Prostaglandin analogs: Xalatan® (latanoprost), Lumigan® (bimatoprost), Travatan Z® (Travoprost), and Zioptan™ (tafluprost), and Vyzulta™ (latanoprostene bunod), and they work by increasing the outflow of fluid from the eye. They have few systemic side effects but are associated with changes to the eye itself, including change in iris color and growth of eyelashes. Depending on the individual, one of these preparations may be more effective and produce fewer side effects. Latanoprost and some formulations of bimatoprost are now available in generic form. Tafluprost is a preservative-free prostaglandin analog.
Beta blockers: Timolol are the second most often used class of medication and work by decreasing production of fluid. They are available in generic form and, therefore, may be less expensive. Timolol is also available in a preservative-free formulation. Systemic side effects of beta blockers can be minimized by closing the eyes following application or using a technique called punctal occlusion that prevents the drug from entering the tear drainage duct and systemic circulation.
Alpha agonists [Alphagan®P (brimonidine), Iopidine®] both decrease production of fluid and increase drainage. Alphagan P has a purite preservative that breaks down into natural tear components and may be better tolerated in people who have allergic reactions to preservatives in other eye drops. Alphagan is available in a generic form.
Carbonic anhydrase inhibitors (CAIs) reduce eye pressure by decreasing the production of intraocular fluid. These are available as eye drops [Trusopt® (dorzolamide), Azopt® (brinzolamide)] as well as pills [Diamox (acetazolamide) and Neptazane® (methazolamide)]. Except for brinzolamide, all CAIs are available in generic form.
Rho khinase inhibitors [Rhopressa® (netarsudil)] increase the drainage of intraocular fluid
Combined medications can offer an alternative for patients who need more than one type of medication. In addition to the convenience of using one eyedrop bottle instead of two, there is decreased exposure to preservatives.
Cosopt® is a combination of a beta blocker (timolol) and a carbonic anhydrase inhibitor (dorzolamide) and is available in generic form and also as a preservative-free formulation (Cosopt® PF).
Combigan® combines an alpha agonist (brimonidine) with a beta blocker (timolol).
Simbrinza® is a beta blocker-free combination medication consisting of brinzolamide and brimonidine.