Generic names: 1. Carisoprodol; 2. meprobamate.

Primary use

These agents are used to treat skeletal muscle spasms. In addition, meprobamate is used as a psychotherapeutic sedative in the treatment of nervous tension, anxiety and simple insomnia.

Ocular side effects

Systemic administration

Certain

1. Decreased accommodation

2. Decreased vision

3. Diplopia – extraocular muscle paresis

4. Eyelids or conjunctiva

a.Allergic reactions

b.Angioneurotic edema

c.Urticaria

5. Random ocular movements

Possible 

1. Decreased corneal reflex

2. Visual fields

a.Constriction

b.Enlargement

3. Non-specific ocular irritation

a.Edema

b.Burning sensation 4. Nystagmus

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

6. Eyelids or conjunctiva

a.Erythema multiforme

b.Stevens-Johnson syndrome

c.Exfoliative dermatitis

Clinical significance

Significant ocular side effects due to these drugs are uncommon and transitory. At normal dosage levels decreased accommodation, diplopia and paralysis of extraocular muscles may only rarely be found. Carisoprodol has been associated with acute porphyria attacks and this needs to be considered if acute photophobia or eyelid reactions occur.

References and Further Reading

Barret LG, et al. Internuclear ophthalmoplegia in patients with toxic coma. Frequency, prognostic value, diagnostic significance. J Toxicol Clin Toxicol 20: 373, 1983.

Edwards JG. Adverse effects of antianxiety drugs. Drugs 22: 495, 1981. Hermans G. Les Psychotropes. Bull Soc Belge Ophtalmol 160: 15,

1972.

McEvoy GK (ed). American Hospital Formulary Service Drug Information 87, American Society of Hospital Pharmacists, Bethesda, pp 1024–1026, 1146–1153, 1987.

Walsh FB, Hoyt WF. Clinical Neuro-Ophthalmology, 3rd edn, VoI. III, Williams & Wilkins, Baltimore, pp 2633–2634, 1969.

Class: Anticonvulsants

Generic names: 1. Ethosuximide; 2. methsuximide.

Proprietary names: 1. Zarontin; 2. Celontin.

Ocular side effects

Systemic administration

Certain

1. Decreased vision

2. Photophobia

3. Myopia

4. Periorbital edema

5. Eyelids or conjunctiva

a.Hyperemia

b.Allergic reactions

c.Angioneurotic edema 6. Visual hallucinations

Possible 

1.Myasthenia gravis (aggravate)

a.Diplopia

b.Paresis of extraocular muscles

c.Ptosis

2. Eyelids or conjunctiva

a.Lupoid syndrome

b.Erythema multiforme

c.Stevens-Johnson syndrome

d.Exfoliative dermatitis

3. Subconjunctival or retinal hemorrhages secondary to druginduced anemia

Clinical significance

Methsuximide induces ocular side effects more frequently than ethosuximide or phensuximide. All adverse ocular reactions other than those due to anemias or dermatologic conditions are reversible after discontinuation of the drug. This group of drugs can trigger systemic lupus erythematosus by producing anti­ nuclear antibodies. They may also aggravate myasthenia gravis.

References and Further Reading

Alarcón-Segovia D. Drug-induced antinuclear antibodies and lupus syndrome­ . Drugs 12: 69, 1976.

Beghi E, DiMascio R, Tognoni G. Adverse effects of anticonvulsant drugs – a critical review. Adverse Drug React Acute Poisoning Rev 5: 63, 1986.

Drug Evaluations, 6th edn, American Medical Association, Chicago, pp 72, 187, 1986.

Drugs for epilepsy. Med Lett Drugs Ther 25: 83, 1983.

Millichap JG. Anticonvulsant drugs. Clinical and electroencephalographic indications, efficacy and toxicity. Postgrad Med 37: 22, 1965.

Taaffe A, O’Brien C. A case of Stevens-Johnson syndrome associated with the anti-convulsants sulthiame and ethosuximide. Br Dent J 138: 172, 1975.

Walsh FB, Hoyt WF. Clinical Neuro-Ophthalmology, 3rd edn, Vol. III, Williams & Wilkins, Baltimore, p 2645, 1969.

Generic name: Ethotoin.

Proprietary name: Peganone.

Primary use

This hydantoins is effective in the management of psychomotor and grand mal seizures.