Glaucoma Medications Chart: Classes, IOP Lowering, Side Effects
Last updated: October 2026
All the glaucoma drop classes on one page: how they work, how much they lower pressure, how often to use them, and what to watch for.
| Class (cap colour*) | Examples | Mechanism | IOP lowering | Dosing | Main side effects | Avoid or caution |
|---|---|---|---|---|---|---|
| Prostaglandin analogues (teal) | Latanoprost 0.005%, bimatoprost 0.01–0.03%, travoprost 0.004%, tafluprost 0.0015% | ↑ uveoscleral outflow | 25–33% | Once at night | Red eye, lash growth, iris and lid darkening, periorbital fat loss | Active uveitis, history of HSV keratitis, CME risk, unilateral use in light irides (cosmetic) |
| Latanoprostene bunod | 0.024% | Uveoscleral + nitric oxide on trabecular outflow | ≈ latanoprost or slightly more | Once at night | As above | As above |
| Beta-blockers (yellow; blue for 0.25%) | Timolol 0.25–0.5%, betaxolol 0.25–0.5% (cardioselective) | ↓ aqueous production | 20–25% | Twice daily (gel once daily) | Bradycardia, bronchospasm, fatigue, depression, masked hypoglycaemia | Asthma or COPD, heart block, bradycardia, uncontrolled heart failure; less effect at night |
| Alpha-2 agonists (purple) | Brimonidine 0.1–0.2% | ↓ production, ↑ uveoscleral outflow | 20–25% | Twice or three times daily | Allergic follicular conjunctivitis (up to 1 in 4), dry mouth, fatigue | Children under 2 (apnoea), MAO-inhibitor use, breastfeeding |
| Topical carbonic anhydrase inhibitors (orange) | Dorzolamide 2%, brinzolamide 1% | ↓ aqueous production | 15–20% | Two or three times daily | Stinging (dorzolamide), blurring (brinzolamide), bitter taste | Sulfonamide allergy (caution), corneal endothelial disease, severe renal failure |
| Rho-kinase inhibitor | Netarsudil 0.02% | ↑ trabecular outflow, ↓ episcleral venous pressure | 15–20% | Once at night | Conjunctival hyperaemia, corneal verticillata, small haemorrhages | Limited availability in India |
| Miotics (dark green) | Pilocarpine 1–4% | ↑ trabecular outflow | 20–25% | Three or four times daily | Brow ache, dim vision, myopic shift, retinal tear risk | Uveitis, neovascular glaucoma, high myopia or retinal breaks, young patients |
| Oral carbonic anhydrase inhibitor | Acetazolamide 250 mg tablets or 500 mg SR | ↓ aqueous production | 30–40% | 250 mg up to four times daily (short term) | Tingling, fatigue, low potassium, acidosis, kidney stones, rarely blood disorders | Sulfonamide allergy, renal or hepatic failure, low sodium or potassium; avoid long-term use |
| Hyperosmotic | Mannitol 20% IV (1–2 g/kg over 30–45 min), oral glycerol 50% | Dehydrates vitreous | Large, short-lived | Emergency use | Headache, fluid overload, confusion | Heart or renal failure; glycerol raises blood sugar |
*AAO cap colour convention; local brands may differ. See AAO colour codes for eye drops. IOP reductions are typical ranges from trials and differ between patients.
Fixed combinations available in India
- Timolol + dorzolamide, timolol + brinzolamide, timolol + brimonidine, timolol + latanoprost / bimatoprost / travoprost, brinzolamide + brimonidine.
- Combinations improve adherence and reduce preservative exposure; use them once each component has been shown to be needed.
Practical points: start with one drug and check the effect in one eye if possible; add a second class rather than increasing frequency; leave 5 minutes between drops; teach eyelid closure after each drop; consider preservative-free options for ocular surface disease; think of SLT early (LiGHT trial).
Related: target IOP, SLT first line, drug delivery and MIGS, drugs in pregnancy.
Key sources
- European Glaucoma Society Terminology and Guidelines for Glaucoma, 5th edition (2020)
- American Academy of Ophthalmology. Primary Open-Angle Glaucoma Preferred Practice Pattern (2020)
- van der Valk R et al. Intraocular pressure-lowering effects of all commonly used glaucoma drugs: a meta-analysis. Ophthalmology 2005;112:1177–85
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