A COMPARISON OF THE EFFICACY OF VARIOUS METIPRANOLOL-PILOCARPINE COMBINATIONS IN PATIENTS WITH OCULAR HYPERTENSION AND PRIMARY OPEN-ANGLE GLAUCOMA

We compared the ocular hypotensive effects of four fixed-dose metipran olol-pilocarpine combinations in nineteen ocular hypertensive subjects and glaucoma patients. Each patient was tested with all of the study medications: vehicle alone, 0.1% metipranolol HCl + 2% pilocarpine HCl , 0.1% metipranolol HCl + 4% pilocarpine HCl, 0.3% metipranolol HCl 2% pilocarpine HCl, and 0.3% metipranolol HCl + 4% pilocarpine HCl, in a single dose, randomized, double-masked, cross-over placebo-controll ed trial. In addition, another eight age and baseline intraocular pres sure (IOP)-matched subjects received 0.1% or 0.3% metipranolol HCl, wh ile a similar group of 14 volunteers received 2% or 4% pilocarpine HCl . A two week washout period was instituted between the various groups of treatments. All four metipranolol-pilocarpine combinations were mor e effective than placebo or either medication alone in reducing the av erage IOP for up to 8 hours (p < 0.05 for each treatment group). Metip ranolol HCl 0.3%, regardless of the pilocarpine concentration, demonst rated the most significant IOP lowering effect, reducing the IOP by 4. 9 mm Hg or about 20% from baseline. However, 0.1% metipranolol HCl in combination with 4% pilocarpine HCl was found almost as effective with a 18.5% reduction in IOP from baseline, but a shorter duration of act ion. In conclusion, all metipranolol-pilocarpine combinations were mor e efficacious than either medication alone in a single-dose trial. Add itional multiple-dose studies are needed to determine the long-term ef fectiveness and tolerance of combining 0.3% metipranolol HCl with eith er 2% or 4% pilocarpine HCl.