With some drugs, the risk of increased intraocular pressure is stated in the package insert as a contraindication for patients with glaucoma. However, these drugs have often been prescribed in glaucoma patients. In the present study, we investigated the drugs that had been prescribed to glaucoma patients in our hospital as well as the use of such contraindicated drugs to see if they were being used rationally or not.
In 53 patients hospitalized for glaucoma surgery in the ophthalmologic ward of the University of Tokyo Hospital, 38 patients (70%) had used drugs other than eye drops. Seven of the 38 patients had used drugs described in the package inserts as having contraindications for glaucoma patients, absolute contraindications in the case of 5 patients and relative contraindications in the case of 3 patients, with one patient having used drugs in both categories. The drugs with absolute contraindications were withdrawn in two patients, and continued in the other three patients based on the doctor's judgment that they had no effect on intraocular pressure.
In addition, when we asked pharmaceutical manufacturers if there had been any case reports involving adverse effects for 59 drugs contraindicated for glaucoma in their package inserts, we discovered that for 16 of these drugs, there were no such case reports or other clinical evidence of adverse effects.
From our investigation, we found that even in cases when increases in intraocular pressure may be prevented through ophthalmologic treatment, certain drugs are contraindicated for use in glaucoma patients in their package inserts. Thus there should be information in package inserts concerning the possibility of using such drugs together with ophthalmologic treatment so that they may be used in a more rational manner for glaucoma patients.
