Maximising glaucoma treatment outcomes
Fixed combinations of IOP-lowering medications provide several advantages in clinical practice over unfixed combinations.


Cheryl Guttman Krader
Published: Thursday, March 23, 2017

Approximately half of patients with open-angle glaucoma need more than one medication to reach target IOP.“Some doctors only know the commercial brand name of the fixed combination. If they cannot make an educated guess about a causal relationship with one of its ingredients, it will be necessary to stop the fixed combination and restart therapy, building it up in a stepwise manner,” he said. Cost may also be lower with a fixed combination product. Dr Holló said the limitations of fixed combination drops are minor compared with the benefits. Although IOP reduction in controlled comparative trials was greater using two drugs as an unfixed combination than as a fixed combination, the difference was minimal, and not clinically significant. Another downside of fixed combinations is that they limit dosing flexibility. Dr Holló suggested, however, this issue is only rarely important. “Special attention may be required for a patient who needs smoothing of a funny IOP spike during the day, and in that situation we cannot use the fixed combination,” he explained.
Tags: glaucoma, medication
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