effects side ocular induced-Drug • 7 Part

Possible

1. Keratoconjunctivitis sicca

2. Myasthenia gravis

a.Diplopia

b.Ptosis

c.Paresis of extraocular muscles 3. Corneal deposits

4. Eyelids or conjunctiva

a.Lupoid syndrome

b.Exfoliative dermatitis

5. Subconjunctival or retinal hemorrhages secondary to druginduced anemia

Clinical significance

Ocular side effects possibly associated with quinidine are rare and many are not well proven. While blurred vision has been reported in the literature and in the National Registry, this is seldom a significant problem and is reversible. There have been no reports of permanent blindness with quinidine. There are reports of optic neuritis, constricted visual fields, mydriasis, scotomas, night blindness, keratitis sicca, photophobia and toxic amblyopia, but a cause-and-effect relationship has not been proven. Zaidman (1984) reported fine gray epithelial opacities in a whorl-type pattern resembling those of chloroquine in a patient on quinidine for 2 years. These disappeared 2 months after stopping the drug. There are no reports in the National Registry. We are aware of nine cases of uveitis associated with this agent. This is probably an allergic or type I or II hypersensitivity reaction characterized by keratic precipitates, flare and cells in the anterior chamber. Koeppe nodules and elevation of intraocular pressure have been reported. Five of the nine cases were bilateral. While there are no rechallenge data, patients improved rapidly with treatment when the drug was discontinued. Recently, well-documented data from Edeki et al (1995) show that this agent blocks the action of cytochrome P450 enzyme CYPZD6 which metabolizes timolol. Higher plasma levels of this beta blocker have therefore occurred. Higginbotham (1996) has reviewed this in an ophthalmic editorial.

References And Further Reading

Birch J, et al. Acquired color vision defects. In: Congenital and Acquired Color Vision Defects, Pokorny J, et al. (ed), Grune & Stratton, New York, p 243–350, 1979.

Caraco Y, Arnon R, Raveh D, et al. Quinidine-induced uveitis. Isr J Med Sci 28: 741–743, 1992.

Edeki TI, He H, Wood AJJ. Pharmacogenetic explanation for excessive β-blockade following timolol eye drops: potential for oral-ophthalmic drug interaction. JAMA 27: 1611–1613, 1995.

Fisher CM. Visual disturbances associated with quinidine and quinine. Neurology 31: 1569, 1981.

Fraunfelder FW, Rosenbaum JT. Drug-induced uveitis. Drug Safety 1(3): 197–207, 1997.

Higginbotham EJ. Topical β-adrenergic antagonists and quinidine. Arch Ophthalmol 114: 745–746, 1996.

Hording M, Feldt-Rasmussen UF. Acute iridocyclitis with fever and liver involvement during quinidine therapy. Ugeskrift for Laeger 153(34): 2362–2363, 1991.

Hustead JD. Granulomatous uveitis and quinidine hypersensitivity. Am J Ophthalmol 112(4): 461–462, 1991.

Kaeser HE. Drug-induced myasthenic syndromes. Acta Neurol Scand 70(Suppl. 100): 39, 1984.

Mahler R, Sissons W, Watters K. Pigmentation induced by quinidine therapy. Arch Dermatol 122: 1062, 1986.

Naschitz JE, Yeshurun D. Quinidine induced sicca syndrome. J Toxicol Clin Toxicol 20: 367, 1983.

Spitzberg DH. Acute anterior uveitis secondary to quinidine sensitivity. Arch Ophthalmol 97: 1993, 1979.

Wittbrodt ET. Drugs and myasthenia gravis: an update. Arch Intern Med 157: 399–408, 1997.

Zaidman GW. Quinidine keratopathy. Am J Ophthalmol 97: 247, 1984.

Class: Antihypertensive Agents

Generic names: 1. Acebutolol; 2. atenolol; 3. carvedilol; 4. labetolol hydrochloride; 5. metoprolol; 6. nadolol; 7. pindolol.

Proprietary names: 1. Sectral; 2. Tenormin; 3. Coreg; 4. Trandate; 5. Toprol-XL, Lopressor; 6. Corgard; 7. Visken.

Primary use

Systemic

These adrenergic blockers are used in the management of mild to severe hypertension, myocardial infarction and chronic stable angina pectoris.

Ophthalmic

These adrenergic blockers are used in the treatment of elevated intraocular pressure.

Ocular side effects

Systemic administration

Certain

1. Decreased vision

2. Visual hallucinations

3. Non-specific ocular irritation (labetalol, metoprolol)

a.Photophobia

b.Ocular pain

Probable

1. Eyelids or conjunctiva

a.Hyperemia (metoprolol)

b.Erythema

c.Blepharoconjunctivitis (metoprolol)

d.Urticaria (labetolol, metoprolol)

e.Purpura (metoprolol)

g.Eczema (metoprolol)

h.Exacerbation psoriasis 2. Keratoconjunctivitis sicca

Possible

1. Decreased intraocular pressure

2. Myasthenia gravis

a.Diplopia

b.Ptosis

c.Paresis of extraocular muscles

3. Subconjunctival or retinal hemorrhages secondary to drug-induced anemia

4. Enhances migraine scotoma

5. Eyelids or conjunctiva – lupoid syndrome (acebutolol, labetolol)

Local ophthalmic use or exposure

Certain

1. Decreased intraocular pressure

2. Irritation

a.Lacrimation

b.Burning sensation 3. Keratitis

4. Local anesthetic effect

5. Keratoconjunctivitis sicca

6. Blepharoconjunctivitis (nadolol)