From the Guidelines
Patients with glaucoma, especially narrow-angle glaucoma, should avoid pseudoephedrine due to the risk of increasing intraocular pressure and precipitating an acute angle-closure attack. Pseudoephedrine is a decongestant found in many over-the-counter cold and allergy medications, and its sympathomimetic effects can affect the production or drainage of aqueous humor in the eye, leading to increased intraocular pressure 1. According to the study published in the Journal of Allergy and Clinical Immunology, oral decongestants, including pseudoephedrine, should be used with caution in patients with certain conditions, such as glaucoma, due to the potential for adverse effects 1.
The study highlights that oral α-adrenergic agents, like pseudoephedrine, can relieve nasal congestion by acting as vasoconstrictors, but they may also raise intraocular pressure (IOP) and have not been well established as safe for patients with glaucoma 1. Patients with narrow-angle glaucoma are particularly at risk, as their drainage channels are already anatomically restricted, and pseudoephedrine can precipitate an acute angle-closure attack, which is a medical emergency that can lead to permanent vision loss if not treated promptly.
Alternative treatments for congestion might include:
- Saline nasal sprays
- Steam inhalation
- Medications specifically approved by their eye care provider Patients with glaucoma should carefully read medication labels and consult with their pharmacist or ophthalmologist before taking any decongestants or cold medications to ensure their safety and prevent potential complications 1.
From the Research
Pseudoephedrine and Glaucoma
- Pseudoephedrine is a sympathomimetic drug that can cause pupillary dilation, which may increase the risk of closed-angle glaucoma in patients with narrow iridocorneal angles 2.
- There is no direct evidence in the provided studies that specifically addresses the use of pseudoephedrine in patients with glaucoma.
- However, studies suggest that sympathomimetic drugs can increase the risk of closed-angle glaucoma in susceptible individuals 2.
- Patients with narrow-angle glaucoma should be cautious when using medications with sympathomimetic properties, such as pseudoephedrine, as they may exacerbate the condition 2.
Glaucoma Treatment and Management
- The primary goal of glaucoma treatment is to reduce intraocular pressure (IOP) through pharmacological or surgical means 3.
- Various medications, including beta-blockers, carbonic anhydrase inhibitors, and prostaglandin analogs, are used to reduce IOP and slow disease progression 3.
- Patients with glaucoma should be closely monitored by an ophthalmologist to prevent vision loss and manage the condition effectively 4.
Drug-Induced Glaucoma
- Several systemically used drugs, including those with sympathomimetic or parasympatholytic properties, can induce glaucoma in susceptible individuals 2.
- Drug-induced glaucoma can occur in patients with narrow or open iridocorneal angles, and it is essential to recognize the risk factors and take preventive measures 2.
- Clinicians should be aware of the potential risks of drug-induced glaucoma and monitor patients closely to prevent this condition 4.