Clinical significance

Minoxidil can cause an increase in the growth of fine hair that is darker and longer in up to 80% of the patients taking this drug. This usually occurs 3–6 weeks after exposure, and often occurs first between the eyebrows and on the forehead hairline. This side effect regresses and disappears 1–6 months after stopping the drug. There are more than 80 reports in the National Registry of non-specific conjunctivitis with or without ocular pain associated with the oral use of this agent. Gombos (1983) reported a case of bilateral optic neuritis associated with minoxidil usage.

Weinberg et al (1988) reported topical minoxidil in solution to treat alopecia can cause significant transitory ocular irritation with inadvertent ocular exposure.

References And Further Reading

Degreef H, et al. Allergic contact dermatitis to minoxidil. Contact Dermatitis 13: 194, 1985.

DiSantis DJ, Flanagan J. Minoxidil induced Stevens Johnson syndrome. Arch Intern Med 141: 1515, 1981.

Friedman ES, Friedman PM, Cohen DE, et al. Allergic contact dermatitis to topical minoxidil solution: etiology and treatment. J Am Acad Dermatol 46: 309–312, 2002.

Gombos GM. Bilateral optic neuritis following minoxidil administration. Ann Ophthalmol 15: 259, 1983.

Mitchell NC, Pettinger WA. Long-term treatment of refractory hypertensive patients with minoxidil. JAMA 239: 2131, 1978.

Trattner A, David M. Pigmented contact dermatitis from topical minoxidil 5%. Cont Derm 46: 246, 2002.

Traub YM, et al. Treatment of severe hypertension with minoxidil. Isr J Med Sci 11: 991, 1975.

Weinberg RS, Haynes JH, Ferry AP. Toxic keratitis following topical ­minoxidil use for baldness. In: The Cornea: Transactions of the World Congress on the Cornea III, Cavanagh HD (ed), Raven Press, New York, pp 141–145,1988.

Generic name: Prazosin hydrochloride.

Proprietary names: Minipress, Minipress XL.

Primary use

This quinazoline derivative is used in the treatment of hypertension.

Ocular side effects

Systemic administration

Certain

1. Blurred vision

2. Eyelids or conjunctiva

a.Erythema

b.Conjunctivitis – non-specific

c.Edema

d.Urticaria

3. Visual hallucinations

Probable

1. Aggravate keratoconjunctivitis sicca

Conditional/Unclassified

1. Central serous retinopathy

2. Sclera – red discoloration

blurred vision occurs, primarily after the first dosage. Schachat (1981) reported two cases of retrobulbar optic neuritis possibly related to prazosin therapy. The National Registry has received several cases of aggravation of dry eyes following the administration of this agent. This is in conjunction with significant drying of the nose and mouth. The very unusual finding of reddening of the sclera is reported in the Physicians’ Desk Reference (1999), and there are descriptions in the medical literature. While there have been various reports of central serous retinopathy to the National Registry, the data are soft and inconclusive.

References And Further Reading

Chin DKF, Ho AKC, Tse CY. Neuropsychiatric complications related to use of prazosin in patients with renal failure. BMJ 293: 1347, 1986.

McEvoy GK (ed). American Hospital Formulary Service Drug Information 87, American Society of Hospital Pharmacists, Bethesda, p 854–857 1987.

Physicians’ Desk Reference, 53rd edn, Medical Economics, Montvale NJ, pp 2394, 1999.

Schachat A. Retrobulbar optic neuropathy associated with prazosin therapy. Ophthalmology 88(Suppl 9): 97, 1981.

Generic names: 1. Rescinnamine; 2. reserpine.

Proprietary names: 1. Moderil; 2. Serplan.

Primary use

These rauwolfia alkaloids are used in the management of hypertension and agitated psychotic states.

Ocular side effects

Systemic administration

Certain

1. Conjunctival hyperemia

2. Non-specific ocular irritation

a.Lacrimation

b.Hyperemia

Probable

1. Problems with color vision

a.Color vision defect

b.Objects have yellow tinge

Possible

1. Horner’s syndrome

a.Miosis

b.Ptosis

c.Increased sensitivity to topical ocular epinephrine

preparations

2. Extraocular muscles

a.Oculogyric crises

b.Decreased spontaneous movements

c.Abnormal conjugate deviations

d.Jerky pursuit movements

3. Decreased vision

4. Decreased intraocular pressure

5. Mydriasis – may precipitate narrow-angle glaucoma