive Therapies: Beta-Blockers
If the newest generation of prostaglandins fails to achieve target IOP range, then we generally add a
nonselective beta-blocker such as timolol to be administered shortly upon awakening (see Figure
20). This dosing schedule is successful for patients who work first, second or third shifts, because
the adrenergic system is largely active while we are awake and is physiologically down-regulated
when we sleep, even if we habitually sleep during the day. This largely explains why beta-adrenergic
receptor antagonists do little or nothing while we sleep.
Numerous studies have found that once-daily instillation sufficiently reduces IOP and is much easier
for patients to use than medications requiring twice-daily instillation. Such once-daily administration
obviously reduces the cost by 50%, as compared with the early-on, traditional twice-daily use of
these medications.
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