Drug Interactions between brimonidine / dorzolamide / latanoprost / timolol ophthalmic and fenoldopam

MONITOR: Topically administered alpha-2 adrenergic receptor agonists such as apraclonidine and brimonidine are systemically absorbed, with the potential for producing rare but clinically significant systemic effects such as hypotension and bradycardia. The possibility for an additive or potentiating effect on blood pressure and heart rate should be considered when used with other medications that affect these parameters, such as ophthalmic and systemic beta blockers, vasodilators, cardiac glycosides, and antihypertensive agents.

MANAGEMENT: Blood pressure and pulse rate should be monitored regularly when topical alpha-2 adrenergic receptor agonists are prescribed in combination with cardiovascular drugs. Patients should be advised to notify their physician if they experience slow pulse, irregular heartbeat, dizziness, lightheadedness, or syncope.

GENERALLY AVOID: The use of fenoldopam in combination with beta-blockers has not been studied. Theoretically, beta-blockers may potentiate the risk of severe, symptomatic hypotension by inhibiting the sympathetic reflex response to fenoldopam-induced blood pressure decreases.

MANAGEMENT: Concomitant use of fenoldopam with beta-blockers should be avoided if possible. The same precaution may be applicable to beta-blocker ophthalmic preparations, as they are systemically absorbed and can produce clinically significant systemic effects even at low or undetectable plasma levels. Moreover, since fenoldopam may cause a dose-dependent increase in intraocular pressure, caution should be exercised if it is administered to patients with glaucoma or ocular hypertension receiving ophthalmic beta-blockers.

MONITOR: Topically administered alpha-2 adrenergic receptor agonists such as apraclonidine and brimonidine are systemically absorbed, with the potential for producing rare but clinically significant systemic effects such as hypotension and bradycardia. The possibility for an additive or potentiating effect on blood pressure and heart rate should be considered when used with other medications that affect these parameters, such as ophthalmic and systemic beta blockers, vasodilators, cardiac glycosides, and antihypertensive agents.

MANAGEMENT: Blood pressure and pulse rate should be monitored regularly when topical alpha-2 adrenergic receptor agonists are prescribed in combination with cardiovascular drugs. Patients should be advised to notify their physician if they experience slow pulse, irregular heartbeat, dizziness, lightheadedness, or syncope.